Dialectical behaviour therapy for adolescents who repeatedly self-harm : a qualitative study
Despite the level of concern generated by adolescents who repeatedly self-harm, there is a dearth of empirically validated interventions for this client group. In the adult domain, dialectical behaviour therapy (DBT; Linehan, 1993) is the only evidence-based intervention for individuals at high risk of repetition, and preliminary research has suggested its utility with adolescents. This study employed a qualitative methodology to evaluate an existing inpatient DBT programme for adolescents with multiple presenting problems including deliberate self-harm. Four female adolescents were interviewed in depth about their experiences and the perceived impact of receiving DBT. Transcripts were analysed for significant and recurrent themes using interpretative phenomenological analysis. Overall, the results supported existing quantitative data indicating that this client group can benefit from DBT. Participants emphasised the role of applying DBT skills in gaining a sense of control over internal experiences and overt behaviours (including self-harm). However, there were marked individual differences in the degree to which such control was attained. Furthermore, for most participants, the effective use of DBT skills was at least partially dependent upon the continued receipt of therapy. Motivation to engage in and comply with therapy appeared to be significantly influenced by participants' perceptions of staff and peers within the inpatient unit. A sense of connection or identification with others emerged as an important source of learning and inspiration, as well as serving to normalise participants' difficulties. The role of social comparison was particularly salient in participants' attempts to make sense of the changes in self since entering DBT. The findings are discussed in relation to the existing literature, with particular emphasis on the extent to which therapeutic processes deemed important by DBT theory were concordant with participants' experiences. Implications for clinical practice are highlighted and directions for future research suggested.