All three authors:
This book could not have been written if it were not for the guidance, input, and support of so many people during the past decade.
We cannot begin to describe the appreciation we feel toward Barbara Watkins, our editor at The Guilford Press, who served as our compass, our cowriter, and our cheerleader. Her endless patience sustained us, and her meticulous editing made the book what it is.
We wish to thank many other experts in adolescent treatments—those doing dialectical behavior therapy (DBT) mostly by the book, those also adapting it, and those integrating it into other forms of treatment. Alan Fruzzetti, Kelly Koerner, Dan Santisteban, Brad Beach, Tony Dubose, Nancy Gordon, Jennifer Sayrs, Soonie Kim, Shari Manning, and Linda Smith, to name a few, gave many helpful suggestions and ideas from their own work with adolescents and families.
Alec L. Miller and Jill H. Rathus:
We first want to thank Marsha Linehan, for her genius, inspiration, and mentorship, and for her encouragement to build upon and adapt her work. Her input at every stage has clarified and enhanced our thinking and writing, and has made us better clinicians and teachers in the process.
Back in 1995, it was Scott Wetzler who first suggested considering DBT as a possibly relevant evidence-based treatment for our multiproblem suicidal adolescent population at Montefiore Medical Center, and we thank him for this. We also thank Charles Swenson, whose passion for DBT and encouragement about our adaptation idea confirmed our decision to start our journey, and whose ongoing support and mentorship have been invaluable. We would like to honor the memory of Cindy Sanderson, who first trained us in DBT and inspired us with her talent and wit to become not only DBT therapists but also DBT trainers. Perry Hoffman provided the consultation for our program as it took off the ground and offered many helpful insights about working with families. We would like to acknowledge the American Foundation for Suicide Prevention for awarding Jill the original grant in 1995 that supported our intensive training in DBT. Marcia Landsman deserves enormous gratitude for contributing to the original Montefiore DBT program, serving as one of the first DBT therapists, eventually leading both the multifamily skills training group and the adolescent graduate group for several years, and sharing insights that helped inform our adaptation. Juliet Glinski, Kristen Woodberry, Aimee Mitchell, and Jay Indik all contributed to our thinking about synthesizing family therapy and DBT. Laura Silver McGuire deserves acknowledgment for helping us formulate our set of adolescent dialectical dilemmas and secondary treatment targets. Finally, we also appreciate Behavioral Tech and the group of DBT trainers and colleagues from around the world whose friendship and support have greatly influenced us personally and professionally.
Alec L. Miller:
I would like to thank Dale and Bruno Terilli, Ginny Gerbino, Jeff Atlas, Michael Quittman, Bill Arsenio, Scott Wetzler, and Bill Sanderson, all of whom have served as professional mentors to me in very different ways. Thanks also to T. Byram Karasu, Bruce Schwartz, George Como, and Judy Berenson, who have supported me and my clinical research program at Montefiore Medical Center since 1995. As a child psychiatry fellow, subsequent colleague, and friend, Laurence Katz went on to initiate an inpatient adaptation of adolescent DBT, and his curious intellect always forced me to clarify my own thinking about DBT theory and practice. Valerie Porr, an advocate, provider, and educator, has been another source of support to me during these years.
Thanks to my countless psychology interns, psychology externs, psychiatry residents, and fellows, whose inquisitive minds helped me to crystallize my thinking at nearly each therapist consultation meeting, supervisory session, and lecture. Some of my former trainees (not mentioned above) to whom I am particularly grateful for sharing ideas on my consultation team, treating adolescents and their families, coleading groups with me, and participating in various scholarly endeavors include Pam Straining, Catherine Monk, Sharon Wyman, Jonathan Huppert, Jordana Muhlmeister, Kim Halaby, Julie Nathan, David Markowitz, Marc Gurtman, Gabriella Johr, Lizz Dexter-Mazza, Arielle Goldkang, Carrie Spindel, Jennifer Muehlenkamp, Colleen McClain Jacobson, Maribel Rivera, Nira Golombeck, and Debbie Neft. I owe many thanks to my current and former staff and DBT colleagues at Montefiore who have supported me personally and professionally, many of whom were former trainees mentioned above. Jennifer Hartstein stands out in particular for her innumerable contributions over the past few years; others include Jill Emanuele, Elizabeth Wagner, Lori Greene, and Lisa Lyons. Special thanks to Madelyn Garcia, my assistant at Montefiore, who has continued to function as my right arm and often as my left brain. Without her, I would not have been able to carry out my various professional responsibilities and still write and rewrite this book.
I am very grateful to my friends and family, who empathically understood why deadlines for “the book” rendered me unable to attend myriad barbecues. In particular, I wish to thank my parents, who not only influenced my career choice by serving as role models themselves, but also have functioned as sources of unyielding support and encouragement ever since. My sister has provided me with good humor and helpful advice over these years. Finally, I am forever indebted to my wife for being my best friend, most invaluable sounding board, source of emotional support, and ultimate cheerleader, and for making her own sacrifices during this process. My wonderful children, Jenna and Ian, have taught me how amazingly rewarding and challenging it is to be a parent. In true “making lemonade out of lemons” fashion, these life lessons have made me a better DBT therapist by enhancing my capacity to validate the parents and children with whom I work.
Jill H. Rathus:
I want to thank my staff and colleagues at Long Island University, C.W. Post Campus. Cathy Kudlack helped me in innumerable ways and always greeted my clients in the Psychological Services Center with a smile. Dolores Burns is always friendly, supportive, and willing to lend a hand, and has helped me to become more computer-savvy. I also want to thank Robert Keisner, Eva Feindler, David Roll, Danielle Knafo, Marshall Silverstein, Geoff Goodman, Camilo Ortiz, and Joyce Roll. In addition, Laura Silver McGuire, the assistant clinic director, was my expert coleader in multifamily skills training groups during my first year of conducting DBT at Post.
Also at Post are many graduate students who helped with the completion of this project. I’d particularly like to thank Lauren Sher, Matthew Brightman, and Christine Cantner, who worked reliably and tirelessly over many long hours assisting me with research for the book. I would also like to thank the many excellent graduate student therapists and skills trainers (most of whom have since graduated) who participated with me on my DBT teams at Post over the years, including Nick Cavuoto, Vince Passarelli, Dan Wagner, Anthony Anzalone, Kristen Baker, Lauren Wisely, Martha Stroh, Danielle Kramer-Phelan, Alan Phelan, Wayne Zito, Mandy Habib, Ayme Turnbull, Dawn Cuglietto, Tinia Aperghi, Jacqueline Widmer, Koby Meydan, Peter Wigg, and Andrea Riskin.
In addition, I would like to acknowledge my Stony Brook faculty—particularly Daniel O’Leary, an inspiring mentor who set the bar high and whose influence continues to touch me strongly in my career, and Marvin Goldfried, who had himself worked with Marsha Linehan and first introduced me to DBT in his intervention class in 1988, years before her texts were published! I also want to thank another important early mentor, Bill Sanderson, for furthering my training in research and cognitive-behavioral therapy while I was on internship at Montefiore. Bill also invited me to write my first book, Marital Distress, as part of his edited series on empirically validated treatments, and continues to be a valued and trusted colleague. Other colleagues who contributed to the process of writing this book, whether through direct words of support and guidance or through their teaching and writing, include Zina Rutkin, Ruth DeRosa, David Pelcovitz, and Jon Kabat-Zinn.
Finally, I would like to thank my family. My parents have helped me keep my eye on the ball regarding the completion of this long project, and have been a tremendous source of guidance, support, and encouragement in general. My aunt, Rita Shawn (an accomplished social worker), has supported this work and shown a continued interest in it. I thank my husband, Lloyd, who has patiently tolerated the many busy years of this book-writing process without giving up on me! I appreciate the clarity of thinking and support he provides while he keeps me laughing. I also appreciate how he exemplifies a balance of the two DBT interaction styles: irreverence and reciprocal communication. My daughters, Lauren and Julia, provide me with daily inspiration and joy. They manage to keep me young while building my wisdom. They are wonderful teachers and continually challenge me to live in the moment, pay close attention, and keep my life in balance.
Marsha M. Linehan:
Alec Miller and Jill Rathus are experts in the treatments of suicidal and difficult-to-treat adolescents. This book is a reflection of their courage in taking on this population, as well as their willingness to take a complex treatment like DBT and make it not only their own but available to kids who have complex lives but little ability to understand a complex treatment. Believe it: They wrote most of this book. With marvelous good humor, they put up with having the original treatment developer hanging over their shoulders at practically every sentence, and certainly at every proposed modification, adaptation, or addition. I am intensely grateful that they allowed me to work with them on this book.
I would also like to thank the many DBT researchers, particularly the principal investigators who have managed the arduous task of conducting randomized clinical trials, all of whom are referenced in this book. Without their research, we would not have the evidence that DBT is indeed an effective treatment for suicidal behaviors. And without that evidence, there would be little need for this book.
I am especially appreciative of my executive assistant, Elaine Franks. Without her at my side—organizing, encouraging, reminding, and running interference—I could not have contributed what I did to this book. Katie Korslund took over the reins of our research clinic to free up my time to work on this book, and I could not have done it otherwise. The National Institute of Mental Health took a chance on me before I knew anything, and since 1980 has continuously funded my research on treating suicidal behaviors. Without that funding, the research that made this book possible would not have been done. Jane Pearson, a tireless advocate for research on suicidal behaviors, and James Breiling, an equally tireless advocate for research on borderline personality disorder (BPD), have supported our work with suicidal patients meeting criteria for BPD. Finally, I want to thank The Guilford Press and Seymour Weingarten. They too took a chance on me many years ago, and have never failed to support my work and the dissemination of DBT.