than the TAU group. Miller et al (1997) also showed that there were fewer suicide attempts made by the DBT group during the 12 week period. From reviewing the work of Miller et al (1997) it appears that the adapted method of delivering DBT appears to work effectively at treating adolescents who display DSH type behaviours. However, although DBT is now being used in many CAMHS settings across the UK, evidence for the effectiveness of the adapted form of DBT outside the USA is very rare. Interestingly, a pilot study was carried out by Swales et al (2000) in North Wales to consider the effectiveness of adapted DBT on British adolescents. The work of Swales et al (2000) suggested that DBT in its adapted form “seems to be as acceptable to British clients and therapists as to their American counterparts” (page 23).

KERFOOT (2005) Client groups that challenge services: Suicide and deliberate self-harm. In WILLIAMS, R. & KERFOOT. M. (2005) (eds) Child and Adolescent Mental Health Services: strategy, planning and evaluation. Oxford: Oxford University Press.

SWALES, M., HEARD, H. L. & WILLIAMS. M. G. (2000) Linehan’s Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation. Journal of Mental Health (9) 1, 7-23.

LINEHAN, M. (1993) Cognitive Behaviour Therapy for borderline personality disorder. New York: Guilford

MILLER, A. L., RATHUS, J. H., LINEHAN, M., WETZLER, S. & LEIGH, E. (1997) Dial

This article will examine an intervention used to address self harming behaviours amongst adolescents. Kerfoot (2005) tells us that “one of the leading causes of death among young people aged 15-24 in the UK is suicide” (page 197). Leading on from this Kerfoot (2005) goes on to explain that cases of deliberate self harm (DSH) (including attempted suicide), among British adolescents is higher than almost all other European countries. Due to these increasing rates of DSH, CAMHS teams in the United Kingdom are finding 20% of their referrals are related to DSH, thus causing them to commit a large amount of time to providing assessment & aftercare for these individuals.

A therapeutic intervention which appears effective in reducing DSH type behaviours in adolescents is Dialectical Behaviour Therapy (DBT) Lineman (1993). Swales (2000) tells us that DBT is a form of “structured, time-limited, cognitive behavioural treatment”, (page 7), which was originally developed by Lineman (1993) to treat ‘para-suicidal’ behaviours in women with a diagnosis of borderline personality disorder.

Miller et al (1997) explains that standard DBT runs with individual and group therapy side by side for a period of 1 year. Miller et al (1997) goes on to explain that standard DBT has a 4 stage target system:

Pre-Treatment Targets (Commitment) First-Stage Targets (Stability, Connection & Safety) Second-Stage Targets (Exposure & Emotion) Third-Stage Targets (Increase Respect for Self & Individual Goals)

Miller et al (1997) explain that Lineman (1993) developed a ‘subhierarchy’ within the first stage targets of the following therapeutic goals:

Decreasing life-threatening behaviours Decreasing behaviours that interfere with therapy Decreasing behaviours that interfere with quality of life Increasing behavioural skills

It is pointed out by Miller et al (1997) that “the problem focus of each individual DBT session is jointly determined by this hierarchy and the patients behaviour in each targeted area since the last session” (page 80). Patients are also encouraged to engaged in telephone consultations in between sessions with their individual therapist.

Miller et al (1997) states that this assists the patient with problem solving in situations of crisis, which is considered more useful to the patient than having to wait until their next session to address the issue, and after the maladaptive behaviour has occurred.

The group work is described by Miller et al (1997) as a process which involves “weekly meetings for two and a half hours that follow a psycho-educational format” (page 80). The group members learn behavioural skills in what Miller et al (1997) outlines as being four main areas:

Core-mindfulness skills Distress tolerance skills Interpersonal skills Emotional regulation skills

Literature such as Swales et al (2000) suggests that DBT in its standards form can be a very effective form of treatment. However, how effective is it at addressing the problems of those adolescents referred to CAMHS teams with DSH behaviours? The work of Miller et al (1997) shows the development of a therapeutic intervention, intended to be used with suicidal adolescents and adolescents with DSH behaviours which is an adapted form of standard DBT.

Miller et al (1997) have adapted standard DBT for using with these adolescents by modifying 3 major aspects. Firstly, Miller et al (1997) explain that alterations were made to the skills training group. The modification comprised of the inclusion of a family member and Miller et al (1997) explain the reason for this inclusion is due to the fact that adolescent patients “often continue to reside in their invalidating environments” (page 80). It is the view of Miller et al (1997) that not only does this give the opportunity of improving the adolescents ‘dysfunctional’ home environment, it also offers the chance to teach the family members “how to model and reinforce adaptive behaviours for their children” (page 80).

It is the belief of Miller et al (1997) that including a family member in the group session offers the adolescent and their parent a forum to also work on improving communication between themselves. It is also noted that family members are invited to participate in the individual sessions and Miller et al (1997) explain that this participation typically consists of one to four visits.

The second modification made by Miller et al (1997) was reducing the length and format of treatment. It appears that the standard 12 month period used in adult DBT was reduced to 12 weeks (1 session per week) and group sessions were also reduced (1 session per week). Miller et al (1997) explain that in order for this modification to work it was necessary to reduce the number of skills taught. However, Miller et al (1997) go on to explain that a 12 week follow up patient consultation group was set up to focus on peer teaching and reinforcement, to compensate for this.

A third change made by Miller et al (1997), and perhaps the most important was the simplifying of the language used in handouts and skills lectures. Miller et al (1997) explain that this was thought necessary “to meet the needs of an underprivileged adolescent population” (page 80), many of which could not read to the expected level of that age group.

If we now consider how effective DBT is at addressing the needs of these adolescents, we can see that Miller et al (1997) examined how effective their adapted treatment method was. Miller et al (1997), which included Marsha Lineman (the original developer of DBT), compared their study group of adolescents against what was described as a ’treatment as usual’ group (TAU group), which received the treatment which was usually offered. By examining the study it is evident that allocation to treatment group was not random, but was based on clinical need, with the DBT group picking up the adolescents with more severe pre-treatment symptoms.

Miller et al (1997) revealed that despite the fact that those delegated to the DBT group were considered to have more severe problems, the DBT group had significantly fewer admissions to hospital during the treatment period and a higher treatment completion rate than the TAU group. Miller et al (1997) also showed that there were fewer suicide attempts made by the DBT group during the 12 week period. From reviewing the work of Miller et al (1997) it appears that the adapted method of delivering DBT appears to work effectively at treating adolescents who display DSH type behaviours. However, although DBT is now being used in many CAMHS settings across the UK, evidence for the effectiveness of the adapted form of DBT outside the USA is very rare. Interestingly, a pilot study was carried out by Swales et al (2000) in North Wales to consider the effectiveness of adapted DBT on British adolescents. The work of Swales et al (2000) suggested that DBT in its adapted form “seems to be as acceptable to British clients and therapists as to their American counterparts” (page 23).

KERFOOT (2005) Client groups that challenge services: Suicide and deliberate self-harm. In WILLIAMS, R. & KERFOOT. M. (2005) (eds) Child and Adolescent Mental Health Services: strategy, planning and evaluation. Oxford: Oxford University Press.

SWALES, M., HEARD, H. L. & WILLIAMS. M. G. (2000) Linehan’s Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation. Journal of Mental Health (9) 1, 7-23.

LINEHAN, M. (1993) Cognitive Behaviour Therapy for borderline personality disorder. New York: Guilford

MILLER, A. L., RATHUS, J. H., LINEHAN, M., WETZLER, S. & LEIGH, E. (1997) Dial

eveloped a ‘subhierarchy’ within the first stage targets of the following therapeutic goals:

Decreasing life-threatening behaviours Decreasing behaviours that interfere with therapy Decreasing behaviours that interfere with quality of life Increasing behavioural skills

It is pointed out by Miller et al (1997) that “the problem focus of each individual DBT session is jointly determined by this hierarchy and the patients behaviour in each targeted area since the last session” (page 80). Patients are also encouraged to engaged in telephone consultations in between sessions with their individual therapist.

Miller et al (1997) states that this assists the patient with problem solving in situations of crisis, which is considered more useful to the patient than having to wait until their next session to address the issue, and after the maladaptive behaviour has occurred.

The group work is described by Miller et al (1997) as a process which involves “weekly meetings for two and a half hours that follow a psycho-educational format” (page 80). The group members learn behavioural skills in what Miller et al (1997) outlines as being four main areas:

Core-mindfulness skills Distress tolerance skills Interpersonal skills Emotional regulation skills

Literature such as Swales et al (2000) suggests that DBT in its standards form can be a very effective form of treatment. However, how effective is it at addressing the problems of those adolescents referred to CAMHS teams with DSH behaviours? The work of Miller et al (1997) shows the development of a therapeutic intervention, intended to be used with suicidal adolescents and adolescents with DSH behaviours which is an adapted form of standard DBT.

Miller et al (1997) have adapted standard DBT for using with these adolescents by modifying 3 major aspects. Firstly, Miller et al (1997) explain that alterations were made to the skills training group. The modification comprised of the inclusion of a family member and Miller et al (1997) explain the reason for this inclusion is due to the fact that adolescent patients “often continue to reside in their invalidating environments” (page 80). It is the view of Miller et al (1997) that not only does this give the opportunity of improving the adolescents ‘dysfunctional’ home environment, it also offers the chance to teach the family members “how to model and reinforce adaptive behaviours for their children” (page 80).

It is the belief of Miller et al (1997) that including a family member in the group session offers the adolescent and their parent a forum to also work on improving communication between themselves. It is also noted that family members are invited to participate in the individual sessions and Miller et al (1997) explain that this participation typically consists of one to four visits.

The second modification made by Miller et al (1997) was reducing the length and format of treatment. It appears that the standard 12 month period used in adult DBT was reduced to 12 weeks (1 session per week) and group sessions were also reduced (1 session per week). Miller et al (1997) explain that in order for this modification to work it was necessary to reduce the number of skills taught. However, Miller et al (1997) go on to explain that a 12 week follow up patient consultation group was set up to focus on peer teaching and reinforcement, to compensate for this.

A third change made by Miller et al (1997), and perhaps the most important was the simplifying of the language used in handouts and skills lectures. Miller et al (1997) explain that this was thought necessary “to meet the needs of an underprivileged adolescent population” (page 80), many of which could not read to the expected level of that age group.

If we now consider how effective DBT is at addressing the needs of these adolescents, we can see that Miller et al (1997) examined how effective their adapted treatment method was. Miller et al (1997), which included Marsha Lineman (the original developer of DBT), compared their study group of adolescents against what was described as a ’treatment as usual’ group (TAU group), which received the treatment which was usually offered. By examining the study it is evident that allocation to treatment group was not random, but was based on clinical need, with the DBT group picking up the adolescents with more severe pre-treatment symptoms.

Miller et al (1997) revealed that despite the fact that those delegated to the DBT group were considered to have more severe problems, the DBT group had significantly fewer admissions to hospital during the treatment period and a higher treatment completion rate than the TAU group. Miller et al (1997) also showed that there were fewer suicide attempts made by the DBT group during the 12 week period. From reviewing the work of Miller et al (1997) it appears that the adapted method of delivering DBT appears to work effectively at treating adolescents who display DSH type behaviours. However, although DBT is now being used in many CAMHS settings across the UK, evidence for the effectiveness of the adapted form of DBT outside the USA is very rare. Interestingly, a pilot study was carried out by Swales et al (2000) in North Wales to consider the effectiveness of adapted DBT on British adolescents. The work of Swales et al (2000) suggested that DBT in its adapted form “seems to be as acceptable to British clients and therapists as to their American counterparts” (page 23).

KERFOOT (2005) Client groups that challenge services: Suicide and deliberate self-harm. In WILLIAMS, R. & KERFOOT. M. (2005) (eds) Child and Adolescent Mental Health Services: strategy, planning and evaluation. Oxford: Oxford University Press.

SWALES, M., HEARD, H. L. & WILLIAMS. M. G. (2000) Linehan’s Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation. Journal of Mental Health (9) 1, 7-23.

LINEHAN, M. (1993) Cognitive Behaviour Therapy for borderline personality disorder. New York: Guilford

MILLER, A. L., RATHUS, J. H., LINEHAN, M., WETZLER, S. & LEIGH, E. (1997) Dial

ows the development of a therapeutic intervention, intended to be used with suicidal adolescents and adolescents with DSH behaviours which is an adapted form of standard DBT.

Miller et al (1997) have adapted standard DBT for using with these adolescents by modifying 3 major aspects. Firstly, Miller et al (1997) explain that alterations were made to the skills training group. The modification comprised of the inclusion of a family member and Miller et al (1997) explain the reason for this inclusion is due to the fact that adolescent patients “often continue to reside in their invalidating environments” (page 80). It is the view of Miller et al (1997) that not only does this give the opportunity of improving the adolescents ‘dysfunctional’ home environment, it also offers the chance to teach the family members “how to model and reinforce adaptive behaviours for their children” (page 80).

It is the belief of Miller et al (1997) that including a family member in the group session offers the adolescent and their parent a forum to also work on improving communication between themselves. It is also noted that family members are invited to participate in the individual sessions and Miller et al (1997) explain that this participation typically consists of one to four visits.

The second modification made by Miller et al (1997) was reducing the length and format of treatment. It appears that the standard 12 month period used in adult DBT was reduced to 12 weeks (1 session per week) and group sessions were also reduced (1 session per week). Miller et al (1997) explain that in order for this modification to work it was necessary to reduce the number of skills taught. However, Miller et al (1997) go on to explain that a 12 week follow up patient consultation group was set up to focus on peer teaching and reinforcement, to compensate for this.

A third change made by Miller et al (1997), and perhaps the most important was the simplifying of the language used in handouts and skills lectures. Miller et al (1997) explain that this was thought necessary “to meet the needs of an underprivileged adolescent population” (page 80), many of which could not read to the expected level of that age group.

If we now consider how effective DBT is at addressing the needs of these adolescents, we can see that Miller et al (1997) examined how effective their adapted treatment method was. Miller et al (1997), which included Marsha Lineman (the original developer of DBT), compared their study group of adolescents against what was described as a ’treatment as usual’ group (TAU group), which received the treatment which was usually offered. By examining the study it is evident that allocation to treatment group was not random, but was based on clinical need, with the DBT group picking up the adolescents with more severe pre-treatment symptoms.

Miller et al (1997) revealed that despite the fact that those delegated to the DBT group were considered to have more severe problems, the DBT group had significantly fewer admissions to hospital during the treatment period and a higher treatment completion rate than the TAU group. Miller et al (1997) also showed that there were fewer suicide attempts made by the DBT group during the 12 week period. From reviewing the work of Miller et al (1997) it appears that the adapted method of delivering DBT appears to work effectively at treating adolescents who display DSH type behaviours. However, although DBT is now being used in many CAMHS settings across the UK, evidence for the effectiveness of the adapted form of DBT outside the USA is very rare. Interestingly, a pilot study was carried out by Swales et al (2000) in North Wales to consider the effectiveness of adapted DBT on British adolescents. The work of Swales et al (2000) suggested that DBT in its adapted form “seems to be as acceptable to British clients and therapists as to their American counterparts” (page 23).

KERFOOT (2005) Client groups that challenge services: Suicide and deliberate self-harm. In WILLIAMS, R. & KERFOOT. M. (2005) (eds) Child and Adolescent Mental Health Services: strategy, planning and evaluation. Oxford: Oxford University Press.

SWALES, M., HEARD, H. L. & WILLIAMS. M. G. (2000) Linehan’s Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation. Journal of Mental Health (9) 1, 7-23.

LINEHAN, M. (1993) Cognitive Behaviour Therapy for borderline personality disorder. New York: Guilford

MILLER, A. L., RATHUS, J. H., LINEHAN, M., WETZLER, S. & LEIGH, E. (1997) Dial

r et al (1997) explain that in order for this modification to work it was necessary to reduce the number of skills taught. However, Miller et al (1997) go on to explain that a 12 week follow up patient consultation group was set up to focus on peer teaching and reinforcement, to compensate for this.

A third change made by Miller et al (1997), and perhaps the most important was the simplifying of the language used in handouts and skills lectures. Miller et al (1997) explain that this was thought necessary “to meet the needs of an underprivileged adolescent population” (page 80), many of which could not read to the expected level of that age group.

If we now consider how effective DBT is at addressing the needs of these adolescents, we can see that Miller et al (1997) examined how effective their adapted treatment method was. Miller et al (1997), which included Marsha Lineman (the original developer of DBT), compared their study group of adolescents against what was described as a ’treatment as usual’ group (TAU group), which received the treatment which was usually offered. By examining the study it is evident that allocation to treatment group was not random, but was based on clinical need, with the DBT group picking up the adolescents with more severe pre-treatment symptoms.

Miller et al (1997) revealed that despite the fact that those delegated to the DBT group were considered to have more severe problems, the DBT group had significantly fewer admissions to hospital during the treatment period and a higher treatment completion rate than the TAU group. Miller et al (1997) also showed that there were fewer suicide attempts made by the DBT group during the 12 week period. From reviewing the work of Miller et al (1997) it appears that the adapted method of delivering DBT appears to work effectively at treating adolescents who display DSH type behaviours. However, although DBT is now being used in many CAMHS settings across the UK, evidence for the effectiveness of the adapted form of DBT outside the USA is very rare. Interestingly, a pilot study was carried out by Swales et al (2000) in North Wales to consider the effectiveness of adapted DBT on British adolescents. The work of Swales et al (2000) suggested that DBT in its adapted form “seems to be as acceptable to British clients and therapists as to their American counterparts” (page 23).

KERFOOT (2005) Client groups that challenge services: Suicide and deliberate self-harm. In WILLIAMS, R. & KERFOOT. M. (2005) (eds) Child and Adolescent Mental Health Services: strategy, planning and evaluation. Oxford: Oxford University Press.

SWALES, M., HEARD, H. L. & WILLIAMS. M. G. (2000) Linehan’s Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation. Journal of Mental Health (9) 1, 7-23.

LINEHAN, M. (1993) Cognitive Behaviour Therapy for borderline personality disorder. New York: Guilford

MILLER, A. L., RATHUS, J. H., LINEHAN, M., WETZLER, S. & LEIGH, E. (1997) Dial

than the TAU group. Miller et al (1997) also showed that there were fewer suicide attempts made by the DBT group during the 12 week period. From reviewing the work of Miller et al (1997) it appears that the adapted method of delivering DBT appears to work effectively at treating adolescents who display DSH type behaviours. However, although DBT is now being used in many CAMHS settings across the UK, evidence for the effectiveness of the adapted form of DBT outside the USA is very rare. Interestingly, a pilot study was carried out by Swales et al (2000) in North Wales to consider the effectiveness of adapted DBT on British adolescents. The work of Swales et al (2000) suggested that DBT in its adapted form “seems to be as acceptable to British clients and therapists as to their American counterparts” (page 23).

KERFOOT (2005) Client groups that challenge services: Suicide and deliberate self-harm. In WILLIAMS, R. & KERFOOT. M. (2005) (eds) Child and Adolescent Mental Health Services: strategy, planning and evaluation. Oxford: Oxford University Press.

SWALES, M., HEARD, H. L. & WILLIAMS. M. G. (2000) Linehan’s Dialectical Behaviour Therapy (DBT) for borderline personality disorder: Overview and adaptation. Journal of Mental Health (9) 1, 7-23.

LINEHAN, M. (1993) Cognitive Behaviour Therapy for borderline personality disorder. New York: Guilford

MILLER, A. L., RATHUS, J. H., LINEHAN, M., WETZLER, S. & LEIGH, E. (1997) Dialectical Behaviour Therapy Adapted for Suicidal Adolescents. Journal of Practical Psychology and Behavioural Health. (3) 78-86.