[Emotional Regulation, Cutting, and DBT-- A Clinical PsychologySession]
ERIN PARKS: Hello, I'm Erin Parks.I'm a clinical psychologist. [Erin Parks, PhD, UCSD EatingDisorders Treatment and Research Program]I did my clinical internship at the San Francisco VA, whichis a consortium with the University of California SanFrancisco.While there, I received training in evidence-based treatmentsfor trauma, depression, anxiety, and also substance use.Today I'm going to talk with a 17-year-old who'sbeen struggling with emotion dysregulation.
ERIN PARKS [continued]: Her mother has recently noticed that she'sbeen doing some cutting and askedher to come in for treatment.She's not excited about being here.You're going to see one of our first sessions,where we talk about her ambivalenceabout stopping her behaviors, someof her thoughts around her behaviors,and also the emotions that precede her behaviors.
ERIN PARKS [continued]: [Approach to Treatment] [Dialectical BehavioralTraining (DBT) Emotion Regulation] Emotion regulationis one of the four primary skills modules in DBT.[Helps clients recognize and label emotions] It involveshelping individuals recognize and label their emotions.It is also important to teach clientsthat negative emotions are not bad.[Negative emotions are not bad]Anger, anxiety, guilt. They do not need to be avoided,
ERIN PARKS [continued]: and are a normal part of life [Goalis to help clients learn ways to acknowledge their feelingsand let the feelings pass] The goal of emotion regulationis to help clients learn ways to acknowledge their feelings,and then also let the feelings pass,so that their actions aren't controlled by their feelings.For Kelly, her negative emotions aredriving her actions of cutting. [Negative emotionsare driving actions of cutting] Whenshe feels a negative emotion, she'sfound that cutting herself helps to decreasethe intensity of the negative emotion she's experiencing.
ERIN PARKS [continued]: The hope is that, by increasing her awareness and acceptanceof her negative emotions, exploring the ineffectivenessof cutting, and providing her with alternative coping skills,she'll be able to cease her self-harm behaviors.One way that people try to regulate their emotionsis through self-injury, also called self-harm.One of the most common forms of self-harming is cutting.
ERIN PARKS [continued]: Self-harm can also take the form of burning, scratching,hitting, any way of harming one's body.Cutting involves making superficial cutson the person's body.Common areas include the forearms and upper legs.Self-harm can be misinterpreted as a suicide attempt,though people engaging in self-harm reportthat their goal is not to die, rather
ERIN PARKS [continued]: to decrease the intensity of the emotion they are experiencing.[Although dangerous, self harm is often misinterpretedas a suicide attempt]While self-harm is not a suicide attempt,it is very dangerous, as people can accidentallyharm themselves more than they intend.Self-harm or self-injurious behavioris not, in and of itself, a diagnosis.It is a symptom seen in several different disorders.[Self harm or self injurious behavior aloneis not a diagnosis]People who struggle with emotion disregulation, which
ERIN PARKS [continued]: can be seen with diagnoses such as depression, anxiety eatingdisorders, PTSD, and borderline personality disorder, allmay use self-harm behaviors to copewith their distressing emotions.For Kelly, she reports feeling out-of-controland having negative emotions such as anger, anxiety,self-doubt.She worries that she will engage in actions
ERIN PARKS [continued]: that could harm her relationship with her friendsand her boyfriend.And thus, for her, self-harming helpsby reducing the negative emotion she wishes to escape.Throughout our sessions, we will explore the ways that cuttingis both effective, because it reduces her negative emotions,and also ineffective. [Explore effectivenessand ineffectiveness of cutting] For example,leaving scars and being against her values.[Less judgemental toward emotions][Better coping skills]
ERIN PARKS [continued]: And we will help her become less judgmentaltowards her emotions, and also havemore effective coping skills.The modality of treatment that I'm going to be providingis Dialectical Behavioral Therapy, or DBT.It was founded by Marsha Linehan,and two of the core tenants of DBTare, one, the dialectical stance. [Dialectical stance]That means recognizing that two things that are seemingly
ERIN PARKS [continued]: opposite can co-exist.In this case, she can really want to stop self-harming,and she can want to continue to self-harming.There are reasons for both.Another kind of more simplistic example,you can think about, maybe, a sibling or a best friend.Sometimes it helps to think of a sibling,that you really, really love your sibling,
ERIN PARKS [continued]: and you've had moments when you'refighting with your sibling, and you feel feelingsof hate towards your siblings.Both of those things can coexist.So the dialectic is a core tenet of DBT.Another one is the nonjudgmental stance,recognizing that everyone is trying their best.And then the dialectic, they're doingthe best they can, and they have to try and do better.
ERIN PARKS [continued]: [Nonjudgmental stance] So really taking a nonjudgmental stancetowards the individual you're working withand the behaviors that they're presenting.Nothing is all good or all bad.In this session with Kelly, you will see that I talk a lotabout skills in a formal DBT skills group.[Full Dialectical Behavior Therapy (DBT)] In full DBT,there are four modes of treatment.One, structured individual therapy with a focus
ERIN PARKS [continued]: on behaviors. [1.Structured individual therapy] Thisis one session that you're viewing now.Two, weekly DBT skills groups. [2. Weekly DBT skills groups]Three, skills coaching. [3. Skills coaching] To allowskills to generalize across settings,the clients are encouraged to call or text their therapistsfor skills coaching.And lastly, a DBT consultation team,where the DBT therapist meets weekly with her
ERIN PARKS [continued]: peers for support and ongoing learning.I'll just start by introducing myself and telling youa little bit about what we're doing here.I know that you probably have a lot of questions,and then we'll go from there, OK?
ERIN PARKS: So I'm Erin Parks.Call me Erin.I'm a psychologist.
Я беру на себя верхнюю четверть пунктов, вы, Сьюзан, среднюю. Остальные - все, что внизу. Мы ищем различие, выражаемое простым числом. Через несколько секунд всем стало ясно, что эта затея бессмысленна.