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Problem:
Client appeared shaken and reported having a "really rough week." Client described experiencing intense emotional swings, particularly during relationship stress, leading to impulsive behaviors such as sending multiple texts in moments of distress. 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 expressed feeling out of control and unsure how to stop these behaviors in the moment.
Intervention:
The session was 50 minutes, in-office. Therapist introduced DBT skills, focusing on emotion regulation and distress tolerance. Therapist explained and practiced urge surfing with the client, using visualization and breathing techniques to manage urges. TIP skills (Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation) were also introduced, with specific examples such as using cold water to reset the nervous system. A coping plan was collaboratively developed, outlining steps for managing urges, including noticing the urge, using TIP skills, waiting 20 minutes, and reassessing before acting.
Response:
Client initially expressed skepticism about urge surfing but acknowledged that the concept made sense. Client appeared relieved to have a concrete coping plan and engaged actively in the discussion. Client demonstrated understanding of the skills introduced and showed openness to trying them.
Plan:
Client was assigned homework to practice urge surfing at least once during the week, even with a small urge, and to keep the coping plan accessible on her phone. The therapist plans to check in during the next session to evaluate the effectiveness of these strategies and adjust as needed. Continuation of DBT-based interventions is anticipated.
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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