Clinical Focus

  • Dialectical Behavior Therapy
  • Mindfulness
  • Acceptance and Commitment Therapy
  • Trauma
  • Emotion Regulation
  • Adolescents
  • Personality Development
  • Psychology

Academic Appointments

Administrative Appointments

  • Director, Stanford DBT, Stanford University Medical Center (2011 - Present)
  • Clinical Director, Early Life Stress and Pediatric Anxiety Program, Stanford Children's (2012 - Present)
  • Outpatient Assistant Clinical Director, Stanford Children's (2013 - Present)

Professional Education

  • Fellowship:Stanford University School of Medicine (2010) CA
  • Internship:Beth Israel Medical Center - New York (2008) NY
  • Professional Education:Pennsylvania State University - College of Medicine (2008) PA

Research & Scholarship

Current Research and Scholarly Interests

Dr. Zack is involved with ongoing research related to the treatment of adolescent and adult trauma (Trauma Focused Cognitive Behavioral Therapy - TF-CBT; Prolonged Exposure - PE), and the effective provision of Dialectical Behavior Therapy (DBT) to adolescent girls and women with disorder of emotion regulation. She additionally studies Acceptance and Commitment Therapy (ACT) for adolescent girls with anxiety. More broadly she is interested in the impact of Evidenced Based Treatments on improving quality of life, and helping individuals find the right match for clinical care. Research is conducted through the Early Life Stress and Pediatric Anxiety Disorders Program at Stanford Children's Hospital and the Stanford Dialectical Behavior Therapy Program.


Graduate and Fellowship Programs


All Publications

  • Attachment History as a Moderator of the Alliance Outcome Relationship in Adolescents PSYCHOTHERAPY Zack, S. E., Castonguay, L. G., Boswell, J. F., Mcaleavey, A. A., Adelman, R., Kraus, D. R., Pate, G. A. 2015; 52 (2): 258-267


    The role of the alliance in predicting treatment outcome is robust and long established. However, much less attention has been paid to mechanisms of change, including moderators, particularly for youth. This study examined the moderating role of pretreatment adolescent-caregiver attachment and its impact on the working alliance-treatment outcome relationship. One hundred adolescents and young adults with primary substance dependence disorders were treated at a residential facility, with a cognitive-behavioral emphasis. The working alliance and clinical symptoms were measured at regular intervals throughout treatment. A moderator hypothesis was tested using a path analytic approach. Findings suggested that attachment to the primary caregiver moderated the impact of the working alliance on treatment outcome, such that for youth with the poorest attachment history, working alliance had a stronger relationship with outcome. Conversely, for those with the strongest attachment histories, alliance was not a significant predictor of symptom reduction. This finding may help elucidate alliance-related mechanisms of change, lending support for theories of corrective emotional experience as one function of the working alliance in youth psychotherapy.

    View details for DOI 10.1037/a0037727

    View details for Web of Science ID 000354606900016

    View details for PubMedID 25822108

  • Mindfulness Based Interventions for Youth JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY Zack, S., Saekow, J., Kelly, M., Radke, A. 2014; 32 (1): 44-56
  • HELPFUL AND HINDERING EVENTS IN PSYCHOTHERAPY: A PRACTICE RESEARCH NETWORK STUDY PSYCHOTHERAPY Castonguay, L. G., Boswell, J. F., Zack, S. E., Baker, S., Boutselis, M. A., Chiswick, N. R., Damer, D. D., Hemmelstein, N. A., Jackson, J. S., Morford, M., Ragusea, S. A., Roper, J. G., Spayd, C., Weiszer, T., Borkovec, T. D., Holtforth, M. G. 2010; 47 (3): 327-344


    This paper presents the findings of a psychotherapy process study conducted within the Pennsylvania Psychological Association Practice Research Network (PPA-PRN). The investigation was the product of a long-term collaborative effort, both in terms of the study design and implementation, between experienced clinicians of various theoretical orientations and full-time psychotherapy researchers. Based on a relatively large sample of clients seen in independent practice settings, close to 1,500 therapeutic events (described by clients and therapists as being particularly helpful or hindering) were collected. These events were coded by three independent observers using a therapy content analysis system. Among the findings, both clients and therapists perceived the fostering of self-awareness as being particularly helpful. The results also point to the importance of paying careful attention to the therapeutic alliance and other significant interpersonal relationships. The merits and difficulties of conducting scientifically rigorous and clinically relevant studies in naturalistic contexts are also discussed.

    View details for DOI 10.1037/a0021164

    View details for Web of Science ID 000282850000007

    View details for PubMedID 22402090

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