How Dialectical Behavioral Therapy Can Support Family Harmony: A Q&A with Leigh McInnis

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Dialectical Behavioral Therapy (DBT) is a powerful clinical modality that can help parents and teens break unproductive patterns and strengthen their relationship. Over a decade in the treatment field, Leigh McInnis, LPC, Executive Director at Newport Academy’s Virginia location, has seen first-hand how DBT can make a significant difference in families’ lives.

In this Q&A, she discusses some of the pitfalls parents face when navigating mental health challenges, and explains how family therapy in general—and DBT in particular—support positive change and recovery.

How do you support parents who feel that they’ve failed because their teen is struggling?

Many of the parents I’ve worked with have suffered from intense feelings of guilt and regret related to their child’s mental health challenges. A crisis or crises forced them to acknowledge that their child was suffering, and they often realized that there were warning signs of depression and anxiety that they unintentionally ignored or found ways to justify, because they didn’t want to believe that their child was suffering.

No matter what, it’s essential to remember that parenting is not easy—there’s no guidebook. And, many times, typical parenting strategies have to be thrown out the window when you have a teen who requires residential treatment because they are a risk to themselves or others.

If you, as a parent, are willing to dive into your own story—your own patterns of behavior and reactions to stress as a result of your personal history—and look at how your child is reacting to those patterns, you’re more likely to find some solutions. It takes insight, awareness, and the willingness to be vulnerable and to acknowledge your role.  Taking that jump into family therapy and fully, actively participating models to your child that it’s okay to be vulnerable, to take risks, to be flawed, and to speak your truth. If parents aren’t willing to do that, then the child isn’t likely to be motivated to do it either.

Is it the parents’ responsibility or the teen’s responsibility to create change?

Both parents and teens hold responsibility for change, and family therapy can support the process and guide the family toward collaborative problem-solving. The parent usually needs to initiate changes first, but over time, as the adolescent becomes more invested in their recovery process, the effort will become more balanced. Therapy helps everyone learn to negotiate who needs to be giving a bit more in each moment, and that will probably vacillate all the time.

What’s most important to understand is that parents are part of the solution and essential to the teen’s recovery process. Without parents’ involvement, it’s difficult for teens to progress in treatment. Family therapy, including DBT for families, is an opportunity for parents to help children have the realizations that will allow them to recognize their own patterns early in life, instead of having to wait until they see them reflected years down the road in their own children. This way, teens have a better chance at having a more fulfilling life and might avoid making those same mistakes.

Woman seated on a walkway out on a lake, looking over the water.

How does Dialectical Behavioral Therapy reconcile the seemingly opposing beliefs that parents and teens may hold about a situation? 

The guiding principle of Dialectical Behavioral Therapy is that there are no extreme black-and-white truths. Two conflicting concepts can both be true. Parents can love and adore their children—and, at the same time, they can also hate how much time and energy their child consumes or be infuriated by their child’s behaviors. If parents don’t allow themselves to recognize both truths, this can contribute to unacknowledged guilt, anger, and frustration. These compounded feelings can, often unintentionally, lead to acting out of resentment toward their children.

Parents want to believe that their children are safe and stable, and that can be true even though their child presents as unsafe and unstable at times. A child can be both depressed and healthy; they can be angry at you even while you are being a good parent. The key is being able to acknowledge all truths, and for the family to embrace both the experience of the parent and the child, even though they may seem counter to one another.

Another DBT framework is the idea that we don’t cause all of our problems, but we are responsible for managing our reaction to our problems. Again, both can be true at the same time. We may not have caused all the stress at home or work, but we are responsible for managing it. Ultimately, we are all doing the best that we can with what we have—and we can do better, be better, live and love better. This is a foundational dialectical belief.

What are the four main components of Dialectical Behavioral Therapy?

DBT focuses on four main areas. One is mindfulness—cultivating awareness of what’s unfolding in your mind and emotions, as well as in your surroundings and environment. Another component is interpersonal effectiveness: learning to engage in conflict without rejecting a person or relationship, and how to ask for what you want and need. The other components are emotion regulation—managing the ups and downs of emotion; and distress tolerance—building tools for empowerment and stress resilience.

Could you explain more about what distress tolerance means for parents?

For example, let’s say a teen tells their parent how left out and rejected they feel at school. It would be perfectly understandable for the parent to not want to accept that their teen is in pain and/or that their child is not liked by their peers. So they say, “Oh, that’s not true, you have lots of friends and everyone likes you, you don’t have anything to worry about.” The parent genuinely believes what they are saying and believes that they are encouraging their child. However, what the teen hears is, I can’t express my emotions in a way that my parent will understand, and there must be something wrong with me because I don’t see things that way. It’s not about fixing their problems, it’s about listening and validating their experience, letting them know you get it—saying something like, “That must be so hard for you to go to school every day feeling like no one likes you.”

As a parent, it’s so important to be able to tolerate your child’s distress, instead of personalizing it—“If my child is sad and depressed and angry, I must be doing something wrong.” Maybe you’re not doing something wrong, but maybe there’s something you could change. Family therapy and DBT techniques help parents to feel a sense of empowerment and receive empathy for what they’ve gone through, as well as what their child is dealing with. Everyone deserves hope and healing.

Special thanks to Leigh McInnis for contributing to this article.

 

Sources:

Behaviour Res and Ther. 2006 Dec;44(12): 1811–1820.

Fam Process. 1999 Winter;38(4):399–414.

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