Dialectical Behavior Therapy (DBT)

Martina Arduini

Emotional regulation skills

The patient is a 25-year-old woman, Elisa, who has been referred to therapy for emotional
regulation problems. She reports feeling overwhelmed by her emotions and having difficulty
managing them in a healthy way. She often experiences intense mood swings and struggles
with self-control. These issues have led to problems in her personal and professional life,
including strained relationships and difficulty keeping a job. The patient reports that she has
always had difficulty regulating her emotions, but her problems have become more
pronounced in recent years. She describes feeling like her emotions are "out of control" and
that she is unable to manage them effectively. She has had several conflicts with friends and
family members, often in response to perceived slights or criticisms. She also reports
difficulty controlling her impulses, including binge eating and overspending.
In one of our session we decide to help Elisa using a metaphore which could represent all
her emotional experience and struggles that she’s going through:
Patient: “I feel too many emotions all together and sometimes it feels like it’s impossible for
me to handle all of them”
Therapist: “Let’s try to represent your emotions as they were waves. Waves are a natural
part of the ocean, and just like our emotions, they can be unpredictable and powerful. When
a wave comes, it can be overwhelming and feel like it's going to knock us down. But if we
learn to ride the wave, we can stay afloat and come out the other side. Similarly, when we
experience strong emotions, it can be tempting to try to push them away or ignore them.
However, this often just makes them stronger and more overwhelming. Instead, by
acknowledging the emotion and learning to "ride the wave," we can develop the skills to
manage it in a healthier way”. This metaphor can be used to teach patients skills like
mindfulness and emotion regulation. For example, when a patient experiences a strong
emotion, they can imagine themselves as a surfer on a wave, acknowledging the power of
the emotion but also remembering that it will eventually pass.
Validating feelings is an important strategy in therapy for building trust and rapport with a
patient, as well as helping them feel understood and heard. Here are some intervetions that
a therapist might do to validate a patient's feelings:
Patient: “I always have intense fights with my parents because they never miss a chance to
criticise me and everything I do, so I get mad and start shouting at them without any control.
I just want them to leave me alone!! Do you get what I’m saying?””
Therapist: “Yes, I can understand your reaction”
Patient: “And everytime my emotions starts taking control of me I start eating a lot. Food
feels like the only way I have to feel some comfort. But I feel so guilty aftewards….”
Therapist: “It takes a lot of courage to open up and share these difficult emotions and
feelings, and I want you to know that I'm here to support you and help you work through
these feelings in a way that feels safe and comfortable for you. Your emotions matter, and
they're an important part of your experience. I want to work with you to help you develop the
tools and strategies you need to manage your emotions in a healthy way, and to help you
feel more in control of your life”
Stylistic strategies are communication techniques that therapists can use to build rapport,
facilitate change, and promote therapeutic goals. Two such strategies are reciprocal
communication and irreverent communication. Let’s see some examples in this case:
-Reciprocal communication:
Client: "I just feel so overwhelmed with everything going on in my life right now."
Therapist: "It sounds like you're dealing with a lot of different stressors at the moment. Can
you tell me more about what's been going on and how it's been affecting you?"
- Irreverent communication
Patient: "Oh and I also broke up with my last boyfriend, but I just can't seem to get over him!
It's been months and I still think about him all the time."
Therapist: "Well, I'm no magician, but if I had a wand, I'd wave it and make your ex disappear
faster than you can say 'abracadabra'! But unfortunately, we can't control our thoughts or
feelings, as much as we might want to. Let's explore some strategies for managing these
thoughts and feelings in a way that feels empowering and helps you move forward."