You are nearing the end of a long week in your community mental health outpatient counseling practice when your supervisor asks you to squeeze in an intake with an unexpected new client who walked in without an appointment. You go to the waiting room and greet a young man, Jasce, who is clearly anxious and distressed. Upon closing the door to your office, Jasce looks down at the floor and quickly blurts out that he was diagnosed yesterday by his psychiatric medical provider as having Borderline Personality Disorder (BPD). He tells you he was up all night searching the internet for information on BPD and now he feels worse than he did before he received this diagnosis. He said he tried counseling when he was a teenager immediately following a brief hospitalization for an overdose attempt, and he tried counseling again last year when he turned 21 and suicidal thoughts began returning. He mumbles that he only went to a couple of sessions both times because the counselors didn’t “get him.” He raises his head and looks you directly in the eyes with what looks like something between desperation and hopelessness and asks you quietly, “Can you help me?” What do you do and say in response? Use your own words as if you are speaking directly to Jasce. In addition to sharing what you would say in your initial response, please also continue this brief “live” script of how you would explain DBT to this vulnerable individual.
Describe a turning point in Marsha Linehan’s session with her suicidal client where you feel the client began to consider other choices or new perspectives on his situation. Describe what Marsha said or did to elicit this shift and how the client responded. Name and briefly explain which aspect of DBT Marsha was using at this moment.
Now return to your clinical practice client, and share with us how DBT could be used to provide treatment for your client’s primary identified issue and goals. Be specific in describing which aspect of DBT you feel would be most helpful and why. Please include a sample dialogue from a DBT interaction/session with your client as part of your response to this question.
Close your post with a brief critical assessment of DBT. Discuss what you feel is relevant and helpful, what you see as it’s limitations or risks, and how you would rate this approach in relation to strengths-based and culturally sensitive and trauma-informed practice.
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