Inside Eliot’s expanding commitment to Dialectical Behavior Therapy — and what it means for the young people who need it most.
Featuring insights from Kerry Rivard, Director of Evidence-Based Treatment; Jessica Montoya, Director of Clinical Services – CYF Division; Zane FitzGerald, Director of Youth & Family Behavioral Health; Jennifer Dacey, Assistant Director of Clinical Services – CYF Division; Jean Dowling, Clinical Director Carbone Hall – Juvenile Justice; Senna Georges, Team Leader Family-Based Intensive Treatment; Benjamin Hoyt, Clinician Family-Based Intensive Treatment; and Justin Towers, Clinical Program Specialist – CYF Division
There’s a moment Jessica Montoya describes that cleaves to the heart of why and how Eliot applies Dialectical Behavior Therapy (DBT).
A young man at Carbone Hall — one of several Department of Youth Services residential facilities Eliot operates — had a pattern. When emotions overtook him, he’d destroy his room. Lose himself to the surge. Then, one day, he said something different: I’m going to go to the bathroom and take a deep breath.
That was it. That was everything.
“To see that these are the things that are landing,” says Montoya, Director of Clinical Services in Eliot’s Children, Youth & Families Division. “These are the tools, the things that they’re taking with them [when they return to the community].”
It sounds small. It isn’t. For a young person who has spent years in systems that often treat their behavior as their identity rather than a survival response, choosing a breath over chaos is an act of real self-determination. It is the fruit of a deliberate investment Eliot has made in DBT, which is a clinical framework that is reshaping how the organization shows up for some of the most vulnerable young people in Massachusetts.
More Than a Skills Toolkit
DBT was originally developed for adults in suicidal crisis. What clinicians discovered over the following decades is that its core principles translated powerfully to adolescents navigating overwhelming emotions, self-harm, and the disruption of lives shaped by trauma and systems involvement.
At its most visible level, it’s skill-based: young people learn to identify their emotional states, build resilience to distress, and establish more effective relationships. But Kerry Rivard, Eliot’s Director of Evidence-Based Treatment, is quick to point out what gets missed when people reduce DBT just to its skills modules.
The principle biosocial theory that underlies DBT doesn’t posit a young person’s mental and behavioral health struggles as pathology. It frames them as the logical outcome of emotional vulnerability meeting an environment that wasn’t equipped to support it. “Many of the youth who enter one of these programs often feel like there’s something innately wrong with me, or I’m broken,” Rivard says. “[Changing that framing] gives a perspective that hopefully can engage them a little bit more.”
There’s also what DBT calls radical genuineness — the expectation that clinicians show up as full human beings rather than neutral professionals. For youth who have learned, reasonably, to distrust the system, a clinician who is present, sometimes irreverent, and honest about their own reactions can represent something distinct. “Being a real human is really powerful for a lot of these youth,” Rivard says. “They’re used to people who write notes and nod their heads and maintain this professional stance that really gets in the way of seeing them as a human.”
And then there’s the dialectic itself, which is the therapeutic practice and teachable skill of holding two truths at once. When a young person says the system has failed them, a DBT clinician doesn’t argue. They hold it: You’re right. And, how are you going to build a life within the system that exists?
Where DBT Lives at Eliot
In DYS settings, DBT has been the adopted framework across the state for years. What’s shifted is the depth of implementation and the reach.
At Carbone Hall, for example, the work starts at intake. Every new resident is walked through “Wise Mind.” This is a core DBT concept that our clearest decisions come from integrating emotion and reason. DBT groups run twice weekly. Weekly awards recognize young people who demonstrate the skills in real moments. “The more that we talk about it,” clinician Jean Dowling says, “other kids are also trying to get that award.”
For youth further into DYS programming, clinician Jennifer Dacey describes an approach that has become genuinely family-centered. By the time a young person steps back into their community, their family, caseworkers, and DYS district team have all been working from the same vocabulary. A caseworker can ask, in a moment of crisis, what’s the middle path here? — and be understood.
“It’s not just the kiddo anymore,” Dacey says. “It’s the kiddo, the casework team, the family.” A collective approach that reduces feelings of isolation, powerlessness and shame.
The newer edge of Eliot’s DBT investment is in Family-Based Intensive Treatment (FIT) and Community Service Agency (CSA) programs, which are children and youth-centered, home-based services for families whose needs exceed what traditional care can address. FIT clinicians work inside active crises, with a four-to-six month window to provide intensive intervention and help families step down to lower levels of care. Zane FitzGerald, who leads Eliot’s Youth and Family Behavioral Health services, articulates DBT as a natural fit precisely because of that time constraint: it gives clinicians a structured way to engage when emotional dysregulation is the driving concern, without requiring them to first confront a family’s perspective or win an argument about whose reality is correct.
Senna Georges, a FIT clinician, puts the practical value plainly. New clinicians working with complex presentations may be uncertain where to start. DBT’s hierarchy — address life-threatening behavior first, then work systematically down — gives them a roadmap. “It might feel on the day-to-day like we’ve made zero progress,” she says. “But look at the target behavior you identified in the beginning, and look how much progress you’ve made.”
The Investment Behind It
Thirty Eliot clinicians recently completed a five-day intensive foundational DBT training, which typically runs $1,500 per person through standard outsourcing. Rivard negotiated a flat-rate arrangement to make that scale possible. Introductory tracks are being developed for non-clinical staff so everyone shares a common language. And trained clinicians enter an ongoing consultation model with structured peer support built into the treatment framework itself, designed to keep people held in work that demands a great deal from them.
With nearly three decades of professional experience in community-based mental health, Rivard is direct about what she observes across the field: most mental health organizations aren’t making this investment. The infrastructure, the in-house expertise, the cross-program coordination — it isn’t standard practice. Justin Towers, a Clinical Program Specialist working across Eliot’s Department of Children & Families and Juvenile Justice programming, names the dimension that’s hardest to manufacture: the absence of silos. What works in DYS gets examined for DCF. What’s learned in FIT informs broader CSA services. “There’s constant communication across the different compartments of Eliot,” Towers notes. “It’s something that I really appreciate.”
That young man at Carbone Hall who chose a breath over a broken room demonstrated that something in him had shifted, that he had begun, in both a small and significant way, to author his own response to the world.
DBT has a phrase at its center that captures what Eliot is working toward: a life worth living. Not managed behavior. Not categorized pathologies. A life. That’s what’s being built here, one session at a time, in clinics, facilities and family living rooms across Massachusetts.
It’s careful, grounded, person-centered work. It’s care in action.
Eliot Community Human Services is a nonprofit behavioral health organization serving tens of thousands of individuals and families across Massachusetts. This piece is part of Eliot’s Mental Health Awareness Month series.
