Interview with JoAnn Heap

Q: How do you handle conflict, which is so common, when a client storms out or shuts down? 

A: Focus on the here and now, clients cannot process the past, they also have great difficulty processing past emotions.  Focus on how the client currently feels, where they feel it in their body.  Share with client that it is normal to feel that way, and how they managed that feeling.  Also ask what they could have done differently to manage feelings.  JoAnn reiterated that psychodynamic processing has a place after clients can regulate emotions, not go home and cut or experience suicidal ideation.  DBT provides clients with the tools , skills and knowledge to manage their emotions and struggles in a healthy way, so that they can process painful past events with a therapist who has a psychodynamic approach. 

JoAnn also shared that she shocked her clients, especially her adolescent clients because she “never gave up on them”.  She discussed expressing intense belief that they patient will overcome and acquire skills.  She emphasized that this will always demand patience on the therapist’s end since we tend to so desperately want our clients to magically feel better as quickly as possible. 

Q: How do you promote motivation to help clients stop parasuicidal behavior?

A:  Firgure out what they want.  Maybe they don’t know so she helps them consider common areas of concern like peer or familial relationships.  JoAnn said girls commonly state that they want a boyfriend or an improved relationship with their current boyfriend.  She said she emphasizes that she wants to work on that area of concern with them.  States that DBT is a research proven therapy.  Typically asks a client: Can you see yourself accomplishing your goal while cutting?  Also state- “cutting may scare him”, “Im worried about working with you if you are cutting yourself”, “I would be horrified to lose you”.  “Are you getting what you want now”?  “Have you ever done anything hard? “ If discontinued the use of drugs or alcohol WOW emphasize how difficult you know that must have been and how impressed you are by their strength.  How that strength will help them on this journey. Consider and ask, “What do you think will get in the way of you meeting your goal”  “I have a lot to teach you”. 

EMPHASIZE ITS GOING TO BE HARD

Q:  What are 1 or 2 important lessons you have learned as a DBT therapist? 

A:  Apologizing to the client or patient when you make a mistake.  JoAnn reiterated that she has made many mistakes and that I will make many mistakes too, which will be okay.  Always recognize and apologize for mistakes with clients.  When you are feeling stuck with a patient, when you feel you aren’t helping them or making progress in some way JoAnn emphasized the importance of sharing that feeling with a client as long as you had a plan of attack to solve issue.  She said whether you go home and plan an alternative way to address issue or ask client if it is okay with them to allow a session to be observed by her colleagues and provide suggestions.  She discussed how important staff and supervision consultations were in DBT because this work can be frustrating and clients will disappoint me as a therapist. 

Most difficult part of being a DBT therapist: worrying about clients and their SI.  JoAnn emphasized how easy it is to lose sleep over client’s wellbeing.  She also stated that as a therapist who cares a great deal for her clients, typically “does too much work for their patients”.  This means that we tend to want to see improvement in our clients so bad that we forge ahead or engage in therapy before the client is ready or motivated.  JoAnn said she learned that by telling clients that she does not believe they are ready for therapy, really causes clients to say YES I am lets get started!  Revere psychology is apparently a useful skill for DBT therapists. 

Q: When a client says, “I love you” or “You are the best therapist I have ever had”, how do you address these comments? 

A:  JoAnn said she would validate these feelings and not feel concerned about the client’s boundaries.  She said she would remind client that it is her goal for the client not to need her that they are working together so that the client does not need therapist.  Emphasize the strengths and abilities are already within the client, that the therapist is simply facilitating the process.  She said she would address physical expressions of love but not verbal. 

Case Example Discussion

Pt discuss hurt and disappointment in parent because they were physically, verbally and emotionally abusive to them their entire life.  JoAnn said to focus on describing that. “I think your mom was doing the best she could, but something was missing concerning her ability to appropriately provide care to you.  Your mother lacked the skills, tools, knowledge, or emotional capability to provide you the love and guidance you needed.  Therapy can teach you things that your mother could not.  You are not your mother.” 

Still would like to learn more about boundaries and appropriateness concerning sharing personal examples and stories with clients.  “I would be terrified to lose you if you cut”  It would hurt me deeply if you committed suicide”