Hsin-Yun Chou
Suicide Prevention Center
MacKay Memorial Hospital, Taipei, Taiwan
STUDY OBJECTIVES
Adopting Dialectical Behavior Therapy (DBT) and Somatic Experiencing (SE) treatments to patients with deliberate self-harm behaviors and dissociative symptoms. In this case study, we demonstrate our treatment approaches with two patients.
METHODS & MATERIAL
Two patients were both female, hereinafter referred to as Case A (14 year old) and B (28 year old). Case A was referred from the Emergency department, and Case B was referred from an OPD in a general hospital in Taipei, Taiwan. Prior to treatment, they both had multiple self-harm histories and both have several scars on their arms. Depression severity scores (Patient Health Questionnaire-9, PHQ-9) for the two patients were 23 and 22 which can be classified as having severe depression (scores above 20).
The researcher adopted DBT and SE treatment skills to treat the two patients. DBT informed treatment was used to reduce self-harm frequency, and SE treatment skills to reduce dissociative symptoms within the therapy session. PHQ-9 scores were also taken during the treatment period.
Adopted DBT treatment modes (still ongoing) included individual treatments, group skills training (DBT group, with a total of 16 sessions within 8 weeks for Case A, and one module 8 sessions– Distress Tolerance for Case B), between session coaching and therapist consultations.
In individual treatments, treatment interfering behaviors were frequently shown by the patients, and their attendance rate were poor at the beginning. Patients easily dissociated whenever the researcher conducted chain analysis, especially in step 4 (while describing in excruciating detail the chain of events – feelings and emotions they experienced). After several sessions, the researcher decided to include SE skills to help them to ground and stay in the present moment, in order to get a hold of the patients and to continue with the chain-analysis in session. The researcher applied SE at least 2 times for both patients.
RESULTS
After 34 individual and 16 group sessions for Case A, and 14 individual and 8 group sessions for Case B, their self-harm behaviors have been reduced (twice a week to less than once a week), and treatment interfering behaviors (absence and dissociative symptoms during the therapy session) have also been reduced. However, PHQ-9 scores showed no notable differences for both patients.
CONCLUSION
People who dissociated easily may have suffered from previous long-term trauma, resulting in emotion dysregulation. By combining DBT and SE, we showed that there is hope that we can help patients with deliberate self-harm behaviors and dissociative symptoms by reducing their frequency of such behaviors and symptoms. More future studies are required to draw concrete conclusion.
周昕韻 諮商心理師 