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.