Marsha Linehan session 1 part 1

Summary

This video presents a clinical demonstration of dialectical behavior therapy (DBT) with a client who is struggling with chronic suicidal thoughts, borderline personality disorder, and emotional instability. The therapist, introducing the session, explores the client's chaotic life, emotional struggles, and difficulties in maintaining stable relationships. Through this session, the therapist aims to help the client reduce mood dependency and increase personal control, addressing the underlying emotional challenges. The video serves as a training tool for therapists to observe DBT techniques in real-time as they work with complex, high-risk clients.

Takeaways

• 😀 A DCT is presenting a clinical Grand Rounds series, showcasing unrehearsed therapy sessions to demonstrate treatment approaches for clinical problems.
• 😀 The simulated patients in the video have been prepared to play specific roles to illustrate therapy techniques for particular clinical issues.
• 😀 The therapist shares a personal story about the difficulty of creating video tapes of therapy sessions, specifically due to challenges with actors portraying difficult-to-treat, chronically suicidal patients.
• 😀 The client in the video is a 28-year-old woman with a history of suicide attempts, borderline personality disorder, and possibly schizoaffective disorder, who is being seen for outpatient therapy.
• 😀 The therapist has already seen the client once with her family, who expressed concerns about her suicidal ideation and wondered if inpatient treatment would be necessary.
• 😀 The second session is focused on understanding the client’s problems and building rapport, with an emphasis on the client’s chaotic life and emotional struggles.
• 😀 The client feels her life is out of control, citing a lack of relationships, job instability, and poor finances, with little to show for her efforts to establish stability.
• 😀 The therapist tries to understand the client’s emotional volatility, recognizing that the client’s moods fluctuate and can lead to difficulties in maintaining stable relationships and following through on commitments.
• 😀 The client expresses a desire to change and improve her ability to follow through, acknowledging that her emotional instability has contributed to ongoing problems in her life.
• 😀 The session involves exploring the client’s suicidal ideation in depth, including her recent suicide attempt, and the therapist seeks to understand the emotional triggers that led to the crisis.
• 😀 The therapist emphasizes the difficulty of the therapeutic process but reassures the client that the goal is to help her regain control over her emotions and life, focusing on reducing mood dependency.

Q & A

What is the primary focus of the therapy session in this transcript?

The session focuses on dialectical behavior therapy (DBT) for a client with borderline personality disorder, suicidal tendencies, and other mental health challenges. The therapist aims to explore the client's chaotic life and emotional struggles while providing insight into treatment.

Why is the client feeling disconnected from her life?

The client feels disconnected because she perceives her life as chaotic and out of control. She lacks stable relationships, a job, or financial stability, and feels emotionally unstable, which leads her to believe she doesn't have a life like others.

What does the therapist believe is the primary issue in the client's life?

The therapist identifies that the client’s life is chaotic, largely due to mood dependence, emotional instability, and an inability to follow through on commitments, which exacerbates her feelings of hopelessness and lack of control.

How does the client describe her emotional state and its effect on her behavior?

The client describes being highly emotional and mood-dependent, leading to extreme behavior shifts. She can initially appear in control but quickly loses it when emotions overwhelm her, making it difficult to maintain relationships or responsibilities.

What was the client's response to the therapist asking about suicidal thoughts?

The client acknowledged her suicidal thoughts, explaining that although she's not actively suicidal at the moment, the thoughts are always present and can resurface quickly, especially when her emotions spiral or when life feels unmanageable.

How does the therapist approach the subject of suicide with the client?

The therapist gently probes into the client’s recent suicide attempt, asking about the details of the event and the feelings leading up to it. The goal is to understand the depth of the client’s distress and to assess the level of current risk.

What treatment goals does the therapist outline for the client?

The therapist aims to help the client gain more control over her emotions and life. Key goals include reducing mood dependence, fostering stability, and helping the client follow through on her commitments and goals, ultimately reducing chaos in her life.

Why does the client believe therapy might work with this therapist?

The client believes therapy might work because this therapist is reputed to be an expert in treating individuals with her specific challenges, as her previous therapist had recommended this treatment approach before discontinuing their sessions.

What role does the family play in the therapy process?

The client’s family is highly involved, expressing concern about her suicidal behavior and seeking treatment options for her. They initially brought her to therapy, believing that the therapist could prevent her from harming herself further.

How does the client perceive her family’s reaction to her struggles?

The client feels misunderstood by her family, who often view her emotional struggles as manipulative or self-destructive. She expresses frustration with their lack of empathy, feeling as though they do not understand the intensity of her distress.