Category: Gay / Lesbian / Bisexual / Transgender Issues
Keywords: LGBTQ+ | DBT (Dialectical Behavior Therapy)
Presentation Type: Clinical Roundtable
The primary goal of this clinical roundtable is to discuss the application of Dialectical Behavior Therapy (DBT) to the treatment of emotion dysregulation in gender diverse people. Existing literature consistently documents mental health disparities in gender diverse people, most notably high rates of clinical distress and engagement in high-risk behaviors (e.g., suicidality, substance use), reflecting patterns of emotional and behavioral dysregulation. Despite these well-documented findings, theory-based conceptualizations and evidence-based approaches to the treatment of emotion dysregulation in gender diverse people are lacking. The Biosocial Model of emotion dysregulation (Linehan, 1993) posits that emotion dysregulation is the outcome of a transactional process between an emotionally vulnerable temperament and an invalidating environment. Gender diverse people are exposed to chronic invalidation in every aspect of their daily lives, which may result in emotion dysregulation, even in the absence of biological vulnerability (Koerner, 2012). Indeed, research has also revealed that gender diverse people experience invalidation at strikingly high rates (James et al., 2016), and that these experiences directly relate to health disparities (Blosnich et al., in press). The Biosocial Model of emotion dysregulation effectively explains the transactional process between a marginalized identity (e.g., gender minority identity), and an invalidating, binary-gendered environment, marked by both a failure to acknowledge, accept, and tolerate and active punishment of gender diverse identities. In the context of chronic invalidation, gender minorities may be likely to develop emotional and behavioral dysregulation, despite best efforts to cope with chronic invalidation of their identities and experiences. By teaching sills to cope effectively with this environmental challenge, gender diverse people may be able to move through their worlds with less distress. Thus, we propose to apply a DBT principle-driven approach to directly target emotional and behavioral dysregulation, which prioritizes treatment in such a way to 1) keep clients alive; 2) keep clients engaged in treatment; and 3) keep clients actively working to create a life worth living, all of which are directly relevant and necessary when working with gender diverse people. The panelists will turn to the DBT skills training mode of therapy, in particular, and will provide applications of skills training that directly relates to the unique experiences of chronic invalidation for gender diverse people. Given the novelty of this approach, the panel will also highlight future directions for research to investigate the application of this evidence-based treatment when working with gender diverse clients.
Director, LGBT Health Program
Veterans Health Administration; VA Boston Healthcare System; National Center for PTSD; Boston University School of Medicine
Saturday, November 18
8:30 AM – 10:00 AM
VA Boston Healthcare System
Friday, November 17
3:30 PM – 5:00 PM
Harvard Medical School
VA Boston HCS; Boston University School of Medicine
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