Session overview
- Describe the client’s current emotional state, distress level (SUDS rating), and observations about affect and behaviour.
- Detail events contributing to current issues.
- Document reported high-risk behaviours since last session (self-harm, suicidality, substance use) and relevant diary card data.
Focus areas
- Life-threatening behaviours: Document issues related to suicidal ideation, self-harm, or life-threatening impulsivity.
- Therapy-interfering behaviours: Detail issues related to attendance, engagement, non-collaboration, or avoidance.
- Quality-of-life interfering behaviours: Describe issues related to substance use, interpersonal conflict, or emotional dysregulation.
- Skills acquisition and reinforcement: Document work on mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness, and/or walking the middle path.
Therapeutic interventions
- List specific DBT interventions used in session (validation strategies, dialectical strategies, behaviour chain analysis, commitment strategies, problem-solving, irreverent communication).
- Detail DBT skills reviewed or assigned as homework, with focus on generalisation to daily life.
- Document any contingency management techniques employed.
Client’s responses and insights
- Describe client’s engagement, participation in exercises, and response to interventions.
- Document cognitive shifts, emotional insights, or behavioural changes noted.
- Detail barriers to skill use and problem-solving strategies discussed.
Session outcome and next steps
- Describe progress toward treatment goals including evidence of behavioural change.
- Detail skills to be practiced before next session and assigned diary card focus.
- Document agreed crisis management plans if needed.
- Record the time and date of the next session and anticipated focus areas.
Session overview
Rebecca presented with moderate distress (SUDS 6/10) and visible tension following a conflict with her supervisor at work. She successfully managed self-harm urges using distress tolerance skills. Her diary card showed consistent skill practice on 5/7 days with elevated anxiety and shame on workdays. No self-harm, suicidal ideation, or substance use occurred since the last session.
Focus areas
- Quality-of-life interfering behaviours: Interpersonal effectiveness in professional relationships, particularly managing perceived criticism without emotional escalation.
- Skills acquisition and reinforcement: Implementation of distress tolerance (TIPP, ACCEPTS) and interpersonal effectiveness (DEAR MAN) skills in workplace interactions.
Therapeutic interventions
- Conducted behaviour chain analysis of the workplace conflict, identifying vulnerability factors, prompting event, thoughts, emotions, and subsequent behaviours.
- Reviewed DEAR MAN skill components relevant to workplace communication, with attention to maintaining self-respect while being assertive.
- Reinforced Rebecca’s successful use of distress tolerance skills during urges to self-harm.
Client’s responses and insights
- Rebecca identified a pattern of interpreting neutral feedback as personal criticism connected to her core belief of inadequacy.
- She recognised how her non-verbal behaviour may impact professional interactions, noting “I can see how my body language might make it seem like I’m not confident in my work.”
Session outcome and next steps
- Rebecca demonstrated progress in her ability to observe emotional experiences with less judgment and successfully implemented distress tolerance skills instead of self-harm.
- Agreed for homework to practice DEAR MAN in one workplace interaction and continue diary card completion.
- Reviewed her crisis management plan, reinforcing the use of phone coaching if needed.
- Next session is scheduled for 21/05/2025 at 3:00pm, focusing on interpersonal effectiveness in hierarchical relationships.
