The Cultural Adaptation of Dialectical Behavior Therapy: A Case Study from Clinical Practice

Background and Purpose: 

Mental health clinicians often service their clients with a therapeutic modality chosen to best target the chief diagnosis.  These therapeutic modalities have been researched extensively and have evidence to support the effectiveness of reducing the presenting symptoms of the client. However, there are treatment modalities that have not been researched specifically for its effectiveness on diverse client populations. There is a significant lack of literature that specifically focuses on using standard Dialectical Behavior Therapy (DBT) with the monolingual Spanish speaking Latino population. The purpose of this project is to investigate different approaches and techniques clinicians can use in order to meet the specific needs of diverse client populations to make the treatment modality culturally adherent.  This project will highlight the use of a culturally enhanced DBT program on a 45-year-old Latina female client diagnosed with Major Depressive Disorder and Borderline Personality Disorder.

Methods:

Qualitative data was collected using direct observations via clinical practice of a Spanish enhanced DBT program in an outpatient mental health clinic. The client of this project is “Emma”, a 45-year-old, Latina female who was self referred to the clinic in order to receive mental health services due to presenting symptoms of depression. She initially began treatment by receiving a Cognitive Behavioral Therapy (CBT) treatment modality in order to reduce symptoms of depression.  However, Emma’s functioning throughout treatment included pervasive mood dependence, suicidal ideation and parasuicidal behavior that warrant a change in treatment modalities to DBT. Once in DBT treatment, client had difficulty committing to the new treatment modality due to its structure. This prompted the therapist to use different approaches in order to make the treatment more culturally adherent for the client. The specific approaches used with the client included: using a “Loteria” system approach, using pictures on the client’s diary to meet her literally competence, and having the client participate in the Spanish speaking DBT skills group.

 

Results:        

 

The approaches used by the therapist were successful in having the client eventually commit to DBT treatment. Client reported that the “Loteria” approach was an incentive due to the points that she received by completing her homework. The decision of adapting the client’s dairy card by using pictures was a successful approach as the client reported that initially the requirement of completing the diary card was a reason why she did not want to commit to treatment. Lastly, the client participated in a monolingual Spanish speaking skills group, which translated the DBT skills in a culturally appropriate and sensitive way.

 

 

Conclusion and Implications:

 

This project highlights effective approaches for therapists to use with their monolingual Spanish-speaking clients who are receiving DBT as their treatment modality. Due to the effectiveness that is known of DBT as the treatment modality for clients with borderline personality disorder, this case study highlights how different approaches can be made in order for DBT to be culturally enhanced and appropriate.