Tanuja Gandhi, MD (Host): Welcome back to Mind Cast, Healthy Mind, Healthy Child, a podcast from the mental health experts from Bradley Hospital. I'm your host, Tanja Gandhi.

Greg Fritz, MD (Host): And I'm your co-host Greg Fritz. Today we welcome Amanda Pelletier to Mind Cast. Amanda is Clinical Director for our DBT Girls Residential Program, as well as our arts program. That's the acute residential treatment program for teens struggling with mental health and substance use disorders. Thanks for joining us today, Amanda.

Amanda Pelletier, LICSW: Thanks so much for having me. I've been at Bradley, for the last 15 years and before that have spent a long time working with teenagers struggling with social and emotional problems and behaviors, and I think that's why it's so important today to talk to folks about how they can help the parents of adolescents and children managing their emotions.

Tanuja Gandhi, MD (Host): Amanda, thank you so much for joining us. Today, we are talking about a parenting approach rooted in DBT or dialectical behavior therapy. I know it sounds fancy. But for our audience, we hope we can break it down with real world examples and ideas that can be used right away using this approach that we are calling the DBT approach.

And I'm hoping this will give us a better understanding about what DBT is. So let's start with the basics. What is DBT?

Amanda Pelletier, LICSW:  DBT is dialectical behavior therapy. And, that's an evidence-based treatment model. It's a cognitive treatment that brings in some different Eastern philosophies, a lot rooted in Buddhism, such as acceptance and a lot of mindfulness practices. So it takes those philosophies and values and puts them with skills to help individuals manage their emotions in a more effective manner.

Greg Fritz, MD (Host): So one of the core parts of that is dialectical. That word always gets me. It's sort of a little intimidating, but it's actually pretty powerful in parenting. Can you explain it in plain terms, what dialectical means and how it works?

Amanda Pelletier, LICSW: Sure. It's actually the part when I first learned about the treatment, that was the most intimidating. And

Greg Fritz, MD (Host): I know it's,

Amanda Pelletier, LICSW: You know, when I tried to find an easy way to describe it to trainees, I found entire philosophy curriculums about dialectics. It's the most important to me part of this treatment. And really it's holding on to two seemingly very opposite views at the same time. And in DBT particular, we're looking at holding the idea of acceptance, accepting people that they're doing the best they can, and also pushing for change.

So, we accept that no child or adolescent wakes up in the morning and says, I really want to get into trouble. I'm going to drive my parents crazy and I want to drive my teacher's nuts. Nobody wakes up wanting to do that, but they lack the skills to kind of get their needs met and navigate the world in an effective way.

So we don't just sit there and say, we understand. You just don't get it. That's why you're acting the way you are. We accept that and we push them to learn skills, to do things differently.

Tanuja Gandhi, MD (Host): That totally shifts the way we respond. It seems like it's not about giving in or saying no or clamping down. It's a little bit of both. Validation is another buzz word we've heard in the concepts about DBT and we hear it a lot. What does it really mean to validate your child? Does it mean that you have to agree with everything they say, or do you disagree with everything they say? I mean, obviously that's not validating, but what does it mean?

Amanda Pelletier, LICSW: Absolutely. And I think we do this a lot. We don't even know it right? So validating is something we do every day with people in our lives, with children, with people we take care of. And it's letting people know that they're heard, that they're seen, they're doing a good job, their emotions are valid.

Parents can get stuck on this because they say, well, why would I validate my child when they're saying, Mommy, I don't want to go to bed. That's a terrible thing that I have to do. It's just something you have to do. So we aren't going to validate behaviors or thinking patterns that don't make sense. But we really can't go wrong when we validate emotions.

So in that example, it's fine to say, I understand you don't want to go to bed. It's sunnier later outside, it's summer vacation. You might want to stay up a little bit later. I understand that. And we have a big day tomorrow. You need to get your sleep tonight. So it's really not just staying in that place of validation, it's also acknowledging the other things that we have to do.

Greg Fritz, MD (Host): So that means it's what you're saying is that, when you're saying that it's not that you're okay with the behavior, it just means that you're seeing that where the child's coming from and understanding that, right?

Amanda Pelletier, LICSW: Right. Exactly.

Greg Fritz, MD (Host): And so, let's talk a little bit about what a parent can do when your child is doing something right. How does DBT help us catch and reinforce that? And what sort of tips do you have for parents as to how to get this done?

Amanda Pelletier, LICSW: So, you know, for us in the field, we've all taken classes in behaviorism and behavior modification, and in DBT we teach parents those same essentials and we get a lot further when we let people know what we want them to do rather than what they should not be doing.

And especially with kids. If we think about that, our children are hearing, you can't do this in school, you can't do that at grandma's house, or, don't do this, don't do that. They don't get a lot of do do this, do be a kind person or do one chapter of your reading this evening. So for example, and I'm the parent of a 14-year-old, in the summer, so, you know, we're having some teen struggles of our own right now.

And room cleaning is a great example. So, really breaking that down into not just saying, I need you to clean your room. Why won't you clean your room? My idea as a grownup of what a clean room is, is very different from what a 14 year old's idea of what a clean room is. So if we want to have some success, I need to be very specific in you need to make your bed, you need to get your clothes off the floor, let's work on your desk today. So just being really specific with the behavior that you want to see change or the task that you want to see accomplished and reinforcing that behavior that we do want to see. I think we often get caught up in making a big deal of the behaviors that we don't want to see, and that can sometimes actually reinforce those negative behaviors. So we want to really celebrate the positive ones.

Tanuja Gandhi, MD (Host): So it sounds like parents can actually feel empowered by using DBT strategies and it's a nice experience to feel a win in a situation where you feel like there's a power struggle coming on. So can you tell us how DBT can help parents and caregivers?

Amanda Pelletier, LICSW: One of the great things about DBT that I really like, especially with our adolescents and our multifamily skills group, teens and their parents learn the same skills. And so there's one specific skill that we focus on. The anacronym is, please and every letters for a different self-care thing.

So taking care of physical illness and making sure you get enough exercise, avoiding mood altering substances. So self-care is a big buzzword now and people kind of think that means a trip to the spa or, you know, getting a massage and it's really doesn't, it doesn't, no, it could, you know, it could, that's, that's part of it, but it's really those essential things that we have to do on a regular basis to decrease our own emotion, emotional vulnerability. So make sure we're eating well and exercising, that makes us a little bit less vulnerable to our own emotions. So as parents, this was something that I love to teach in group, because the parents would just go, oh, I really need to work on that.

So we teach it to kids that it's important that you have breakfast before you go to school, but it's really, really important for parents to do the same thing so they can be managing their emotions and their mood and showing those, just really great skills to their kids.

Tanuja Gandhi, MD (Host): Those are some really great ideas. Do you have an example of using this strategy for yourself, in your work in terms of some kind of self-care tip that we could use for our listeners?

Amanda Pelletier, LICSW: Yeah, so I think there's a lot of some really basic things about carving out time for yourself as a parent. So maybe it's making sure that you get that, you know, if it's having 30 minutes to read that novel that you're reading, right? It's important to show that to your kids, that you're taking care of yourself and you're giving that time and it's going to make you feel better in yourself. I think you mentioned something before, but the wins too, between parents and their kids. And I think that is really important. So, recognizing those things that, wow, we did this activity together. Maybe it was, cleaning up the backyard for the summer. And we actually had some fun with it. It went well. There was no meltdown in the middle of it, and we enjoyed this activity and really noticing those.

Being present in those activities with our families, it's really important. Especially I feel like this time of year we're spending more time with our kids, maybe different time with our kids. There's less structure from school. So it's important to notice those moments and celebrate each one of those wins, even if it's something as simple as getting through dinner without an argument or cleaning our rooms without a meltdown. Those are really important things to celebrate and notice.

Tanuja Gandhi, MD (Host): Oh, that sounds so good. I'm reflecting on some of the families we've worked with, in our work here. And what comes to mind is you can have a child who's struggling and the child could be a great kid or have many other strengths.

So the two things can coexist, like a kid can be great at baseball or basketball and have a lot of difficulties in other areas of their life. So holding two opposites together. Well, before we wrap up, I wonder what are some of the small things that parents could do to put some of these ideas into practice this week?

Amanda Pelletier, LICSW: So I guess one of the things that I would say is being very clear with your expectations. I mentioned, the room cleaning. Maybe it's just mostly on my mind because my daughter's room is an absolute disaster this week. But, I also remember a family that I worked with and they had gotten to a crisis point because the mother felt like her child was just disrespecting her by not cleaning the car that she had asked her to clean, but she hadn't been specific with the directions. And once we broke that down, the child felt better that they had accomplished something. Mom felt better and said, oh, I, guess you weren't disrespecting me. You were trying to do it. You just weren't able to read my mind. So I think that's something really, really important that people can do is just being very clear with your expectations and really noticing and celebrating each one of those wins. It makes us just all feel better when we have something to celebrate. And then gives us that sense of mastery that we've accomplished something.

Tanuja Gandhi, MD (Host): So one step at a time. Right. Small successes towards the big trajectory to making positive change.

Amanda Pelletier, LICSW: Absolutely.

Greg Fritz, MD (Host): Seems like you're underlining the fact that it's important to do that intentionally. Not just say I always reinforce and validate but today I'm going to do this or that and do that. clearly. And eventually it'll be habitual. It's very helpful and we can do if we want. So we really appreciate your being here, Amanda, and sharing this experience with us and hopefully it'll be useful to the parents that are listening. For more informative podcasts from the experts at Bradley Hospital, visit www.bradleyhospital.org/ podcast. And until next time, happy parenting.