JAAH 2 (3) pp.

335346 Intellect Limited 2011

Journal of Applied Arts & Health

Volume 2 Number 3
2011 Intellect Ltd Miscellaneous. English language. doi: 10.1386/jaah.2.3.335_7

EMILY LEBOWITZ AND CHANDRA REBER

McLean Hospital

The union of the expressive

arts and Dialectical
Behaviour Therapy with
adolescents presenting
with traits of Borderline
Personality Disorder in a
residential setting
ABSTRACT

KEYWORDS

This article documents the journey of expressive arts-based Dialectical Behaviour

Therapy (DBT) groups with adolescent females struggling with Borderline Personality
Disorder at McLean Hospital in Belmont, MA from their inception in 2009 through
to the present. There has been minimal research done on the efficacy of fusing
the expressive arts with DBT; the theoretical model used at the 3East residential
treatment programme. This article documents the rationale, structure and evolution
of these groups. Furthermore, we discuss indicators of potential benefits from these
groups such as decreasing perfectionism, increasing mastery, coping skills, self

creative arts
adolescents
Borderline Personality
Disorder
Dialectical Behaviour
Therapy
expressive arts therapy
residential treatment

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Emily Lebowitz | Chandra Reber

esteem and self identity, as well as propose changes that could continue to improve
the current groups. Specific interventions and client observations are showcased
with the purpose of sharing our experiences and expanding the dialogue between
clinical psychology and expressive arts. Our work supports a positive outcome for
the combination of these two treatments in this setting.

INTRODUCTION
McLean Hospital in Belmont, MA is a historic and cutting-edge psychiatric
hospital, providing care to patients with a range of diagnoses through their
spectrum of services. The campus includes both short- and long-term treatment in a variety of outpatient, residential and inpatient programmes for
children through to geriatrics. In addition, the facility has strong research
departments, constantly pushing the boundaries of many disciplines. As
a result of working in such a diverse and rich environment, there is room
to explore many areas of enquiry. We would like to share our chosen area
of enquiry with the intention of sparking interest and dialogue in the wider
mental health community. Our focus has been the fusion of the expressive
arts with Dialectical Behaviour Therapy (DBT) in the very specific setting of
the 3East programme at McLean Hospital. This article focuses on the development, rationale, interventions, evolution and benefits of these groups.
One of the many specialized programmes that McLean offers is their 3East
adolescent, all female, residential treatment programme that is a premier,
highly specialized, self-funded treatment program for individuals who are
exhibiting self-endangering behaviours and emerging borderline personality traits that may present as depression, anxiety, impulsivity, eating disorders, substance use disorder, post-traumatic stress or self-injury (McLean
Hospital 2011). This means that the young women we work with are between
the ages of 14 and 21, often from financially privileged backgrounds, and in
addition to presenting with the issues stated, often are admitted to 3East postsuicide attempt or during an ongoing period of suicide ideation.
Treatment at 3East is adapted from the DBT model designed by Marsha
Linehan, which will be further explained in the rationale section below. This
treatment model structures individual therapy and group work around the
patients need for skills acquisition and integration into daily life in order
to manage symptoms, cope effectively and lessen emotional vulnerability. 3East has a continuum of care, and patients begin their journey on the
Intensive unit, an eight-bed, four-week, residential programme focused on
skills acquisition, combining time learning DBT skills in a classroom setting
and in clinician-led groups during the day, and providing continued structure and DBT skills coaching in the evenings and weekends. Some patients
choose to extend their treatment after completing the Intensive programme,
and move to the longer-term, five-bed Step-down unit. Patients on the Stepdown focus more on skills integration, working on independently applying
their work from Intensive into daily life as they begin to build a life worth
living (Dimeff and Koerner 2007: 38). At this time, many patients transition to
the DBT partial hospitalization programme. This is the only part of the 3East
continuum of care that includes both male and female patients, drawing both
from 3East as well as from states throughout the country. If deemed appropriate, 3East patients from the Step-down unit may also attend the therapeutic,
accredited, Arlington High School located on campus. The 3East continuum

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The union of the expressive arts and Dialectical

of care also offers a transitional living programme called Mill St. Lodge for
patients who will be attending Arlington High School for a minimum of 90
days, and will benefit from continued therapeutic support towards building
independence offered in a lower level of care.
From the moment we began working as residential counsellors at 3East
in 2009, we knew we wanted to share the expressive arts foundations; we
both have, and also recognized, the potential benefit to the patients in providing an arts-based approach to learning and personalizing the skills learned
in DBT treatment. We were presented with the opportunity to do so and we
jumped at the chance, diving into the process of becoming co-creators and
co-facilitators of expressive arts groups that have now been established for
two years.
This process has been, and continues to be, one of constant reevaluation
and reflection. As facilitators, the journey in leading these groups has been a
huge growing experience, much like the process we see our patients go through
each week. Our mission was to enhance the DBT treatment by providing
residents with an opportunity to deepen their exploration of the DBT skills
learned in the classroom through the use of arts materials and open-ended
prompts, allowing them to depict the DBT material in a personally meaningful
way. This approach, we felt, would provide a visual guide to their learning
that could be accessed in times of need, further strengthening the overall
goal of independent skills use. We spent a summer in preparation developing
interventions, doing research and working to capture the DBT model in an
arts-based setting. We hope that by sharing our experience of these groups,
and the many manifestations they have taken, we will encourage a dialogue
on the potential benefits of dove-tailing expressive arts therapy and DBT
treatment.

RATIONALE UNDERLYING THE USE OF DBT AT 3EAST

Although DBT is a relatively new treatment developed in the 1980s, it holds
aspects in common with earlier treatment models such as psychodynamic,
paradoxical and strategic approaches (Dimeff and Koerner 2007). It also
directly incorporates components of Cognitive Behavioural Therapy (CBT)
such as problem solving. What sets DBT apart from these approaches is the
application of behavioural science, mindfulness, and dialectical philosophy
(Dimeff and Koerner 2007: 2) as well as the use of continuous validation of a
clients adaptive behaviours and responses.
In addition, DBT has been shown to be particularly effective among adults
with emotional instability leading to maladaptive behaviours, and evidence
supports its efficacy with an adolescent population (Salsman and Arthur 2011).
As Linehan describes, DBT is designed to be able to address multiple issues
at once, whereas other treatments developed for the treatment of adolescents
focus on one issue at a time, and often suicidal adolescents are screened out of
outpatient therapy entirely. DBT includes multiple facets of treatment including family therapy and access to phone-based skills coaching for both patient
and family. Additionally, adolescents often resort to monosyllabic responses
to questions along with other behaviours that can potentially bring a session
to a halt or otherwise interfere with the therapeutic rapport. DBT is unique in
its attention to such therapy interfering behaviours, ensuring that a therapist and client cannot overlook these behaviours when they arise (Miller et al.
2007: 37).

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The premise of DBT is a biosocial theory of development that acknowledges the reciprocity between a predisposition to high emotional reactivity
and a slow return to baseline due to the effects of an invalidating environment
combined with genetic predisposition as well as temperament (Aguirre 2007).
The patients desire to change coupled with her responsibility towards her
own situation is balanced with non-judgemental acceptance that assumes
patients are always doing the best they can (Linehan 1993: 106).
In order to help the patient achieve the change that will enable them to live
a life worth living (Dimeff and Koerner 2007: 38), DBT focuses on the acquisition and generalization of skills in four primary modules, Mindfulness, Distress
Tolerance, Emotion Regulation and Interpersonal Effectiveness. This happens
through repeated coaching and implementation of DBT skills in daily life, therapeutic challenging of cognitive distortions and ongoing validation. The first
module is Mindfulness, which is capacity to focus ones attention and to have a
broad enough perspective to take in new information (Hollander 2008: 82 original emphasis). Mindfulness can be seen throughout all the modules, though it
is taught on its own as well. Distress Tolerance, the second module, is focused
on teaching ways of enduring negative emotions or situations when change is
not possible, or healthy. Third, Emotion Regulation skills teach ways of changing the overwhelming emotional states into manageable levels of emotions.
Lastly, Interpersonal Effectiveness skills centre around ways of talking, asking,
interacting and maintaining relationships with others in an effective manner,
which is something that many people with Borderline Personality Disorder
have difficulty doing. These four primary modules are taught and supported by
additional modules of CBT and problem-solving. These focus, respectively, on
challenging thoughts and beliefs and providing a practical breakdown on how
to effectively approach a problem; a skill many residents never learned.
Thinking dialectically, which is the idea that contradictory truths do not
necessarily cancel each other out or dominate each other, but stand side by
side, inviting participation and experimentation (Miller et al. 2007: 39) carries
through all of these modules. One way in which this is particularly clear is
through Linehans assumption regarding the fact that while patients may not
be entirely responsible for their current situation it is their responsibility to
help themselves out of it (1993: 107).

RATIONALE FOR EXPRESSIVE ARTS AT 3EAST

Rigidity in thinking and the combination of both high intensity of emotional
experiencing as well as the restricted range of emotions often hinders the
ability of 3East residents to flexibly respond to the unpredictability of life.
Malchiodi suggests that Creative interventions serve as a catalyst for individuals to explore thoughts, feelings, memories and perceptions through visual,
tactile, olfactory, and auditory experiences (2008: 15), which indicates the
usefulness of the arts in expanding emotional experiencing. The use of materials such as glitter that often elicit joy as well as the freedom to make artistic
choices is considered a form of play. To play is to free ourselves from arbitrary restrictions and expand our field of action (Nachmanovitch 1990: 43).
As a result, the fact that play is an inherent part of the creative process made
the prospect of combining an expressive arts approach with DBT treatment
appear particularly relevant (Nachmanovitch 1990).
As we got to know the various residents through their time at 3East,
we noticed that each of the residents were creative in their own way. Some

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expressed themselves musically, some through visual arts and some enjoyed
writing. Despite their creativity, we observed that confidence, or Mastery,
as it is called under the Emotion Regulation Module, appeared to be something with which many of the residents struggle. Moon suggests that Artistic
endeavors involve the complex procedures of identification, imaginative
interpretation, integration of, and reformation of, the elements of existence (1998: 5). This concept coupled with our observations led us to wonder
whether an expressive arts-based group would help promote such confidence
and mastery.
We believed that creating an arts-based group framework would
help kinaesthetic and tactile learners to integrate the classroom work in a
physical format, as well as provide patients with another avenue to practice
non-judgemental expression. Furthermore, just as Huckvale and Learmonth
state, It is the synergistic and catalytic processes between art, learning and
therapeutic understandings that (2009: 62) offers a unique vehicle for change.
We also hoped to create a space focusing on what works versus what
has gone wrong. According to Knill et al. to come from a resource-based
perspective adds to the broadening of narrow thinking in the helpless situation (2005: 157). Beyond this we recognized the beneficial effects of using the
arts in a therapeutic context as well as personal practice. Having the ability to
frame clinical material in a personal and creative way offers an opportunity
for self-validation as well as the development of identity through the creation of personal imagery. As Malchiodi emphasizes, Self-expression is used
as a container for feelings and perceptions that may deepen into greater selfunderstanding or may be transformed, resulting in emotional reparation,
resolution of conflicts, and a sense of well-being (2005: 9).
Having identified the clinical rationale for the creation of our groups we
set out to define the general goals. Foremost, we wished to provide a safe
space for residents to explore personal imagery. We also wanted the groups
to provide them with a physical reminder of their journey, as well as a visual
guide to DBT, as a reference to go back to as needed. We felt that the use of
a visual format (such as a journal) would lend itself to each resident personalizing the material to fit her own individual style and frame of reference.

FORMAT/STRUCTURE
Initially, when we began facilitating groups, our format was twice weekly
hour-long groups for the Intensive unit and the same for the Step-down unit.
The admission and discharge dates for residents vary, and residents are part of
each group for their duration of stay. Therefore, we do not use a set progression of interventions, but choose based on the current clinical needs. However,
the curriculums between the Intensive and Step-down groups differ.
All of the groups follow the same basic structure; we begin every group
with materials set-up and background music selection. This decision is based
on the residents energy levels and ability to focus. We also consider the days
prompt and whether or not we want to foster individual focus or collaboration
amongst group members. We describe the clinical topic and explain the
specific prompt allowing time for discussion. We share with the group our
examples to clarify and concretize the verbal description. From this point the
group members work on the prompt for approximately 35 minutes. We then
give a verbal warning that clean up will begin in ten minutes and invite those
willing to share what they created with the group. In the last five minutes

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we ask the residents to clean up their space officially ending the group by
thanking each girl for her presence and participation.
On the Intensive, one night per week was spent working in their visual
journal, and the second evening focused on self-esteem. The self-esteem
projects were created over a longer-term basis, whereas, the visual journaling prompts could be completed in the one-hour group duration. One of the
initial journal-based interventions was to prompt the patients to use imagery
and collage to create a page that represents the idea of a mini-vacation,
using scrapbook paper, magazines, chalk and oil pastels. This prompt comes
directly from Linehans Distress Tolerance module, and often is used as a
mindfulness exercise. The residents may choose locations such as a beach,
a lake, grandmas house or even simply their own bedroom. The place they
depict is to feel safe and comforting, and be an image that they can go back
to in times of emotional duress. One of the self-esteem focused interventions
was to use a hollow wooden book to create my story book. We encouraged
the residents to decorate the outside to reflect who they are in that moment
through the use of colours, words and images. The materials for this include
paint, markers, magazines and three-dimensional objects like plastic jewels
and foam letters. We then invite them to create images or objects to represent significant events, achievements or people in their lives to store inside.
This is done using scrapbook paper, magazines, tissue paper, foam cut-outs
as well as personal photographs they may have with them. Over time, the
intention is that the book would become a reflection of what is important
to each patient and how she has grown and changed over time, building a
sense of identity.
The Step-down groups were focused on the integration of DBT skills into
daily life. The Monday night group focused on using expressive arts to help
patients learn to structure their time and balance needs and wants. The format
was a goals-based group, where patients set weekly intentions and then
assessed the steps needed to achieve the goal. These topics were explored via
both writing and the use of imagery. For example, we invited the residents to
represent their typical day working left to right on paper using colour and line.
We asked them to focus on identifying parts of their day that feel structured
versus unstructured, and recreational versus academic. The primary materials for this were paper and markers. The second Step-down group expanded
upon the journals begun during the Intensive unit groups. The interventions
at times focused on DBT and at times focused on self-esteem. An example
of one of these interventions was asking each resident to create a collage of
images and colours that represent their inner wise women. We invite the
residents to think of women they admire and the qualities that inspire their
admiration, and challenge them to think about how they might embody these
qualities themselves. We have them write for ten minutes, then transition to
representing those qualities they have chosen using magazines, markers and
pastels. This relates to the concept of Wise Mind, which is the synthesis of
rational and emotional thoughts resulting in a balanced thought process. This
intervention relates to the Mindfulness module.

EVOLUTION
Over time, both the content and structure of the groups took on multiple incarnations, including intentional changes in physical location. We noticed that by
holding groups in the unit activity rooms, the patients struggled to separate

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group time from social time. In response to this, we temporarily moved groups
to a space off the unit. This move, combined with a natural shift in culture
due to new patients arriving and being oriented to art groups as a part of core
programming, enabled our time to become more focused. It was also determined that the groups would be most effective if held earlier in the day. Due to
the valid concern that by meeting later in the evening; difficult emotions were
stirred up too near to bedtime. In moving the groups earlier, we encountered
our own scheduling conflicts and therefore had to reduce frequency of groups
from twice weekly to once eliminating the Step-down units goals group and
fusing the self-esteem and journal-based groups on the Intensive unit. Due to
the logistical needs brought about by the resulting time changes, the groups
were moved back to the unit activity rooms, so far with little issue.
We have also changed many of the interventions over the course of
the past two years, eliminating ones that were not well received, or proved
impractical. New interventions were added to address areas we felt were
lacking, including ones with seasonal themes, such as growing trees for the
spring where the prompt invites residents to depict the new growth of spring
in the form of their goals, skills they want to expand on and new beginnings.
We invite them to create a list and then choose how to represent that list in
colour and image. The materials provided are scrapbook paper, markers and
tissue paper. Another example of a new intervention consists of inviting residents to think of ten mantras they want to be mindful of in their everyday life
that focus on balancing acceptance and change. We invite them to create a
list of mantras that includes both word and image and to decorate the page in
a way that will attract them if hung on the wall. Materials provided are scrapbook paper, markers, glitter glue, plastic jewels and ribbon. The hope for this
exercise is to encourage the residents to be gentle with themselves when
thinking of their longer-term goals, and also to think dialectically. Instead of
concentrating on absolutes such as get eight hours of sleep and then feeling
shame or failure if it does not happen, residents are supported in a mantra
of be mindful of sleep. This new intervention also supports self-validation,
a principle that is important to treatment, but something with which the
residents struggle.

OBSERVATIONS
In the course of the past two years, we have made many notable observations. The reactions to the simple existence of groups have changed over time.
Initially not only were the groups a new addition to the schedule, but stepping into the role of group facilitators on 3East was new to us, the rest of the
staff and also the residents. Also, we have also observed that there have been
three primary categories that the residents fall into in terms of their individual
reactions to group and how they are able to utilize the time as a therapeutic
opportunity. We observed that there are the girls who come into the group
with intense anxiety and fear related to perfectionism that presents as an
initial refusal to participate. Then there are the girls who come into the group
excited to have a creative outlet who are therefore grateful to have this space.
Finally, there are the girls who come into the group with few expectations,
manageable, perfectionism and an effective level of willingness if not direct
interest. In all three of these categories we see a mix of girls who have had
experience in the arts, those who insist they are not at all creative and those
who fall somewhere in between.

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Initially, as we took on the role of group facilitators, there was some

uncertainty among the residents around mandatory participation. Naturally
it took time for both staff and clinicians to consistently hold the existence and
timing of group in their minds when speaking to residents about programme
expectations and when planning off unit passes. Despite the fact that groups
are introduced as mandatory, in the face of this natural learning curve on the
part of staff, added with the feelings of fear and anger that arise in the face
of something new, we experienced a certain amount of push back. This took
the form of group refusal, at times by multiple girls; comments directed to us
about the uselessness of group; a high level of distractibility during group; and
also attempts at negotiating, such as asking to come to only part of group or
to do an activity of their choosing rather than the prompt for the day. This
push back behaviour decreased, as groups became a defined part of the
3East schedule and culture.
For some residents we noticed a heightened struggle with perfectionism,
amounting to agitation, frustration and sometimes an inability to begin the
evenings prompt. We noticed with these residents that even choosing the
colour for a background sheet of paper was overwhelming. For these patients
we worked in a directive fashion helping them to break the project into small
steps and offering and modelling the use of cheerleading statements, which
are part of the Distress Tolerance module. A fear of mistakes was so strong,
one resident initially refused to touch her blank sketchbook. With time and
assistance, she began to cut out images from magazines, and eventually glued
down one image each week just prior to the end of group. Over time, she
began to add multiple images to the same page. We also modelled and talked
residents through experiences of mistakes using them as opportunities to
practice self-validation and to recognize that each time we attempt something
new and do not reach our original concept of success, we have either opened
ourselves to a new definition of success or at the least we have uncovered new
information about what does not work, therefore bringing us closer to what
does work.
This has particular relevance for one longer-term resident who has struggled with perfectionism, leading her to avoidance when she feels the results
will not meet the standards she has set for herself. As she has gone through
the continuum of care and began to take on a more active role in her recovery,
she has begun to orient some of the newer residents to group, sharing her
experience as an example of how to make use of the group. One evening as
she was helping to explain the intention of these creative arts groups, she said
that this was a place in which she was able to practice and accept letting go of
her need for perfectionism. Many girls in the room that evening related to her
sentiment and acknowledged feeling the same way.
Other residents are excited for group, greeting us with smiles and energy,
asking multiple times what we will be doing in group that day. These girls
often jump right into the task at hand and have little to no trouble staying fully
engaged through the hour-long session. These patients appeared to continue
developing mastery, sometimes learning to branch out to use new mediums.
Based upon our observations of the images, some of these girls chose to display
on the walls of their bedrooms, it appears, that they not only completed the
prompts, but that the images they created held personal meaning.
It appears that the groups have value, even amongst the residents who
entered the group without excitement or expectations, or with what seemed
to be a (paralyzing) fear. One former resident used to roll her eyes when we

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entered the room, claiming not to have any artistic ability and often chose
to write about the prompt rather than use imagery. She began to share
her writing and sense of humour with peers, and found social connection for the first time since hospitalization. Despite her resistance, group
assisted her in increasing self-esteem and decreasing isolation. Often residents share pleasant memories from their life, through the images created
in group and smile as they recall the creation process. We see them exploring self-identity in the creation of a collage that completes the statements
I am and I like ; and connect with peers over their similarities.
Based upon our observations, and direct requests for second and third journals, some residents used the art journals between groups as their primary
method of distress tolerance, or as a regular means of building mastery or
cultivating pleasant activities.

MOVING FORWARD
Over the last two years, our expressive arts groups have become a fixture on
3East. We feel that these groups have had a positive impact on the unit as a
whole by providing a safe, creative space for the girls to work in while they are
patients in the programme, and valuable skills to build on post-discharge. This
can be seen through an example from a Step-down group, where a resident
approached us prior to the start of group, advocating for a prompt addressing
anger she had been experiencing throughout the day. She expressed that she
often used group as an outlet, and wanted help changing her emotion. We
suggested she depict holding on to anger on one page, and letting go of anger
on the opposite one, with a focus on colours, lines and texture. Afterward she
stated she felt better and her body language appeared more relaxed. This is an
intervention she can repeat on her own, post-treatment.
One of the Emotion Regulation module skills is to build mastery,
which means to increase confidence through activities that are pleasurable.
Participating in expressive arts groups has helped the residents build mastery
of creativity and expression. One girl struggled with avoidance and often
refused to leave her bed for groups. It would take her up to 30 minutes to join
the group but once engaged, she would often beg us to leave the supplies out
for her over the weekend. She began to finish the prompts on her own time,
and do a lot of creative work in free time as well, coming to us excitedly to
show us how she had found distress tolerance in glitter-glue and paint. Since
discharge, she has come back to visit, and both shown and discussed the use
of her sketchbook on an ongoing basis.
The limitations of groups at 3East include elements of time, space, storage, and on occasion, materials. While it is understandable and pragmatic to
structure groups the way we do at present, the benefit would be significantly
increased if we could return to twice-weekly groups. Space is still limited,
leaving us to spend time running around a bit more than is ideal, though a
very easily solvable dilemma. While we receive feedback from the patients on
a consistent basis, it is often mood dependent and fluctuating. Therefore it
would be helpful in the future to solicit staff and therapists to help us evaluate
how we may continue to evolve. We would also like to examine how it could
be possible to bring in image-based interventions exploring what does not
work (such as target behaviours and other maladaptive strategies) in a group
setting without such a focus becoming reinforcing of such a behaviour or
becoming triggering to other group members.

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We would also like an opportunity to explore the possibility of expanding these groups to both the partial hospitalization programme and the
group home components of 3East. The format of groups would be based on
the needs of the individual programmes, such as how to effectively incorporate the treatment goals of both day treatment patients and residential level
patients into one group. For ourselves as facilitators we hope to continue to
engage senior members of both the DBT and expressive arts communities
in dialogue in an effort to develop our own skills as well as to continue to
develop the questions that must be asked and answered in order to effectively wed these two therapeutic approaches. On a global level, by continuing these groups at McLean, we can hopefully provide support for the use
of expressive arts with adolescents struggling with Borderline Personality
Disorder, as well as for Linehans DBT model being adapted to an artistic
model for supplemental use. There is very little published about the efficacy
of these interventions, and not enough about the fusion between expressive therapies in specific therapy models overall. Expressive arts by the very
nature of the creative process it involves, is often seen as not easily lending itself to quantitative research. Perhaps through careful recording of our
interventions, the supplies used and the words we use to introduce them,
we could begin to address this issue and perhaps inspire interest in pursuing
qualitative research.

CONCLUSION
We have learned a lot from the process of creating and implementing the
expressive arts groups on 3East over the past two years. It has been a trial
and error process as we met both logistical and clinical delays ranging
from group structure and location to adapting and crafting interventions.
We spent many weeks researching, developing and preparing demonstrations of interventions to ensure their efficacy prior to presenting them to
the residents. While we both brought prior clinical experience to our work,
we learned new ways of adapting our knowledge and expanded it greatly
as we researched and applied new ideas. Through our observations of the
patients we learned not only about DBT and deepened our knowledge of
expressive arts in a therapeutic setting, but received feedback about our own
personal styles as co-facilitators. We have observed many positive changes
in the residents over the course of groups thus far, indicating a level of effectiveness of our work as well as supporting the potential benefits of the fusion
between the expressive arts and DBT. In sharing this process, our hope is
that the conversation both here at the 3East continuum of care as well as
among the larger mental health community continues, perhaps leading to
research. Building on our observations, it seems that a natural next step
would be qualitative research, following patients as they enter an expressive arts-based DBT group through at least six months post discharge. While
we personally have interest in conducting such research at 3East, we also
hope such exploration will take place beyond our four walls. Such qualitative research would garner the information necessary to make quantitative
research possible and perhaps lead to expressive arts-based DBT groups
joining the ranks of evidence-based treatment.
This work has been a source of great joy for us, and a risk we are glad we
chose each and every day, as we continue to receive affirmation that we are
headed in the right direction.

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Knill, P. J., Levine, E. G. and Levine, S. K. (2005), Principles and Practice of
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SUGGESTED CITATION
Lebowitz, E. and Reber, C. (2011), The union of the expressive arts and
Dialectical Behaviour Therapy with adolescents presenting with traits of
Borderline Personality Disorder in a residential setting, Journal of Applied
Arts & Health 2: 3, pp. 335346, doi: 10.1386/jaah.2.3.335_7

CONTRIBUTOR DETAILS
Emily Lebowitz is a Community Residential Counsellor at the 3East continuum of care at Mclean Hospital in Belmont, MA. She is currently completing M.A. in Dance Therapy at Lesley University in Cambridge, MA. Previous
clinical experience includes practicums at McLean SouthEast Adult Psychiatric
Program; an acute inpatient unit for adults 16 and over, as well as McLeans
SAGE Program, an outpatient geriatric treatment programme.
Contact: Mill St Lodge, Mclean Hospital, 115 Mill St., Belmont, MA 02478,
USA.
E-mail: eblebowitz@partners.org
Chandra Reber (M.A.) is Assistant Program Function Manager at Mill St Lodge,
part of the 3East continuum of care at Mclean Hospital in Belmont, MA. She

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Emily Lebowitz | Chandra Reber

earned her M.A. in Counseling Psychology and Expressive Arts Therapy at the
California Institute of Integral Studies in San Francisco, CA. Previous clinical
experience includes practicums at The Pacific Center in Berkeley, CA, which
focuses on providing a range of services to the LGBT community, and at the
Therapeutic Nursery School in Oakland, CA.
Contact: Mill St Lodge, Mclean Hospital, 115 Mill St., Belmont, MA 02478,
USA.
E-mail: creber@partners.org

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