DBT Skills Manual for Adolescents.: Jill H. Rathus and Alec L. Miller. Foreword by Marsha M. Linehan (2015) New York, NY The Guilford Press. 392 pp.

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DBT (dialectical behavior therapy) has been credited with revolutionizing cognitive behavioral therapies and pioneering and first describing concepts such as mindfulness and acceptance. Dr. Marsha Linehan introduces this comprehensive clinical manual by commenting the authors were her students in one of her first Dialectical Behavior Therapy DBT training courses. She was struck by their “passion and compassion” and how deeply they grasped the fundamentals of this treatment and how thoughtfully they applied it to adolescents. She acknowledged the importance of their work in developing DBT for teens in need.This brief clinical manual is an original contribution now recognized to the field of DBT therapies. The authors have adapted the Linehan model creatively so that it now can be used in the struggles between teens and teens, parents and teens, and teens and their therapists. The manual teaches dialectics as a skill set not only for therapists but also as a skill set for teens and their parents. The authors have spelled out novel ways to teach biosocial theory to parents, to list its theoretical assumptions and underpinnings. They have also devised mindfulness exercises that have special appeal to a teenage population, while maintaining the essential elements of DBT, such as its dialectical underpinnings, its Biosocial Theory of Disorder, its assumptions, its change procedures, and its treatment strategies.Their clinical work began in the 1990s when they began applying DBT to suicidal multi-problem adolescents and families in an inner city outpatient clinic. They recognized early that many of the youth and their parents had difficulty reading and comprehending the basic materials and exercises necessary for therapy. They began to adapt the original Linehan protocols to use with this special population and then to get feedback from teenagers and their parents. They have maintained the essential elements of DBT, but adapted it to this difficult and hard-to-reach population. They have also identified life’s problems which are peculiar to adolescent life (such as residing with parents, lack of independence, skipping school, and using drugs). They have modified both the language and look of the original skills manuals for adolescents. The modifications include:slightly reducing the amount of content in a treatment sessionlimiting the amount of information presented to a single handoutsimplifying language on handouts to patients and parents with reading levels at or below middle school leveladjusting teaching stories, exercises, and examples on handouts and in teaching techniques which are developmentally relevant for an adolescent populationadding graphics and different fonts to make the handouts more visually and emotionally accessible to distractible and dysregulated teensadded a new 5th module titled Walking the Middle Path (special skills to target the special issues that arise working with teens and families)They have also devised some new handouts which teach important skills related to emotional regulation, sleep, and to pleasant activities which parents and teens can share.They report that before publication of the book, many of the skills handouts were first used in the treatment, research, and clinical settings they worked in. They are hopeful that the manual makes their handouts more widely available. They also hope that treatment will become more standardized and replicable for the special under-treated population, and will enhance research in the area.I was most impressed with the skills training handouts they have designed and pioneered, including the comic book characters created which are sure to catch the attention of distracted teenage patients and illustrate the points that the written handouts convey.

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