In this session you will be introduced to the DBT case conceptualization. As a result, almost all elements of the biosocial theory (see introductory video) are discussed: behavioral frameworks as an expression of being in a convincing hell or just as arising to prevent/temporarily stop that hell, vulnerability factors, skill deficits and self-invalidation that result of growing up in a disabling environment, and so on. At the end of the conversation, Anne is presented with a choice: if you want a decent life, are you willing to stop the behavior that makes this impossible? Are you willing to stop cutting, drinking, doing drugs? Are you ready to do this right away? Of course, then the doubts set in. Roland will therefore use 'commitment strategies', including shaping, door in the face, foot in the door, mutually, which will help Anne to make room for that doubt and still come to a decision. Throughout the clip you will also see other strategies typical of DBT: prioritizing treatment goals, accurate assessment, generating solutions, surprise exposure, alternating reciprocal responses with confrontation, and keeping the momentum going.

In this session you will be introduced to the structure of individual therapy in DBT. It starts with mindfulness. After that, the agenda is determined based on how someone is there and diary card data. If life-threatening, therapy-impaired, quality-of-life-reducing behavior is involved, a similar chain analysis is performed. In that analysis, vulnerability factors, triggering events, fundamental links, problem behavior and consequences are determined. This makes it clear what the client could do to ensure that 'problem behavior' (in this case pushing away, withdrawing, drinking alcohol) decreases and is replaced by skills (in this case making conscious choices, asking for help, anticipating, distraction, self-consolation). This behavior is immediately practiced and reinforced with coaching feedback. The session with summarizing, making agreements and strengthening commitment. We see many interventions aimed at change. In addition to chain analysis, providing solutions, behavioral exercises, reinforcement and commitment support also provide additional exposure and cognitive modification of the revue. Roland's communication style is direct and at times unorthodox. However, this is balanced with validation, reciprocity and humour. This variety keeps the tension bearable and creates a flow in the session.

In this video you can see the behavior that makes it difficult or impossible, is seen as part of the treatment. It does not lead to a fight or answering statements about the person requesting help. The behavior is framed as an affirmed, useless expression of anger and powerlessness. Validation is the first step in the therapist's approach. Roland gives space to the anger, acknowledges why that interruption is and also takes stock of his own shortcomings. At the same time, he makes it clear what's wrong and keeps reminding Anne of her goals and DBT skills. This requires an immobile centered attitude, and thus humility, acceptance and emotion regulation. In the moments when Roland and Anne "get stuck", he uses the dialectical strategies to help Anne reach the trap: entering the paradox, modeling mental flexibility himself, using metaphors. In addition, you get demonstration of counteracting in anger and facts controlled by fear of abandonment. With the latter you will notice that it is especially important to dare to ask questions.

The rule of thumb in DBT is that after +- 60% of the client's treatment you start preparing for the end of the therapy. There is no step-by-step plan for this, and the preparation involves more than arranging aftercare. Above all, it requires alertness and ‘reading between the lines’. For many clients, the approaching end of intensive immersion therapy evokes intense emotions. And if, like Anne, they have a developmental history that includes mobile relationships with sudden abandonment, then they have developed few skills to deal with that. You can see that Roland responds with care, validates and uses didactic strategies to teach Anne what goodbyes can entail. Meanwhile, radical acceptance and anticipation play a crucial role, and of course a watertight relapse prevention plan.

During this director’s cut of expert’s perspective, Roland Sinnaeve provides you with more insight into his choices as a therapist, illustrated by fragments of pivotal moments in the therapy sessions with Anne.