Overcoming Therapy-Interfering-Behaviors and Promoting Skills in DBT PE

Middle Path Solutions, PLLC

Key Points

  1. Adriana’s therapy-interfering behaviors, such as session cancellations and shutdowns, were effectively addressed through environmental support, validation, and reinforcing accurate expression.
  2. Increasing social engagement, adjusting family dynamics, and practicing mindfulness to better recognize and manage emotions enhanced Adriana’s quality of life.
  3. A significant setback due to a marital crisis resulted in Adriana recommitting to treatment, demonstrating resilience and readiness to continue with the planned DBT PE approach.
Earn 1 CE Credits

Addressing Therapy-Interfering Behaviors in Adriana’s Treatment

Overcoming Session Cancellation Issues

Adriana faced challenges with therapy attendance due to childcare issues. Solutions included hiring a babysitter for sessions and having a backup plan. This approach proved more reliable than her previous arrangements and helped reduce session cancellations.

Targeting Shutdown Behavior

In sessions, her therapist addressed Adriana’s tendency to shut down by validating her emotional experiences and reinforcing accurate expression. The therapist balanced this by pointing out the unhelpfulness of shutdown behavior and encouraging Adriana to articulate her feelings, especially regarding her mother.

Enhancing Quality of Life Through Behavioral Activation

Expanding Social Engagement

Adriana began engaging in activities outside of therapy to combat her tendency to isolate. This included walks with other mothers and attending a pottery class, shifting her focus from solely child-centered activities to personally enriching ones.

Changes in Family Dynamics

Adriana and Mark worked on validation and dialectics in couples therapy to improve communication. Adriana made significant changes in her approach to parenting, reducing the number of after-school activities for her children and incorporating more unstructured, enjoyable activities like art projects and baking.

Skill Development and Mindfulness Practice

Recognizing and Responding to Emotional Cues

Adriana focused on noticing her emotions rather than avoiding them through medication or sleep. She learned to identify early signs of dissociation and implemented strategies like using ice, hot sauce, or physical activities to counteract these tendencies.

In Vivo Exposure Tasks

The therapist assigned real-life tasks to challenge Adriana’s problematic beliefs, such as leaving dishes undone or not vacuuming, to help her tolerate imperfection.

Setback and Recommitment to Treatment

Crisis Following Marital Disclosure

In May, a crisis emerged when Mark disclosed an emotional and physical affair in couples therapy. Adriana’s acute suicidal response led to a hospital stay. Upon returning, she recommitted to treatment and DBT PE, with a new target start date set for September.

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Overcoming Therapy-Interfering-Behaviors and Promoting Skills in DBT PE