DBT Enhances Treatment Engagement, Motivation, and Adherence in Multi-Problem, High-Risk Adolescents

We propose that many of the principles, components and strategies in Dialectical Behavior Therapy for Adolescents may provide useful templates that can be adapted or adopted by pediatric clinicians in order to improve motivation, adherence to treatment and successful outcomes with youth. Addressing treatment engagement with highly emotionally dysregulated adolescents can be especially challenging. Unlike adults, teens typically do not bring themselves to mental health treatment and are often referred by schools, parents, or other health care providers and must rely on caregivers to facilitate treatment. Thus, obtaining and maintaining both teen and caregiver commitment and motivation is of paramount importance. The discrepancy between need for mental health services for youth and access to it is large, with up 60–80% not receiving treatment. The modal number of sessions for those who do connect to mental health services is only one, suggesting a vexing problem with engagement and an urgent need for improvement. In this chapter, the authors describe the application of key ingredients of Dialectic Behavior Therapy. These include pre-treatment and orientation, commitment strategies, targeting therapy interfering behaviors, roles for caregivers, the therapist consultation team, and the dialectical balancing of validation with change strategies to enhance the motivation and adherence.