DBT vs other therapy

[Anonymous]

A few years ago, my son's neuropsych suggested DBT (among other things), but we were unable to find any DBT providers for his age (10 at the time). We found a therapist trained in other methods who has been great for him (mostly talk/play therapy).

Due to that and many other changes and hard work, he is doing really well now compared to when the prior eval was done, but some of the emotional regulation challenges that led to the DBT suggestion remain (albeit more muted now).

We are moving and will need a new therapist in our new city, and I'm wondering if we should look for someone who does DBT now that we have another opportunity. Is DBT a shorter-term approach, whereas it might be more long-term with other approaches? We definitely expect needing him in therapy pretty much consistently throughout the teen years. Would DBT be a major upheaval compared to what he has been doing? Does he need to be totally "bought in" for DBT to work? Since he hasn't had a ton of emotional challenges recently, I wonder about this last question as it relates to working on specific things (which he may or may not see as issues he needs to work on). Any thoughts on DBT for AuDHDers?

Obviously, I'll ask his current provider and prospective ones, but I'm curious to find out what experiences have been for others.

[Anonymous]

I have a late diagnosed teen AuDHDer, who started in DBT when it was first thought that BPD might be an eventual diagnosis. A couple of thoughts -- yes, the child has to be 'bought in', so do parents. It's more like a curriculum than therapy, although the best therapists still find a way to connect with clients in a more traditional, personal way. My DD was barely bought in.. and it has been slow going at times, but there has been real progress with emotional regulation. She has completed her traditional course of DBT (explained below) but is continuing with her DBT therapist, staying true to DBT skills, but entering more of the traditional therapist/client role.

By authentic/traditional DBT I mean.. one on one weekly sessions the entire time, weekly parent/child group sessions (for at least 6 months), then weekly adolescent group sessions (no parents) for another several months, and likely parent DBT sessions (parents alone with a therapist.) It's a lot. And expensive. But many people say life changing. We're still in the thick of it.

[Anonymous]

DBT was life changing for us. It really changed a long-standing pattern of dysregulation and aggression in times of distress. My DD continues with her individual DBT therapist post program and they work on things that come up in a normal teenage life, but in the context of DBT, so it can be used for continued regular therapy. I’m not sure it would be as helpful without having done the full program of DBT mentioned above first.

There are a lot of therapists who say they are “DBT informed.” What that means varies by person, but it does not follow the specific DBT model. If you go that route, I would ask a lot of questions about how many clients they have with emotional regulation issues and maybe some examples of how severe and then what they do to work on those (see if those align with DBT skills). And also how do they incorporate parents learning DBT because that part is as important as the adolescent part.

Another thing that a true DBT program offers is phone coaching which enables the client to text the therapist for coaching in a dysregulated moment. We also found that very impactful when my DD knew the skills but was still learning to apply them in the moment.

[Anonymous]

I am currently doing DBT-C with our child. It has been amazing so far. DBT-C is for under 12. It begins with parents attending solo learning the skills. The theory is that if parents learn the skills even without buy in from child it changes the environment enough to help change behavior. We are about to bring our child to begin in two weeks. Doing this therapy with my husband has enabled us to have common language when dealing with difficult behaviors and be on the same page. We also get to text the therapist to help us know what to say and do during meltdowns. It is really transformative in my parenting and how I deal with my own emotions especially in connection to our child with challenging behaviors.

[Anonymous]

I just want to say that if DBT is not for your AuHDer, do not despair. A very seasoned psychologist told me that many kids with ASD do not respond to it. It's a lot of long acronyms to think about and pull from when you are emotionally dysregulated. My DC also has a language-based learning disorder, so complex acronyms are a lift. To learn them takes time, buy-in, and a lot of money (I think it was going to be $35K with one DC practice!).

This person told me that my best bet was to find someone with extensive experience with ASD and its many presentations. That person would have a sizeable toolkit to draw from.

We ultimately found someone who borrowed from a lot of ACT for my DC, with some CBT. I bet there was some DBT-informed work in there, too. There are so many acronyms.

[Anonymous]

OP here. These are all helpful insights - thanks to you all. Sounds like DBT could be great but also like we should look for someone with ASD experience. We'll see what's out there!