Recently, a frustrated mom reached out to me in her search of neuropsychological testing for her 11-year-old daughter. She shared a piece she wrote in Slate Magazine regarding her struggle to find effective therapeutic treatment for her daughter. In Lost In The Storm, Jane Ehrenfeld describes trying to navigate a maze of systems that do not work for her family. Being employed by that system for over 20 years as a psychologist with the State of Maryland and now in private practice, I have seen parents and their families struggle beyond belief. I’ve also seen parents and their children access the help they needed.

Families are often outraged by the system that promises to provide support or some form of relief. Unfortunately, systems are made up of people and human beings are fallible. Families are complicated. My experience has shown me that one size doesn’t fit every child or family. I often use the metaphor of a wind chime when describing treating families. When one of the chimes is activated, it impacts all of the other chimes. Similar to psychiatry and prescribing medication, it’s often trial and error in the quest to find just the right balance of medication, therapy, skills, homework, validation and encouragement. I often say that a hammer is not the right tool for every job. I have found it extremely useful to have a variety of tools in my professional tool kit: Cognitive behavioral therapy (CBT), prolonged exposure therapy (PE), dialectical behavioral therapy (DBT), mindfulness, yoga, and breath work. I also recommend medication when it’s necessary. I like to think of medication as scaffolding to help the client be more available for treatment.

Marsha Linehan, Ph.D. developed dialectical behavioral therapy (DBT) in the late 80s for women diagnosed with borderline personality disorder (BPD). These women had difficulty managing their emotions and often resorted to self-injury, suicidal gestures, or other risky behaviors. Clients diagnosed with BPD typically have a history of interpersonal trauma by a caregiver, resulting in attachment issues and difficulties with interpersonal relationships. In the 2014, Rathus and Miller adjusted the adult model of DBT to meet the needs of teens and their families. It is difficult to be the treating therapist for tweens and teens who are emotionally sensitive, highly reactive and are slow to return to baseline. If that sounds like the Bio Social Theory of DBT - it is! Dialectical behavioral therapy is well researched and has been shown to be effective for adults, teenagers and their families. One of the assumptions of DBT is that teens and their families cannot fail in DBT. Similar to the 12-step principal, it works if you work it. DBT works; however, it requires consistent therapy and practice.

I was trained in dialectical behavioral therapy in 2015 and incorporate the principals and philosophy in therapy with my clients. I also find many of the skills useful in my life. Dialectical behavioral therapy has taught me the importance of validation - feeling heard and understood. Dialectical behavioral therapy does a great job of teaching teens and families how to validate themselves and others. Validation does not mean that we agree or accept or settle for something. Rather, we learn how to listen and convey our understanding. If possible, we can identify a kernel of emotion or feeling in the other person or ourselves. From DBT, I have learned the importance of dialectics; being open to multiple perspectives. Dialectical behavioral therapy teaches us that there are multiple perspectives and no absolute truth. There is always more than one way to view a situation.

Mindfulness or present-moment awareness is an important component of DBT, and is threaded throughout each module and is the start of each session. It’s difficult to be mindful if we are distracted or multitasking. Children are reactive to the emotional and behavioral responses of the adults in their lives. Children do not feel safe if we as adults are reactive and in emotion mind.

I felt depressed and anxious most of my life. Perfectionism and people pleasing were my survival skills as a child. My personal therapist encouraged me to try Zoloft for depression and anxiety. I was determined to conquer my depression and anxiety more holistically. Practicing yoga at least three times per week helped to dial down my depression and eliminate my low back pain. Similarly, when my primary care doctor suggested a Statin for high cholesterol, I refused and insisted on changing my diet and exercise regime to lower my cholesterol. And it worked! When I started practicing yoga in 2000, my body was flexible, and I was physically healthy. For me, yoga was exercise, and I was all about getting in a workout. I didn’t realize that yoga is more than exercise. Yoga is about connecting to your mind, your body and your best self.

Through experience, I learned that changing the way I breathe does change the way I feel. In yoga teacher training, I quickly learned that my breathing was shallow. I knew I had to learn to breathe if I were to succeed in yoga teacher training. Yoga training with Max Strom — a master of breathing techniques — taught me the power of the breath. Now, yoga, mindfulness (present-moment awareness), and a variety of breathing practices are in my personal and professional tool kit. I recommend that my clients also have a wide variety of coping skills. Clients often explain that it’s impossible to access their coping skills when they go into emotion mind. It’s important to practice your skills regularly, even when life is going your way, so you will be prepared the next time you are in a situation that you don’t like, and you don’t want to make it worse.

Are you a parent or caregiver who has or continues to struggle to find effective treatment for your child or adolescent? Are you seeking a forum to speak your truth? Feel free to reach out and let me know your thoughts!