The session lasted 50 minutes and took place 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 their relationship, leading to impulsive behaviors such as sending multiple texts and exacerbating conflicts. Client expressed feeling out of control and uncertain about how to manage these impulses. Therapist introduced DBT skills, focusing on emotion regulation and distress tolerance. Urge surfing was explained as a strategy to manage impulses by observing and riding out urges without acting on them. Client practiced urge surfing during the session, imagining the urge to text, and engaged in breathing exercises to notice and tolerate the urge. Client initially expressed skepticism but acknowledged the concept made sense. TIP skills, including Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation, were also introduced, with an emphasis on using cold water or ice to reset the nervous system during moments of crisis. A coping plan was collaboratively developed, outlining steps to notice urges, use TIP skills to reduce intensity, and reassess after waiting 20 minutes if communication still feels necessary. Client appeared relieved to have a structured plan. Homework assigned includes practicing urge surfing at least once during the week, even with minor urges, and keeping the coping plan accessible on their phone. Therapist and client plan to review the effectiveness of these strategies in the next session.
SIMPLE Note Example
DBT Skills Focused
Client learned emotion regulation and distress tolerance skills to manage intense emotional swings and impulsive behaviors.
Generated SIMPLE Note:
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Client Session Summary:
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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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