Count the colors in the classroom Draw, doodle, or journal
Drum with hand quietly Focus on the class work
Listen to how the teacher’s voice changes as he talks
Think about a favorite pet or a little sister or brother
Ask to leave the room to talk with someone
Squeeze a stress ball
Picture a calm or favorite place Picture myself doing something fun Breathe deeply; count on the exhale Sing a favorite song in my head Look at a magazine
At home or in private Talk on the phone
Read a favorite book or story Make jewelry
Paint my nails
Complete a word search Play computer games Make brownies
Make something for a stuffed animal Call my grandmother
Go for a bike ride
Juggle
Smell perfume or cologne Take the dog for a walk Write a friend a nice note Help my sister with homework Dance or exercise to music Go running
Put on makeup; fix my hair in new do Sort baseball cards
Arrange pictures in a photo album Play the drums
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Dialectical Behavior Therapy for Adolescents with Borderline Features
In teaching the more challenging skill of acceptance, we have found stories to be especially effective. Reading aloud is typically soothing and quiets most groups, facili- tating the openness necessary for acceptance. Effective stories for teaching acceptance paint the picture of a dire situation in which someone is able to “make lemonade out of lemons,” give to others even when he has very little himself, or find beauty in an other- wise unhappy place. We then make a list of situations group members have learned to accept or are trying to accept: parents divorcing, having to live away from home, acne, getting cut from a sports team, or losing a boyfriend to a supposed best friend. Asking “How did you come to accept that?” or “When did you realize you’d accepted that?” can prevent this exercise from deteriorating into a competition for who has the worst events or issues to accept. Teens are usually eager to relay what they’ve learned to accept, and even when the clinician wonders if they really have accepted what they say they have, verbalizing the issue can be an important first step. Personal examples by the clinician of times she thought she’d accepted something only to have to let go and accept it again and again can be helpful in normalizing the process.
Groups also have fun highlighting signs of nonacceptance. Both teens and parents can provide examples of digging their heels in, spreading lies about the boyfriend and best friend who got together, or insisting that a son or daughter was wrong about some- thing when, in fact, they were right. The leader can remind everyone that we often avoid acceptance because it opens us up to painful feelings. Laughter at what we all do to avoid pain is mixed with a quiet acknowledgment that pain hurts.
Physical images and activities seem to be particularly useful for adolescents. Members can make tightly closed fists and open them slowly, or feel the difference in stabil- ity (especially if pushed gently) between standing rigidly with feet close together and spreading them apart while bending the knees. Clinicians or other staff can then evoke this type of image to teach willingness simply by referring to having “willing hands” or taking on a “willing stance.” Helping them observe how they hold tension in their bodies and then practice letting it go provides a concrete step toward acceptance. One of our programs teaches this as a “shrug and a sigh.” Practicing “a shrug and a sigh” three times helps with acceptance even when one does not agree with the situation. Adolescents can usually provide examples from skiing, dancing, skateboarding, or other activities of performing better when they “let go,” such as facing directly downhill and bending their knees or throwing themselves fully into a specific maneuver. The clinician might ask each person to identify at least one image from his own life of accepting or letting go to help in situations in which he feels stuck and unable to accept.
Mindfulness
Introducing mindfulness in terms adolescents can relate to and that are consis- tent with their goals is critical to enlisting their participation. Some groups are already familiar or immediately fascinated with the concept of mindfulness, and individuals will quickly offer to lead a group mindfulness exercise. Others will complain that mindfulness
is “stupid” or “boring.” Creativity and energy are needed to teach mindfulness exercises that lead to a sense of competency and success. Additional flexibility and commitment are sometimes needed to engage adolescents who are committed to making sure you feel as much the fool as they do.
Linehan introduces mindfulness with the concept of “wise mind,” which is the syn- thesis of “emotion mind” and “reasonable mind.” A simpler way of describing this is that knowing involves both feeling and thinking. Since adolescents are preoccupied with relationships, one can talk about being madly infatuated with someone as an example of emotion mind (it’s exciting, inspirational, energizing, and terribly distracting). In contrast, carefully thinking through what values and interests you have in common or whether your backgrounds and goals are compatible uses reasonable mind (quieter, fol- lowing a logical, step-by-step process). Wise mind is achieved when you can integrate the passion of emotion mind with the logic of reasonable mind. If you act on passion alone, you’re headed for pain when the passion fades and there’s nothing left. If you act just on reason, you risk getting into a passionless and uninspiring relationship. In wise mind, you take into consideration both your feelings and your reason. Metaphors help teens jump the gap from abstract concepts to real-life applications. Linehan (1993a, 1993b) offers rich metaphors, many of which work well with teens. Here are some of our favorite activities for teaching wise mind to this age group.