Question 1

What is the key to adapting DBT skills for children so they actually learn them and they work?

Christina Kress · Accepted Answer

Kids learn best through experience. This is sometimes overlooked by the adults in their lives. Kids need to have opportunities to practice skills in real life situations. In teaching children DBT skills I find it helpful to simplify the language wherever possible. Young children may use the word mad when describing anger while slightly older children may use more nuanced words, such as irritated or outraged. Use language your client will be able to identify with.

It's also helpful to use stories and experiences that your client can identify with. These may be examples from their own lives. DBT encourages the use of stories and metaphors to help clients apply skill use to everyday life. This same thing is true for children.

Research tells us that learning and practicing through role play helps children develop problem solving skills as well as an increased connection to their physical environment and improved communication skills. Role playing can increase a child’s capacity for cognitive flexibility which is key in understanding and applying DBT skills. Again, children learn through experience. Providing opportunities in the clinical setting as well as practicing at home can help them learn and then use the skills.

Question 2

Can these skills be integrated into existing therapies?

Christina Kress · Accepted Answer

Yes, DBT skills can be integrated into other therapies as appropriate. In The Anger Workbook for Kids, I have created activities that can easily compliment other therapies. I encourage the adult readers/facilitators to adjust and change the activities in any way they need to in order to work with the child at hand. This flexibility provides opportunities to integrate DBT skills into other modalities. The only exceptions to this may be non-directive play therapy and approaches such as sandtray or art therapy.

Question 3

How can you motivate children to practice and use the skills outside the clinical setting?

Christina Kress · Accepted Answer

I encourage adult participation in learning the skills as much as possible. Learning skills can be an activity that adults and children do together and practice together. Children benefit from seeing the adults in their lives practice, make mistakes and try again. Find ways to keep skills and concepts present in the child’s mind. This can be done with visual reminders as well as using the skills as a common language in daily interactions. The biggest motivator for children will be seeing that they have the power to change their experience and that the skills do work.

Question 4

How do you explain the concept of 'wise mind' to kids?

Christina Kress · Accepted Answer

Between the ages of six and eight is a time of tremendous cognitive change for children. Piaget refers to this as the preoperational and then concrete operational phase. Around this time, children begin to think with logic and reason. This is when they begin to be able to see situations from a point of view different than their own, as well as understand that other people can have different thoughts. Understanding these concepts can help to introduce children to the idea of different types of thinking.

In The Anger Workbook, I introduce the three states of mind as feeling mind, fact mind and full mind, with ‘wise mind’ as full mind. I have found that this works well as it can be translated into observable examples. For example, the children can see a jar full of Skittles and a jar full of M&M’s. When some from each jar are mixed together (full mind) they are able to observe the facts and the feelings mixed together. Teaching wise mind to children can be difficult and takes lots of practice. I recommend that adults help kids understand this by using as many examples as possible. Specifically, examples from things the child is already interested in or uses and experiences in their daily life.

Question 5

With what kind of presenting problems do you introduce DBT-based skills to children?

Christina Kress · Accepted Answer

In a clinical setting you’re likely to see kids who struggle with a variety of issues. In my experience DBT skills can be helpful for anyone. Specifically, DBT teaches emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Often, children who present with peer or interpersonal difficulties are struggling with emotional dysregulation and distress tolerance. Feelings can become very intense very quickly in interpersonal situations, which can be overwhelming for children. DBT encourages children to slow down and check in with their thoughts and feelings.

The DBT curriculum, originally developed by Dr. Marsha Linehan, takes the time to review and teach each individual emotion. How does the emotion feel in my body? Does my emotion make sense? These activities can be helpful with kids who struggle with simply identifying emotions.

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