Wavefront DBT Program

Wavefront Program

The Wavefront DBT Clinic is a clinical program within the Division of Child and Adolescent Psychiatry that targets high risk, multi-problem adolescents. We specialize in identifying and treating depression and risky behavior in adolescents, including self-injury, suicidal ideation and suicide attempts, substance use, binging and purging, risky sexual behavior, physical fighting, and other forms of risk-taking.

Marsha Linehan’s initial conceptualization of dialectical behavior therapy (DBT) was developed for adults diagnosed with borderline personality disorder. Our adaptation follows the work of Alec Miller and Jill Rathus, who originally modified DBT for use with adolescents and young adults. Our program targets five areas:

  • Confusion about self
  • Impulsivity
  • Emotional instability
  • Interpersonal problems
  • Parent-teen problems

The treatment has been shown to be effective in treating self-harming adolescents with depression who demonstrate some traits of borderline personality disorder that are beyond that expected of typical adolescent development.

Depression in adolescence is characterized by depressed or irritable mood, changes in appetite and sleep, withdrawal from and loss of interest in usual activities and friends, feelings of hopelessness and worthlessness, agitation and/or fatigue, difficulty concentrating, difficulty making decisions, and suicidal ideation.

Some traits of borderline personality disorder that may be of concern to teens and parents include: unstable sense of self, unstable interpersonal relationships, inappropriate or uncontrollable anger or other emotions, serious mood swings, recurrent self-harm or and/or suicide attempts, chronic feelings of emptiness, and impulsivity that puts the teen at risk.

Teens referred to the Wavefront DBT Clinic typically have many or all of the problems listed above, which can lead to difficulties fulfilling their obligations in school and at home. This perpetuates their negative ideas about themselves.


The Wavefront DBT Clinic is a comprehensive outpatient service intended to reduce self-harming and other dangerous behavior. It consists of four components:

  • Weekly multifamily skills group (24 weeks) - Teens learn skills to help them cope with the five problem areas identified above and to help in decreasing their target behavior (e.g., cutting, purging)
  • Weekly individual therapy - Teens learn to generalize the skills they are learning in group and gain greater insight into the cognitions and vulnerabilities which contribute to their problem behaviors
  • Family therapy - Individual therapists may schedule collateral family sessions as needed
  • Emergency paging system for coaching - Teens are encouraged to contact their therapist for skills coaching before engaging in their target behavior. Parents learn many of the same skills their teen is learning, as well as others to help improve family functioning


The Wavefront DBT Clinic accepts most major insurance plans and we have successfully negotiated single-case agreements with Kaiser. For an appointment, please call (415) 502-1523.

Community collaborations

Our DBT experts provide training and collaborate with many agencies in the Bay Area to increase access for this evidence-based practice:

  • We work closely with the Child, Youth, & Family System of Care in the San Francisco Department of Public Health to implement DBT in the county system. If you currently receive care through San Francisco County (i.e., MediCal, Healthy Families, etc.) and are interested in DBT, please email [email protected].
  • We also consult with our partners at UCSF Benioff Children’s Hospital Oakland. If you are insured under Alameda County MediCal and would like to receive DBT in the East Bay, please call their intake and referral line at (510) 428-8428.
  • We have worked closely with Child and Adolescent Behavioral Health in Contra Costa County since 2011. If you currently receive care through Contra Costa MediCal and are interested in DBT, please contact Teresa Gibson at (925) 521-5764 or Betsy Hanna at (925) 521-5767.

Core faculty and staff

Natalie Todd, Ashley Maliken, Barbara Stuart, Sarah Forsberg, Sabrina Darrow, Esme Shaller, & Auran Piatigorsky

The team at an advanced DBT training, 2016 (left to right): Natalie Todd, PsyD; Ashley Maliken, PhD; Barbara Stuart, PhD; Sarah Forsberg, PsyD; Sabrina Darrow, PhD; Esme Shaller, PhD; and Auran Piatigorsky, PhD.


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