Mental Health Treatment as Part of Children’s Education

Dialectical Behavioral Therapy to foster self-respect and positive socialization among children

First day and last day gifts from group

It isn’t at a hospital, they said, which is sort of true. It’s only a branch of the hospital in which patients can feel physically apart from white-walled sterility but close enough to be monitored. The walk from the lobby to the elevator isn’t a long one, but it’s one in which you get to play a dubious game of “Who are the students, employees, and the mentally deranged”. Fans of people watching would like this.

The room is smaller than an average classroom, and it feels like one too, the way desks are settled in front of chairs all arranged against the wall. A bulletin board hangs on the back beside poster boards atop a window sill. Phrases like “Skillin’ it up” and “Non-Judgment Zone” color the boards, making it feel like a children’s waiting room. I’m twenty-four years old and nervous, yelling at my legs to take the elevator back and wait for the next bus home. Maybe they’ll never know I chickened out.

After another serious bout of suicidal tendencies, my mental health team urged me into hospitalized care, but I opted for an intensive outpatient program (IOP) in Pittsburgh instead. I wouldn’t have to be isolated from family, friends, and my dog. I could attend class full-time and work while attending group therapy for three hours a day, three mornings a week.

It sounds like a lot because it was. Too much? I’m not sure. But the timeline didn’t matter to me as much as the idea of group therapy. I had refused individual therapy for years and still had reservations about laying out what’s in my head for a room full of strangers. Though, the thought that everyone present had some kind of mental struggle, made me feel better; we can at least bond over the stigmatization of being one of the “crazies.”

Dialectical Behavioral Therapy (DBT) is a therapeutic treatment used for many mental illnesses, including but not limited to depression and borderline personality disorder. This method is considered “ the gold standard psychological treatment” [1]. DBT consists of one-on-one and group therapies and close monitoring of progress by a professional mental health team. The nature of this treatment allows for patients to receive several types of treatments tailored to their specific needs. For example, my DBT team consisted of a therapist, psychiatrist and nurse, skills educator, and an eating disorder consultant and nutritionist.

They’re not vultures. They don’t descend upon patients when they’re most vulnerable; they work together to best help each person. While medication may be a large part of mental health treatment, DBT emphasizes skills training. This is the part that everyone may find useful, especially if we were to teach these skills in schools.

Manners have been assumed to be taught in the home by parents and family; however, this idea is based on an outdated notion of family. In today’s America, there are so many types of families who are in unique situations. Especially if both parents, or the only parent, are working, it is likely that teachers may see more of the children than their own parents. This isn’t to say we have lost family value but that we all have certain conditions that fit us into our current lifestyles.

School may also be a child’s first experience with socialization outside the family and close loved ones. Within a large group, children come from various backgrounds that value or emphasize different mannerisms. However, as Americans, we have our own set of mannerisms that are not meant to be superior to that of other cultures but a standard way of interacting with fellow Americans. Manners from children’s ethnic backgrounds may be taught in the home, but American manners can be taught in schools using DBT.

No, all children should not be assigned a therapist and be required to see him/her on a weekly basis. But DBT highlights interpersonal effectiveness, emotion regulation, distress tolerance, and mindfulness [1]. Why should the education of these human skills be reserved only for those who suffer from mental illness or addiction? Being aware of and maintaining one’s mental and emotional equilibrium will allow someone to react to others in a respectful and least combative manner. That doesn’t mean there will be world peace or that we won’t encounter assholes in our day-to-day.

Children carry such pent up emotions and have difficulty expressing them in ways that we deem appropriate. A child who pushes his bowl of peas on the floor may be trying to communicate he thinks peas are disgusting and would much prefer applesauce. From parent to child and vice versa, there are oftentimes heated disputes, and out of frustration, a parent may yell at his/her child who may not even understand what s/he did wrong. In the end, the child is on the floor wailing and Dad is cleaning up mushed peas while trying to calm an irritated baby.

Children spend much of their time in school, learning what we deem to be the most important subjects to promote well-rounded and intelligent individuals who will grow to be successful members of society. While this is all great and dandy, some children struggle with their behavior more than others.

School days are already arguably too long. Students may be taught for hours on end, fact after fact about subjects that may never be of any relevance to them. It is also common for students to learn the same material at different grade levels, sometimes in a more in-depth way, but that is not always the case. I can’t even remember how many times I took sex education, but it was way more than necessary. Year after year, we filled out anatomy diagrams, skirting around the words penis and vagina.

Rather than emphasizing a single subject by repeatedly teaching it to the same students, we can implement DBT into the curriculum. As mental health is a major part of a person’s ability to live fully, we need to ensure children know how to manage what is in their minds or seek additional help when needed. Young children can benefit from learning interpersonal skills in school because they will all be aware of this “American” mannerism. For example, what is and what is not appropriate to say to another child; “May I see your necklace?” is notably different from “Give me your necklace so I can see it,” which is also different from physically trying to take jewelry from its owner.

Interpersonal effectiveness education will allow teachers to manage children exploring right from wrong in a controlled space. Children will also learn how to help one another when needed and build relationships among themselves and others outside the classroom. Relationships are important regardless of age, so it is important for each child to have a foundation for how to maintain respect for all people in order to work toward a positive relationship in which all parties benefit.

Emotion regulation is a skill rarely ever achieved, except perhaps by Ghandi, but even he might have had his bad days. Expressing oneself to others feels naturally difficult because we are ingrained to feel self-conscious of ourselves and to be on guard in case of attack. Regulation here does not mean stoicism but rather an acceptance of one’s emotions and the ability to change one’s emotions to avoid dwelling in the past or simmering in anger.

Children, especially, find it nearly impossible to express and contain their emotions given their limited language and knowledge of the world around them. Certain emotions and outlets can begin to be entrenched at early ages when influenced by outside factors. If a child often sees a parent physically lash out in anger, the child may mimic that behavior in temperament or in similar fashions. DBT encourages individuals to accept ill feelings and work to keep one’s mental and emotional state in balance. This doesn’t mean a child cannot feel sad when her best friend moves away; it means she can continue making friends while keeping in touch with her other friend.

As adults, we feel as if one day, one magical day, we will be able to either extinguish stress from our lives or to not give a shit at all. Since these two extremes are often hard to maintain on a daily basis, we loosely toss around the term stress management. However, DBT focuses on crisis management. Children should be able to distinguish between a crisis and a non-crisis. We teach our children what to do in case of a fire and to call the police if they’re in trouble (though this may be becoming less common). But we don’t teach our children what to do when faced with a crisis.

Adults: “What crises can a six-year-old have? I have to work for eight hours a day, drive through rush hour, and do my taxes!” Well, as established earlier, children come from different families, each dynamic varying from the ones in the houses around the block. What is a child to do instead of throw a tantrum when he doesn’t get the new toy he sees on TV? Coping with the less-than-ideal may be in the form of playing with the toys he already has and appreciating them. Or it may be behaving well to work toward the new toy as a reward. This learned behavior will become the new norm and set up the child’s preparedness for inevitable letdowns in the future.

When I hear the word mindfulness, I think yoga, partly because I had to attend a four-hour long meditation for a creative writing class one time. It was the longest four hours of my life. I mean the longest four hours of my life. I’m not one for meditation, and even yoga often bores me. However, mindfulness is more than these bodily movements and deep breathing. It is being able to focus on something aside from one’s tasks and stressors in order to charge the brain for more activity or rest. Mindfulness is awareness of one’s surroundings and internal as well as external physical states of being. Notice stress and let it pass; notice pain in the shoulders and stretch.

The recent coloring book craze transcends from the idea of mindfulness. Creativity allows the mind to open up to possibilities, not of wrongness. Some people find coloring to be an art of going with the flow, a seemingly mindless task in between calculus problems. In contrast, coloring is mindful in that it allows a person to be in tune with him/herself on multiple levels of the body and mind.

Similarly, children are often go-go-go people. They have places to be like Mr. Bunny’s tea party and bath time and then a show of dancing animals to attend. Their minds are like lightning compared to some adults’. Sometimes I feel like I have a sloth’s brain — I analyze something so much it’s debatable whether or not I’m thinking at all. Therefore, children are perfect participants in mindfulness. They can allow their minds to wander, free of distress. Many young children like art because they can express themselves without judgment and in the mode they see fit.

I’m apt to consider that we already teach mindfulness, both in art and low-energy group activities. However, the habit of mindfulness should be fostered at a young age to help children cope with emotions and stress in healthy ways. They will be in touch with their bodies and minds more closely than they are now, when it seems like an almost out-of-body experience to concentrate on how it feels for one’s feet to touch the floor. In a culture that is in a rush to have everything done yesterday, it is helpful for children to find their respective balances of the mind, a baseline that can be relied on when in crisis or otherwise. They won’t be thinking of their afternoon snack or recess; they’ll be in the present moment participating in soothing activities, which can then be integrated into other areas of our society, including the workplace. Staring at a computer screen for hours on end can be a killer on the eyes, but a few minutes of desk yoga can soothe oneself from the humdrum of the office.

After “graduating” from DBT, aka my insurance stopped covering my sessions, I want to continue using the skills I have learned and share them with others, not to be saint-like but to de-stigmatize this highly recognized treatment for mental health. I went into group therapy unaware of DBT or what its initials even means. I’m still not “fixed” or “normal” in any way, but I have a better understanding of how to cope with depression and anxiety. During my time in group, I kept thinking about what it would be like to teach this as part of general education, like math and writing.

Not only for the mentally ill, DBT is a methodology that all of us can use to navigate the world as busy, interdependent, emotional individuals, whether we want to admit it or not. What is important for our children who will soon grow into, as we like to call them, “our future” is the ability to communicate effectively while maintaining a balance between all spheres of the human psyche.

[1] “What is DBT?” Behavioral Tech. The Linehan Institute of Behavioral Health, 2016. Web. 16 April 2016.

For more information about Dialectical Behavioral Therapy (DBT), click here.