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Girls DBT Program

Program Overview

Trauma-informed treatment that teaches adolescent girls how to manage their emotions and behaviors more effectively.

The Devereux Massachusetts Girls Residential Treatment Program serves females, ages 13 to 22, across a continuum of treatment settings, including an intake unit, as well as a cottage setting and a community group home.

Diagnoses served include mood disorders, post-traumatic stress disorder, reactive attachment disorder, borderline personality disorder and pervasive developmental disorders. In addition, the youth we serve typically exhibit self-harming behaviors, such as cutting. Many of the girls referred to this program have co-occurring mental health and substance abuse disorders.

The Devereux Massachusetts Girls Residential Treatment Program has modified standard adult dialectical behavior therapy (DBT) for use with adolescent females. This treatment modality is effective for reducing emotion dysregulation and accompanying incidents of self-harming behaviors. For girls with substance abuse problems, the program also integrates substance abuse-specific treatment (e.g., attendance at 12-step meetings, participation in psychoeducation and relapse prevention groups) into the DBT model.

Admission Criteria

The Devereux Massachusetts Girls Residential Treatment Program is appropriate for female adolescents who meet the following criteria:

• Ages 13 to 21
• Mild intellectually disabilities to above-average intelligence range
• A diagnosed mental health disorder
• Co-occurring disorders of substance abuse and mental health
• Impairment that interferes with the adolescent’s functioning in home, school and community settings

Admissions Procedure

Mission Statement

The mission of the Devereux Massachusetts Girls Residential Treatment Program is to teach youth the skills they need to function as independently as possible in a safe, predictable and empathic setting. We involve families in their child’s treatment, and support them in caring for their child.

Program Objectives

• We aim to help girls improve in the following areas:
• Ability to regulate emotional expression
• Ability to control impulses
• Acquire social skills necessary to form positive peer and adult relationships
• Identify triggers related to substance use, as well as strategies for relapse prevention
• Improve relationships within the family
• Reintegrate into the community

Treatment Components 

The treatment program includes each of the standard DBT modes of treatment:

Individual therapy: Each girl in the program participates in individual therapy at least once per week with a clinician who is intensively trained in DBT. The clinician will review progress on target behaviors; conduct behavioral chain analysis of ongoing problems; learn and rehearse positive replacement skills; and discuss other relevant concerns. Clinicians recognize that the quality of their treatment relationship with an individual can profoundly impact the treatment progress, and they make themselves available for consultation in-person or over the phone when an individual is in crisis and needs skills coaching. 

DBT skills training groups: These group sessions, which take place at each of the girls’ residences once per week, are co-led by clinical and residential staff who are an intensively trained in DBT. The groups are typically comprised of six to eight individuals, and run for a total of 26 weeks. These sessions help individuals develop skills related to mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. Youth are taught a new skill each week that is reinforced and coached throughout the week by residential staff and clinicians alike. DBT language and mindfulness exercises are woven into all skills groups.

Skills coaching: Skills coaching is an integral aspect of the treatment milieu. Residential staff are available “in the moment” to coach DBT skills, suggesting what skills should be used, as well as how and when they should be used. Staff prompt youth to use these replacement skills whenever relevant situations arise throughout the course of the day. Team members also make use of these “teachable moments” by validating the individual’s current experience; suggesting an alternative way of handling the situation; and then reinforcing the individual’s attempts to perform the new skill.

DBT diary cards: Diary cards are completed once per day on the residential unit, and are reviewed by both a staff member and the youth. Encouraging individuals to review their diary cards with staff the same day allows immediate feedback, praise, validation and coaching. The diary cards also are reviewed at the beginning of each individual therapy session consistent with standard DBT treatment.

Daily group meetings: Girls are prompted to reflect upon their skill use throughout the day. In addition, they are encouraged to identify skills they witnessed their peers using.

DBT consultation team: The DBT consultation team is comprised of clinical staff, and meets once per week for a two-hour period. The team serves as a regular forum for clinicians to review challenging sessions with individuals; role-play successful interactions; and address burnout.

“Chill out” rooms: These rooms, which are located on the intake unit and at the cottage, provide a place for girls to go to use their skills. Individuals are encouraged or coached to use these rooms to take space from a situation until they become more emotionally regulated. The rooms have beanbag chairs, blankets, and other items contained in each individual’s self-soothing box to help them cope with distress.

Substance abuse treatment: We offer support groups, such as Alcoholics Anonymous and Narcotics Anonymous, on a weekly basis. In addition, our Girls Residential Treatment Program offers substance abuse psychoeducation and relapse prevention groups. These groups are designed to educate youth about substance abuse issues, and motivate individuals to strive for a substance-free lifestyle.

Relational approach: Building and maintaining positive relationships with our individuals is the most important factor in creating a treatment environment that is safe, warm, predictable, empathetic and helps youth feel competent and successful. All learning occurs in the context of relationships and behavior change techniques are most effective when they are employed in the context of a positive relationship.

We believe that positive change can occur when individuals experience a connection with staff. Staff are teachers and role models who demonstrate a genuine interest in, and respect for, those they serve. They respond to each girl as a unique individual and are attuned to her feelings.

Positive behavior support: This approach emphasizes teaching skills as a central behavior change tool, and focuses on replacing coercion with environmental redesign to achieve durable change. Problem behavior is viewed as the result of an individual trying to meet a need without having the skills to meet that need appropriately. It may be an attempt to escape or avoid overwhelming feelings of pain or shame. Accordingly, the role of treatment is to teach the skills required so that the girl can meet her needs in more appropriate and successful ways.

Groups: In addition to DBT and substance abuse groups, we offer a variety of other groups in the residences, including anger management, social skills training, relaxation groups and self-esteem groups. The primary function of these groups is to teach girls new skills to help them cope with their mental health issues.

Family involvement: Family involvement plays a critical role in the successful treatment of the individuals we serve. We believe that the parents/responsible adults in an adolescent's life are experts about their children, and their knowledge must be incorporated into assessment and treatment. We understand that parents need support, education and skills to relate to their adolescent in more satisfying ways.

"When I first came to Devereux, I used to put myself down. Now I have more confidence in myself. I know if I put my mind to it, I can achieve my goals." - Alyssa, 16