Malik Johnson
Personality: Explosive, Sensitive
Presenting Problem: Emotion dysregulation and shame.
Understanding Emotional Waves
One minute I’m fine, and the next I’m snapping at someone for no reason. Then I hate myself for it.
Session Goal:
Introduce the DBT model and help Malik map emotional patterns.
Milestones:
Emotion tracking and DBT biosocial model introduction
Tips for Therapist:
Validate Malik’s intensity and reactivity. Use a visual map to explain how vulnerability factors + triggers = emotion dysregulation. Introduce the diary card as a tool.
Naming Emotions and Building Awareness
Sometimes I don’t even know what I’m feeling. It’s just this fire in my chest.
Session Goal:
Improve emotional literacy and mindful awareness.
Milestones:
Emotion identification and mindfulness of current emotion
Tips for Therapist:
Introduce the emotion wheel or DBT emotion list. Teach mindfulness skills like ‘observe and describe.’ Practice labeling feelings without judgment.
Reducing Vulnerability with PLEASE Skills
I always blow up more when I haven’t slept or eaten. But I feel like I don’t deserve to take care of myself.
Session Goal:
Link physical vulnerability to emotional reactivity using PLEASE skills.
Milestones:
DBT PLEASE skills for self-regulation
Tips for Therapist:
Collaboratively assess current habits related to sleep, nutrition, substances, and illness. Normalize self-care as foundational to emotion regulation.
Tolerating Distress Without Escalation
When I get mad, I just want to break something. I know it’s wrong, but it’s like a volcano.
Session Goal:
Teach Malik how to get through intense emotion without making it worse.
Milestones:
Distress tolerance (TIP, self-soothe, distraction)
Tips for Therapist:
Introduce the idea that distress tolerance is not about feeling better, but about not making things worse. Practice short-term strategies like temperature change, paced breathing, or grounding.
Interpersonal Conflict and Assertiveness
People always think I’m aggressive when I speak up, so I end up either exploding or staying silent.
Session Goal:
Help Malik communicate needs effectively while reducing relational damage.
Milestones:
DEAR MAN and interpersonal effectiveness
Tips for Therapist:
Teach the DEAR MAN skill. Role-play setting a boundary or expressing a need with calm intensity. Affirm that assertiveness is different from aggression.
Radical Acceptance and Letting Go of Shame
I keep replaying stuff I’ve done wrong. I feel broken. Like I’ll always mess things up.
Session Goal:
Introduce radical acceptance and reduce shame cycles.
Milestones:
Radical acceptance and shame resilience
Tips for Therapist:
Introduce radical acceptance as a tool for letting go of suffering. Reflect on Malik’s progress and shift from self-blame to self-compassion.