So therapy is going well. Maybe you used to be really passive and now you’re standing up for yourself. Maybe you used be afraid to try new things, and now you dive right in.
What I notice about clients who have spent their entire lives hiding and running, is that when they finally stop, there is a bit of a pendulum effect. And I see a lot of these on a lot of levels: intimate relationships, office-sized systems, and societal. The Pendulum Effect is worthy of its own blog post, but for now enjoy this mock case-study.
This client, based on a composite of several people, participated in DBT Interpersonal Effectiveness to increase her assertiveness. She is more confident in herself and no longer feels bad when people are dismissive and this has been really helpful for her in a lot of ways. But she is still having a lot of trouble a lot of trouble getting along with other people, which prevents her from making meaningful connections with people she likes and respects, and also regulating her emotions, which is difficult with lots of conflict and without much social support.
So we started by describing her original strategies, including her emotional responses, that she has used for most of her life. Then, on the right, we described where she is now, both what’s working and what’s not working. Then we had a discussion about how she would like to respond to challenging situations. Thus, we’re able to celebrate the progress that’s made (crucial in therapy) but continue to name important goals. This both validates where she is but allows for the fact that she wants to do still better.
It’s also a good reminder not to stop with initial symptom relief–which is where it’s tempting for many clients and therapists (and insurance providers) to stop. And relief of symptoms is the benchmark of success in studies of evidence-based therapies. But as any good practicing therapist knows, clients don’t just want symptom relief, they want to thrive.