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Data:
Session duration was 50 minutes, held in-office. Client appeared shaken and reported having a rough week. Client stated, "I keep doing this thing where I'll get upset and then I just start texting like crazy, and then I regret it later." Client described experiencing intense emotional swings, particularly during stressful moments in her relationship, leading to impulsive texting behaviors that she later regrets. Client expressed feeling out of control and uncertain about how to stop these behaviors. Therapist introduced DBT skills, including emotion regulation and distress tolerance. Urge surfing was explained and practiced, focusing on noticing urges, breathing through them, and allowing them to subside without acting. TIP skills (Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation) were also introduced, with examples provided, such as using cold water to reset the nervous system. A coping plan was collaboratively created, outlining steps to manage texting urges: noticing the urge, using TIP skills, waiting 20 minutes, and reassessing. Client appeared relieved to have a concrete strategy to try.
Assessment:
Client is demonstrating awareness of her impulsive texting behaviors and their impact on her relationships. She engaged in practicing new skills during the session and showed initial understanding of their potential benefits. Client appeared skeptical at first but expressed relief and openness to trying the strategies discussed. Progress aligns with treatment goals of improving emotional regulation and reducing impulsive behaviors.
Plan:
Client will practice urge surfing at least once this week, even with minor urges, and will keep her coping plan accessible on her phone. Therapist and client will review the effectiveness of these strategies in the next session. Continuation of DBT-focused interventions is planned to further support emotional regulation and distress tolerance.
Today's session was 50 minutes, in-office. Jenna came in looking pretty shaken up and said she had a really rough week. She said quote 'I keep doing this thing where I'll get upset and then I just start texting like crazy, and then I regret it later' unquote. She described these intense emotional swings, especially when things get stressful in her relationship. She'll feel this huge wave of emotion, and before she knows it, she's sent like ten texts and made everything worse. She said she feels out of control and doesn't know how to stop herself in the moment.
We talked about how DBT skills can really help with this, especially emotion regulation and distress tolerance. I introduced her to urge surfing, the idea that urges are like waves, they build up but they also pass if you can ride them out without acting. We practiced it together, imagining that urge to text and just noticing it, breathing through it, waiting for it to crest and come back down. She seemed skeptical at first but said it made sense.
Oh right, and we also went over TIP skills, Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. I explained how changing her body temperature, like splashing cold water on her face or holding an ice cube, can actually help reset her nervous system when she's in crisis mode. Then we put together a short coping plan for her. We wrote down what she'll do next time she feels that urge, first, notice the urge, second, use TIP skills to bring down the intensity, third, if she still feels like she needs to communicate, wait 20 minutes and then reassess. She seemed relieved to have something concrete to try. Her homework is to practice urge surfing at least once this week, even with a small urge, and to keep that coping plan on her phone so it's right there when she needs it. We'll check in next session to see how it worked.
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