Assessment of Parents,Couples, and Families in Dialectical Behavior Therapy

Family intervention in Dialectical Behavior Therapy (DBT) is a core part of multiple required functions of DBT, providing opportunities for skill training (including relationship-specific skills that are not covered in individual DBT), skill generalization, and direct intervention into the social and family environment. In order to intervene with parents, partners and other family members efficiently and effectively, therapists must first conduct a careful assessment. The core relationship transaction of emotion vulnerability/dysregulation and inaccurate expression leading to invalidating responses (and vice versa) is highlighted, as are the treatment targets in DBT with families, which inform assessment targets. Then, two core assessment procedures are explored, with clinical examples: (a) conducting “double chain” analyses, demonstrating how one person’s social or relationship responses affect the other’s emotional arousal (and vice versa); and (b) direct behavior observation of family interactions, which allow treatment targets to be identified efficiently. These two assessment strategies may also be combined. Implications for family interventions are discussed.