"Thirteen Reasons Why" and What Comes Next

by Sydnie Dobkin, MA, LPC, Staff Therapist at The Family Institute at Northwestern University


Newswise — Talking about suicide is certainly a step in the right direction, and yet it is not nearly enough. As Clay Jensen, the protagonist of Thirteen Reasons Why passionately states, “it has to get better” (Asher, 2007). I view my role as a licensed professional counselor to educate society on the efficacy of treatment – specifically Dialectical Behavior Therapy or DBT – in helping to reduce suicidality.

     As a therapist that works predominately with adolescents struggling with self-harm, suicidal ideation, and multiple complex problems, I firmly believe that everyone can create a life worth living. I often tell my clients I have seen with my own eyes what effective treatment can do for chronically depressed, suicidal, and self-harming individuals. I firmly believe that EVERYONE can be helped, and here is how.

     The most effective treatment for suicidality is Dialectical Behavior Therapy, or DBT. While DBT is highly efficacious, and is the treatment that currently has the most research to support its effectiveness, there are other treatment options available. People can get help through other forms of therapy, such as Cognitive Behavioral Therapy and Psychodynamic Therapy. Nevertheless, DBT is currently the gold standard of treatment for suicidality.  Recently, Selena Gomez (also the executive producer for Thirteen Reasons Why), has opened up about her own positive experience with DBT after experiencing many of the extreme social pressures common to adolescent girls these days. DBT is an evidence based treatment derived from Cognitive Behavior Therapy that takes inspiration from Zen and mindfulness techniques to teach individuals more effective coping skills (Koerner, 2012). Originally created to treat chronic suicidal crises and borderline personality disorder, DBT has been expanded to address a variety of complex multiple problems. Individuals with borderline personality disorder struggle with impulsivity, cognitive dysregulation, emotional dysregulation, and interpersonal problems. These individuals also present with self-harm and suicidality at a higher rate than other clinical populations (Linehan, 1993). Often, pervasive emotional dysregulation leads to the aforementioned crisis behaviors (Koerner, 2012). According to Kelly Koerner, an established DBT practitioner and author, “when clients have complicated, severe, chronic problems and multiple treatment providers, when misery makes suicide seem the client’s only option, DBT helps therapists (and clients) find order amid chaos” (1993, p.2).

     Dialectical Behavior Therapy is a comprehensive outpatient treatment program consisting of weekly individual therapy sessions, weekly group therapy sessions, telephone coaching, and a peer consultation team of DBT therapists. Involving a hierarchy of treatment priorities and core strategies, DBT offers systematic guidelines for treating life-threatening and therapy-interfering behaviors (Koerner, 2012). Because pervasive emotion dysregulation tends to lead to suicidal crises, DBT treats dysregulation through change, acceptance, and dialectical strategies. Change strategies utilize cognitive behavioral principles to identify variables that cause crisis behaviors through chain analysis. Validation strategies accentuate acceptance and note how empathy produces genuine change, which thus triggers more adaptive emotions (Koerner, 2012). Dialectics is an “idea that one position contains its antithesis or opposite position”, and progress comes from synthesizing two opposites (Koerner, p. 15, 2012). In other words, therapeutic movement comes from simultaneously accepting the client and pushing for change.

     DBT has helped countless individuals create lives worth living. More than thirty randomized controlled trials have demonstrated the efficacy and success rate of Dialectical Behavior Therapy, yet it remains largely unknown amongst non-clinical communities. Since Thirteen Reasons Why premiered on Netflix, numerous teenagers have approached their school counselors with their own suicidality and self-harm urges. Rather than blame Thirteen Reasons Why for causing such chaos, I choose to see the show (and whatever it may have triggered) as an opportunity to educate and encourage people who are suffering. There is always hope. To find a DBT therapist near you, please visit TFINU.org. As Albus Dumbledore once said, “happiness can be found in the darkest of times, if one only remembers to turn on the light” (Rowling, 1999). DBT can be that light, and help is possible. Suicide is not inevitable. Suicide is entirely preventable.

References

Koerner, Kelly. Doing Dialectical Behavior Therapy. New York: Guilford, 2012. Print.

Linehan, Marsha. Cognitive-behavioral Treatment of Borderline Personality Disorder. New York: Guilford, 1993. Print.

Linehan, Marsha. "Frequently Asked Questions about DBT." The Linehan Institute | DBT Videos. N.p., n.d. Web. 04 June 2017.

Robinson, Joanna. "The Unsettling Visual Genius of Netflix's 13 Reasons Why." HWD. Vanity Fair, 03 Apr. 2017. Web. 04 June 2017.

Rowling, J. K. Harry Potter and The Prisoner of Azkaban. Bloomsbury. 1999. Print.

VanNoord, Jack. "'13 Reasons Why' Offers the Wrong Solution to Teen Struggles." Chicagotribune.com.

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