Towards the Development of an Effective Working Alliance: The Application of DBT Validation and Stylistic Strategies in the Adaptation of a Manualized Complex Trauma Group Treatment Program for Adolescents in Long-Term Detention

Am J Psychother. 2015;69(2):219-39. doi: 10.1176/appi.psychotherapy.2015.69.2.219.

Abstract

The current paper details a case of adapting a manualized group therapy treatment for youths experiencing chronic stress. It was used for use with a highly traumatized and behaviorally disordered group of adolescents (ages 14 to 17 years) in long-term juvenile detention. The authors argue for a phasic approach to treatment for this population, with the goal of the essential, initial phase being the development of an authentic therapeutic alliance before other treatment goals are pursued. The authors provide clinical examples of liberally and patiently utilizing dialectical behavior therapy-framed acceptance-based strategies to achieve this therapeutic alliance, and only then naturally weaving in more traditional cognitive behavioral, change-oriented psychoeducational approaches successfully. Clinical and research implications for effective treatment of traumatized, detained youths are also discussed.

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Adolescent Development
  • Behavior Control / methods
  • Behavior Control / psychology
  • Behavioral Symptoms* / etiology
  • Behavioral Symptoms* / therapy
  • Cognitive Behavioral Therapy / methods*
  • Criminals / psychology*
  • Humans
  • Life Change Events
  • Male
  • Psychological Techniques
  • Psychopathology
  • Punishment / psychology*
  • Stress Disorders, Post-Traumatic* / complications
  • Stress Disorders, Post-Traumatic* / psychology
  • Stress Disorders, Post-Traumatic* / therapy
  • Stress, Psychological / complications
  • Stress, Psychological / psychology
  • Stress, Psychological / therapy
  • Treatment Outcome