Marsha Linehan session 1 part 1

a DCT is proud to present the clinical Grand Rounds this series of clinical interviews by skilled therapists was designed to allow the viewer to observe an unrehearsed therapy session the simulated patients in all cases have been prepared to play a specific role and to allow the illustration of the treatment of a particular clinical problem the therapists will be demonstrating their renowned approach to clinical intervention on behalf of a PCT thank you and we hope you enjoy this tape [Music] and let's say that I think she's a great researcher and showed me what warm open-minded person always has fresh eyes for looking at problem [Music] thank you I want to introduce Stacey Joe Welch who for the purposes of today will drop the SHA Welsh and become Stacey my client and the client that we're going to do and I just want to say as I start that as backup just in case this doesn't work I brought a video tape of clients because oh I'm standing near it sorry that was not the place to stand sorry anyway it's a backup I bought videotape because we my group of us have really wanted to make tapes just like today and we went to Norway where they have a troupe of actors known what what they do for a living is that they play the role of mental patients for therapists who are doing training and so they're real expert mental patient actors and actresses and they have a whole thing there where they play the part of people in a symposium on personality disorders so we knew about these actors and so we had agreed that we were going to go and make a series of video tags the whole thing was somewhat of a disaster because it turned out that they could play any patient except a chronically suicidal difficult-to-treat and when I was over there they said all the other therapists making video taste wants the client to cooperate and you don't you keep saying no no our clients would never cooperate like that they said so they don't quite know how to not cooperate so we ended up actually not being able to use any of them so what we're hoping is that by having a graduate student senior graduate student with a lot of experience who has treated to is a research therapist in my clinic and also has launched a million tapes of me that we will do better but we have never done this before so my backup we're gonna do one hour of this my backup is that I do have some videos but it's possible we won't need them but I'm telling you kind of giving you this little disclaimer at the beginning now the client set of problems that we're going to show are what we thought what we try to figure out is what do people really probably want to know how to do that a DBT therapist does and sort of how to show you how to do that so usually the way we roleplay is we have people tell us what it is that their clients are doing that drives them crazy and then we roleplay how to deal with that however and we may do that also I'm just telling you we're gonna be a little on the flexible side here I'm sort of kind of giving you a preamble here but we thought as a starter what we would do is just do a first session now a first session in dialectical behavior therapy is actually four sessions those we consider the first session for since it's usually often you can't actually gets to a first session in the first session so because of that we consider four so this in fact is two instead of one we've already had one session and this is a client based of course on a client that we actually have and this particular client I have seen the client once with the clients family and I saw her with the family and the family came because they wanted me to be sure to know that if I didn't do something she was going to be dead and they wanted to know whether they thought that she we should just send her to an inpatient place for life from their point of view and or was I gonna be able to treat her outpatient because she's so suicidal and I had said I would take her in patient I mean outpatient and we've already had a session she has just been terminated from her previous therapist because she attempted suicide and the therapist just said that was that it's over I'm not treating you anymore I can't handle this you're out and so she was on an inpatient unit got off the inpatient unit and it's now coming to see me we've already had one session but but I've never met with her by herself because she's only had her family there but what I do know is that she meets criteria for borderline personality disorder she likely meets criteria for schizoaffective disorder and various and sundry other disorders typical Beuerlein personality disorder and so we're coming in and this is the second session and I'm gonna have to turn around here to get myself organized so that I'm thinking I'm talking to her not you all so all right now because we also do a lot of role-playing with our clients I'll just set us up like I would with client and group skills training okay so you are and we're in the therapy room right yeah okay and so this is my chair is yours and you've come in did you just come into the room a couple minutes ago okay and the door is noise the door okay so the door to the rooms there I see you've got is it there well we're actually is it oh thank you okay so yeah no I see it okay so through there and are there any windows in the room okay so that's one so listen this is your first to your second session with me alone okay and you were in here before with your family okay and so you're coming in and you've sat down just before we get going in this roleplay kind of why don't you physically try to just experience yourself as you might be feeling if you came into this session okay okay well good to see you you got yourself here and I know last week you were worried that you wouldn't actually get to this session and you kept yourself alive and you told me last week that was going to be hard was it was it hard okay so that's good it's good that you can do hard things so why don't we talk about what I'd like to do today is just talk about kind of what you want to get out of therapy and what you're hoping to get I want to tell you a little bit about what this treatment is and then we kind of have to see whether you know you and I think we can work together where do you think you can work with me I'm pretty sure I can work with you but we don't want to make sure that it's a sort of our goal we'll be there just for me to get a feel for you for you to get a feel for me and understand your problems better and figure out and start figuring out what seemed reasonable okay so tell me what they should consume me sure I'm gonna be dead like they told you last week so and know not to see me I mean I've seen so many therapists and then the last one you know he won't see me anymore you there mm-hmm so you're kind of the end of the road mm-hmm we'll listen as your family right are you gonna be death well I almost died I mean I wasn't I mean it wasn't like playing around no that's what I heard yeah well how are you feeling now you're feeling really suicidal now you are yeah okay okay yeah it's not like I mean there's always there's always like the class you know but it's not always like look I'm right there mm-hmm mm-hmm so not I mean I'm not like there right now but it's like always in the back mm-hmm mm-hmm well listen when I asked you though why you came in you said well your family told me that you were suicidal and in your family did say that because they're very worried you're gonna be dead but but what you didn't say is why you're here are you here just because your family by you in or do you have something that you want out of treatment with me mm-hmm so why how so I mean it's more like how not so you know like like every I mean I don't even know where to start everything is totally screwed up like my I mean I don't have a job I have no money I'm a mess with my finances I don't have anything I mean I have like no friends that are like real left and I'm a relationship I mean I have like nothing in my life is [ __ ] mm-hmm okay so is it feeling like your life is chaotic it's feeling like your life's out of control it sounds chaotic it's what you're wanting me to help you with is to get it to be less chaotic or more in control yeah and I just I mean I just want like what have a light like people talk about though getaway huh I mean and I just don't know if there's like I don't have any way uh-huh well where are you living right now let me I just want to understand this better because I'm not exactly sure what you mean by I don't have a life so when you say you don't have a life you know I realized that you told me how old you were last week but I actually have forgotten can you tell me again how old you are you're 28 okay and you're living are you still living with your family or were you living right now mm-hmm does a friend yeah okay is there a reason why you're not living at home or in an apartment or somewhere else your parents my family like I mean it's just a constant tension constant conflict I mean I don't know if they told you I was a fuse and all that so there's just a lot of stuff just to get me a fix so I'm kind of figure out are you how are you paying for your life where do you have some incoming your parents giving you money are you on SSI or you're working occasionally what are you done I mean they have a lot of money that's why I can't foresee you mm-hmm okay yes that's true I do so okay so so from your point of view part of the problem so when you say you don't have a life what what is it exactly you mean is that that you mean you don't have a stable life that you're not living in the same place all the time or what is it that you don't have how other people have like relationships I don't have anything that's mine mm-hmm-hmm so right now you don't have a job either okay so what do you do during the day alright so you're sort of sleeping and and at night what are you doing okay okay and now I'm forgetting again and I realize we talked about it how much college didn't you start college did you and you didn't finish okay and I'm forgetting the why you didn't finish all right okay so okay so so so do you have any thoughts on what's getting the way of having a life that you want I mean that person to be honest I mean I just it's like I can't it's like I think people need me and they're like oh you know she looks together like she's you know people tell me like I'm smart they tell me like oh you're you know attractive whatever you know and when I first meet people like I can hang now I'm gonna do stuff but then like everything just blows up eventually and like either I keep meeting the wrong kind of people or I'm doing something wrong but nothing like I can't it's like it just it doesn't last something slips so in other words for short periods of time you can sort of live a life that seems sort of organized or in control and then something happens in it and you lose control of it okay it's any part of this would you say have to do with emotions do are you an emotional person yeah okay I'm talking to you I'm fine like another day I could be like your worst and it means you know and then but like I can't I mean I it's not like if I'm trying to do all this [ __ ] it's just it happens and people get really pissed like my family like you heard that and they're like she can do this she just doesn't want to get better it's just wallowing she just us always been this way she's this is that like people just think I just want to be this miserable or I'm like you know making manipulative gestures like all that stuff and it's not true it's like there's two Me's or something for like you know three four or something but like it's not like I'm trying to do this I just so I'm sorry I forgot what can I say we sort of we sort of we sort of went off here okay and I'm just sitting here listening trying to come somewhat figure out kinda organize in my own mind what you're telling me to see if I can be helpful okay so it was useful what you were telling me because it sounds to me like a couple of things are going on one is that you're feeling out of control and another is that sometimes you really look like you're in control okay and then I asked you is that do you think it's emotions and you were telling me how emotional you are okay and so what I'm wondering is do you think you're a mood dependent person you know or your person who does things by the mood you are okay yeah is that something you'd like to change would you like to be less mood dependent why would you like to be life smooth dependent cuz I can't do anything you know I can't keep anything like like I'll come home and like I'm say I'm gonna clean my house like in the driving the frizzy when it's dirty I come home one day and I'm like cleaning in the next day I can't do it like I can't I can't hold everything that's like it slips through every time we're like my relationships like I say like I'm never gonna help anyone again or like I'm not gonna do this thing you know we're like I'm not gonna use coke I'm not gonna do this and like I can and then it's like something happens and I just can't hold things like no people can I can't follow through on anything mm-hmm do you want to be a person who can follow through yeah why I mean don't you think so it'd be a lot easier to be a sort of a mood dependent person who doesn't follow through I mean it I mean it seems a little bit difficult your life that you have no idea mm-hmm well it's not being able to follow through creating problems yeah okay yeah okay so one of the things we're going to work on then would be getting you less mood dependent and a person who can follow through more on your goals okay this is going to be really hard I mean that's a lot of work that is an incredibly difficult problem how do you sure you want to do it basically Marsha and claimers yeah yeah sure this is it for me like like I've seen like 13 therapists I've been ever since my parents found hot in my room when I was like nine years old I've been in therapy you know like I've done everything every single thing there is to do why are you trying to kill and I they say you're like the expert in treating people like me I mean that's what my last therapist said when you kicked me out so I figure I give it one last try and if it doesn't work then that's it you know but okay so so it sounds like you want to change and you're willing to give it another try with me yeah okay and one of the things you want to do is get you a lot I just want to be clear that one of the things you want to do is get your life less chaotic yeah okay let's move dependent you know what I mean by that so yeah yeah yeah I wanna be less okay and more in control okay did it has anyone well I was just getting ready to tell you about the treatment before I ask you about the treatment let me just go back and get a little bit of information okay because the only thing that just happened is you just tried to kill yourself and my understanding was quite serious what can you let's talk about suicidal behavior and how suicidal you are and how suicidal you've been so yes we do sorry so tell me my suicide attempt was from was it an overdose okay and would you overdose on [Music] and how much time at all did you tack I mean I had one of those I got that like huge thing from Costco I mean I think were like I just started taking handfuls handfuls handful okay nice taste a little bit so that like I'm making sure not to vomit it all up mm-hmm and then till I got menu mm-hmm so how did you end up still alive mm-hmm so where'd you do this huh he left to go to work or something I was just like and I already had that stuff like I mean I bought it before cuz I was thinking about it and it just so were you do you think you intended to die I mean I don't know why I'm still alive or something so so I had somebody find you were you expecting somebody to come back so how'd you end up doing this what happened I was just there Siva how totally one it was I like completely [ __ ] up everything is it's just too much like it's hard to explain to people honestly because I don't think people really get it but it's like it's just not bearable mm-hmm so when did the thought of trying to kill yourself out of your mind and what set you to thinking about it you know like four months and I thought things were good and that was wrong yeah so I started thinking about it and I was just I don't know I mean I just was like waiting for the time or the guts to really do it or something so how is it though that so you broke up with the guy how long was it before you tried to kill yourself from when you broke up to when you tried to tell you something a week or a couple of weeks a week a weekend a couple of days okay and when did the first thought in of your mind I mean it's hard to see because like it's always there the winds it's thought in your mind like I'm gonna do it what I realized he was really leaving mm-hmm and when was that we had this really bad fight and he left and then and then and but like I was staying in his place and then he left but I stayed there and then he came back yeah so he came in the room to pack your bags and get out of here I don't want to see you again okay so what was your first response to that I mean like how'd you respond that the first did that psycho thing your mind anything you said or you just say it I mean I meant it to sell kill myself what'd he say what was your response to that how'd you feel our banker would you do

Channel: Damien Thellier

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Id: fJ_l49jHpVc

Length: 26min 13sec (1573 seconds)

Published: Mon Jul 29 2019