Dialectical behavioral therapy (DBT) has been well documented as an effective treatment for individuals with intense emotions. A comprehensive family model that addresses family systems utilizing DBT has yet to be developed. This article presents a model for DBT for a family system that goes beyond serving the individual and utilizing the family system for support. The theoretical concepts of DBT named “family systems (FS)DBT” are reviewed. The author reviews the current literature of DBT, how (FS)DBT addresses the dialectic of acceptance and change, how the complex model of individualized therapy such as DBT could be systematically applied to a complex and changing family system through psychoeducation, and the remaining phases of (FS)DBT. This proposed comprehensive model for doing (FS)DBT will have significant implications for clinicians working directly with complex FS that have multiple family members with intense emotions.
AsarnowJ. R.TompsonM.HamiltonE. B.GoldsteinM. J.GuthrieD. (1994). Family-expressed emotion, childhood-onset depression, and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?Journal of Abnormal Child Psychology, 22(2), 129–146. https://doi.org/10.1007/bf02167896
2.
BeckJ. S. (2011). Cognitive therapy: Basics and beyond. Guilford Press.
3.
Ben-PorathD.DuthuF.LuoT.GonidakisF.CompteE. J.WisniewskiL. (2020). Dialectical behavioral therapy: An update and review of the existing treatment models adapted for adults with eating disorders. Eating Disorders, 28(2), 101–121. https://doi.org/10.1080/10640266.2020.1723371
4.
BrentD. A.RothC. M.HolderD. P.KolkoD. J.BirmaherB.JohnsonB. A.SchweersJ. A. (1996). Psychosocial interventions for treating adolescent suicidal depression: A comparison of three psychosocial interventions. In HibbsE. D.JensenP. S. (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 187–206). American Psychological Association.
5.
CeballosN. A.HoustonR. J.HesselbrockV. M.BauerL. O. (2006). Brain maturation in conduct disorder versus borderline personality disorder. Neuropsychobiology, 53(2), 94–100. https://doi.org/10.1159/000092217
6.
Courtney-SeidlerE. A.BurnsK.ZilberI.MillerA. L. (2014). Adolescent suicide and self-injury: Deepening the understanding of the biosocial theory and applying dialectical behavior therapy. International Journal of Behavioral Consultation and Therapy, 9(3), 35–40. https://doi.org/10.1037/h0101638
7.
CrowellS. E.BeauchaineT. P.LinehanM. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495–510. https://doi.org/10.1037/a0015616
8.
Diagnostic and statistical manual of mental disorders: DSM-5. (2017). American Psychiatric Association.
9.
DixonL.McFarlaneW. R.LefleyH.LuckstedA.CohenM.FalloonI.MueserK.MiklowitzD.SolomonP.SondheimerD. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services, 52(7), 903–910. https://doi.org/10.1176/appi.ps.52.7.903
10.
FruzzettiA. E. (2006). The high-conflict couple: A dialectical behavior therapy guide to finding peace, intimacy & validation. New Harbinger Publications.
11.
FruzzettiA. E.PayneL. G. (2020). Assessment of parents, couples, and families in dialectical behavior therapy. Cognitive and Behavioral Practice, 27(1), 39–49. https://doi.org/10.1016/j.cbpra.2019.10.006
12.
FruzzettiA. E.ShenkC.HoffmanP. D. (2005). Family interaction and the development of borderline personality disorder: A transactional model. Development and Psychopathology, 17(4), 1007–1030. https://doi.org/10.1017/s0954579405050479
13.
FruzzettiA. E.WorrallJ. M. (2010). Accurate expression and validating responses: A transactional model for understanding individual and relationship distress. In Support processes in intimate relationships (pp. 121–150). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195380170.003.0005
14.
GingerichS. L.BellackA. S. (1995). Research-based family interventions for the treatment of schizophreniaResearch on Social Work Practice, 6(1), 122–126. https://doi.org/10.1037/e554972011-004
15.
GurmanA. S.LebowJ. L.SnyderD. K. (2015). Clinical handbook of couple therapy. The Guilford Press.
HarringtonR.KerfootM.DyerE.McNivenF.GillJ.HarringtonV.WoodhamA.ByfordS. (1998). Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. Journal of the American Academy of Child & Adolescent Psychiatry, 37(5), 512–518. https://doi.org/10.1016/s0890-8567(14)60001-0
18.
HayesS. C.StrosahlK.WilsonK. G. (2016). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
HollandJ. H. (1992). Adaptation in natural and artificial systems. MIT Press.
21.
KingC. A.SegalH. G.NaylorM.EvansT. (1993). Family functioning and suicidal behavior in adolescent inpatients with mood disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 32(6), 1198–1206. https://doi.org/10.1097/00004583-199311000-00013
22.
LinehanM. M. (1993). Chapter 1. In Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
23.
LinehanM. M. (1997). Validation and psychotherapy. In BohartA. C.GreenbergL. S. (Eds.), Empathy reconsidered: New directions in psychotherapy. (pp. 353–392). American Psychological Assosiation. https://doi.org/10.1037/10226-016
24.
LynchT. R. (2018). The skills training manual for radically open dialectical behavior therapy: A clinician’s guide for treating disorders of overcontrol. Context Press.
25.
MarschkeJ. (1997). An alternative support model for family members of the mentally ill: Modifying dialectical cognitive-behavioral skill building (DBT). Smith College Studies in Social Work, 68(1), 31–55. https://doi.org/10.1080/00377319709517515
MeadowsD. H.WrightD. (2015). Thinking in systems: A Primer. Chelsea Green Publishing.
28.
MehlumL.TørmoenA. J.RambergM.HagaE.DiepL. M.LabergS.LarssonB. S.StanleyB. H.MillerA. L.SundA. M.GrøholtB. (2014). Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: A randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(10), 1082–1091. https://doi.org/10.1016/j.jaac.2014.07.003
29.
MillerA. L.GlinskiJ.WoodberryK. A.MitchellA. G.IndikJ. (2002). Family therapy and dialectical behavior therapy with adolescents: Part I: Proposing a clinical synthesis. American Journal of Psychotherapy, 56(4), 568–584. https://doi.org/10.1176/appi.psychotherapy.2002.56.4.568
30.
MillerA. L.RathusJ. H.LinehanM. M.WetzlerS.LeighE. (1997). Dialectical behavior therapy adapted for suicidal adolescents. Journal of Psychiatric Practice, 3(2), 78. https://doi.org/10.1097/00131746-199703000-00002
31.
MorenoJ. L. (1972). Psychodrama. Beacon House.
32.
PanosP. T.JacksonJ. W.HasanO.PanosA. (2013). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, 24(2), 213–223. https://doi.org/10.1177/1049731513503047
33.
RasheedM. N.RasheedJ. M. (2013). Family: Practice interventions. In Encyclopedia of social work. National Association of Social Workers Press and Oxford University Press. https://doi.org/10.1093/acrefore/9780199975839.013.546
34.
RathusJ.CampbellB.MillerA.SmithH. (2015). Treatment acceptability study of walking the middle path, a new DBT skills module for adolescents and their families. American Journal of Psychotherapy, 69(2), 163–178. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.163
35.
RathusJ. H.MillerA. L. (2000). DBT For adolescents: Dialectical dilemmas and secondary treatment targets. Cognitive and Behavioral Practice, 7(4), 425–434. https://doi.org/10.1016/s1077-7229(00)80054-1
36.
RathusJ. H.MillerA. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior, 32(2), 146–157.
37.
RathusJ. H.MillerA. L.LinehanM. (2017). DBT Skills Manual for Adolescents. The Guilford Press.
38.
SandageS. J.CookK. V.HillP. C.StrawnB. D.ReimerK. S. (2008). Hermeneutics and psychology: A review and dialectical model. Review of General Psychology, 12(4), 344–364. https://doi.org/10.1037/1089-2680.12.4.344
39.
ShenkC. E.FruzzettiA. E. (2011). The impact of validating and invalidating responses on emotional reactivity. Journal of Social and Clinical Psychology, 30(2), 163–183. https://doi.org/10.1521/jscp.2011.30.2.163
40.
StobV.SladeA.AdnopozJ.WoolstonJ. (2020). The family cycle: Breaking the intergenerational transmission of trauma through mentalizing. Journal of Infant, Child, and Adolescent Psychotherapy, 19(3), 255–270. https://doi.org/10.1080/15289168.2020.1786762
41.
SwartJ.BassC. K.ApscheJ. A. (2015). Third-wave therapies for children and adolescents: Origins and development. In Treating adolescents with family-based mindfulness (pp. 31–52). Springer.
42.
TempleS. (1997). Brief therapy for adolescent depression. Professional Resource Press.
43.
ThorpS. R.FruzzettiA. E. (2003). Ethical principles and practice in couple and familytherapy. In Handbook of professional ethics for psychologists: Issues, questions, and controversies (pp. 391–406). SAGE Publications.
44.
WoodberryK. A.MillerA. L.GlinskiJ.IndikJ.MitchellA. G. (2002). Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review. American Journal of Psychotherapy, 56(4), 585–602. https://doi.org/10.1176/appi.psychotherapy.2002.56.4.585
ZamaniN.ZamaniS.HabibiM. (2019). A comparison between the effectiveness of dialectical and cognitive behavioral therapy on the mental health of mother. Journal of Research and Health, 9(1), 53–61. https://doi.org/1
