Additionally, prolonged drug use, as evident in Shelley's case, can lead to a variety of functional impairments, including diminished workplace productivity and cognitive impairments that persist into adulthood (Dietz & Dunn, 2014). In line with the reasoning that cognitive-behavioural strategies have shown the greatest potential for reducing harmful behaviours, dialectical behavioral therapy (DBT) may be an effective intervention on Shelley's behaviour. .
Within the cognitive-behavioural domain, DBT is a principle-based psychotherapy designed especially for chronically parasuicidal women diagnosed with borderline personality disorder (BPD) (MacPherson, Cheavens & Fristad, 2013). DBT has since been adapted and used to treat a wider range of psychological problems with the aim of helping individuals develop "a life worth living" (Linehan, 1993, as cited in Worchel & Gearing, 2010). The flexible nature of DBT whereby clients can enter treatment at any stage and move backward and forward through different stages throughout treatment distinguishes it from other treatment models (Worchel & Gearing, 2010). .
Structured, Multimodal Framework.
One of the reasons for using DBT in Shelley's case is the structured, multimodal framework used. Challenges such as decreasing suicidality, attending to chaotic behaviours, teaching new behavioural skills and managing in-session distress are typically encountered at the beginning of treatment. To reduce therapists' fear and confusion in treating adolescents such as Shelley, DBT offers the option of using multiple therapeutic modalities to effect change across a wide range of problems (Katz, Gunasekara & Miller, 2002).
As multiple problems all seem to synchronously require attention, DBT utilizes a comprehensive hierarchical stage model in which treatment stages are structured within a hierarchy of importance, hence allowing for flexibility in the addressing of these problems (Nickelson, 2013).
