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Problem:
Client appeared frustrated at the start of the session and reported feeling resentment toward people she cares about. Client stated, "I just say yes to everything, and then I'm angry about it later." Client discussed a pattern of people-pleasing in her relationships, including agreeing to things she does not want to do, prioritizing others' needs over her own, and feeling used and exhausted as a result. Client reported this pattern has been affecting her friendships and her relationship with her partner, as the built-up resentment leads to snapping over small issues.
Intervention:
The session lasted 60 minutes and was conducted virtually. The therapist introduced DEAR MAN, a DBT interpersonal effectiveness skill, and broke it down into its components: Describe, Express, Assert, Reinforce, Mindful, Appear confident, and Negotiate. The therapist and client practiced applying DEAR MAN to a real-life situation where the client has been avoiding setting boundaries with a friend who frequently asks her to babysit last minute. Role-playing was used to help the client practice naming the pattern, asserting her needs, and maintaining confident tone and body language. The therapist also guided the client on how to handle potential pushback while staying mindful and avoiding caving to discomfort.
Response:
Client engaged actively in the session and practiced DEAR MAN through role-playing. Initially, the client found the exercise awkward but showed improvement in tone and body language with practice. Client demonstrated understanding of the skill and expressed willingness to apply it in a real-life situation. Progress was made toward the treatment goal of building boundary-setting skills.
Plan:
Client was assigned homework to have the conversation with her friend using DEAR MAN and to document how it goes and how she feels afterward. The next session will include debriefing this experience and continuing to build boundary-setting skills. The treatment plan will focus on further developing interpersonal effectiveness strategies.
We had a 60-minute virtual session today. Maya logged in looking frustrated and said she's been feeling a lot of resentment toward people she cares about. She said quote 'I just say yes to everything, and then I'm angry about it later' unquote. She talked about how she has this pattern of people-pleasing in her close relationships, she'll agree to things she doesn't want to do, she'll put other people's needs first, and then she ends up feeling used and exhausted. She said it's been affecting her friendships and even her relationship with her partner, because the resentment builds up and then she snaps over small things.
We talked about how people-pleasing often comes from a fear of conflict or rejection, but it ends up creating more problems because the resentment doesn't just go away. I introduced DEAR MAN, the DBT interpersonal effectiveness skill. We broke it down, Describe the situation, Express your feelings, Assert what you need, Reinforce the positive outcome, stay Mindful, Appear confident, and Negotiate if needed. We practiced it together with a real situation she's been avoiding, her friend keeps asking her to babysit last minute, and she's been saying yes even though it stresses her out.
We role-played the conversation. She practiced naming the pattern and asking for more notice, explaining that way she could help without feeling overwhelmed. It felt awkward for her at first, but we worked on her tone and body language so she could appear confident even if she didn't feel it inside. We also talked through what might happen if her friend pushes back, and how she could stay mindful and not cave just to avoid discomfort. Her homework is to have that conversation this week using DEAR MAN, and to write down how it goes and how she felt. We'll debrief next session and keep building those boundary-setting skills.
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