Therapy-interfering behaviors

Having just terminated with my only individual client this year, I am reflecting back on our time together. One of the key parts of the DBT framework that we operated under was the idea of therapy-interfering behaviors. In addition to focusing on the client's behavior, DBT requires the counselor to look at their own behavior and see how it interferes with the therapeutic work. Within the setting of the hospital, I found that the structure of the setting also interfered with treatment. Her primary therapist would schedule appointments during her skills group, because she was on the civil side of the hospital and did not know the treatment schedule (or ignored it). My client would often be off of the ward during we had scheduled to meet because the ward had gone outside to enjoy the nice weather. Also, my schedule did not always allow for us to meet, especially on days where I was sick or had to leave work early. On these days, I violated Linehan's mandatory notification for cancelling appointments.

In reflecting back, I also feel a certain sense of loss I hadn't really felt before in working with other clients over the termination of the therapeutic relationship. Perhaps it was that I was more emotionally invested in this relationship because my role was to positively reinforce all of her efforts and to provide an enthusiastically supportive environment for her. I would psych myself up before each meeting, so that even though we were generally going over pretty boring material (interpersonal effectiveness is not the most interesting DBT module), I would present and engaging front for my client to work with. Perhaps it was that this case was the one on which I worked most closely with the administrators and other treatment staff. I was tasked with creating a behavior plan and received supervision from the clinical administrator. Perhaps it was that this was part of a unit-wide program of implementing DBT for the traumatized women on the ward. I guess it was a combination of those factors that left me with more sadness at the end of the therapeutic relationship.