Case Study

Working with Sera

 Background

One of the most challenging clients I have worked with so

far.

Placed in a seclusion within compound due to being 17

years of age - grey area

Termed as “At Risk” HCN (High Complex Needs)

Two support workers were required to be present with
her on a rotation shift (24/7)

Network of support - psychiatrist, psychologist, GP,

social worker, nurse, consumer advisors, occupational
therapist & support workers

My role - Behavioural Therapist (Two sessions a

week) as well as supporting/supervising support
workers involved with day to day care
 Introduction
Presenting Issues
17 years of age

Borderline Personality Disorder

Reckless behaviours - including sexual behaviours

Severe self harm ie making pockets on arm and inserting objects
Fractured familial relationships at early age

Harming support staff

Recurrent Suicidal Gestures i.e restless or bored, especially if they’re alone

Chronic sense of emptiness

Inability to change behaviour despite multiple attempts
Establishing the Therapeutic
Relationship

Challenging - disengagement (one word answers in

the first session)

Accompanied support workers in outings such as

ride to one tree hill, pokeno or mini golfing - at times
to GP

After the 4th meeting, it was agreed that we will have

a one on one session
 Overview of the
Counselling Process
Goal: Target the negative
behaviour patterns

Main therapeutic Approach:

Dialectical Behaviour
Therapy (Linehan. M,
2014)

DBT programs have a

structured protocol to help
de-escalate and manage
emergency situations
 Key Components of Focus

Emotional Regulation
Interpersonal Relationships
- Learning to manage intense
- Mum
emotions.
- Grandparents
- Planning & Structure
- Caregivers
- Exploration of coping tools

Stress Management
- Unpacking of stress, causes, reflection,
processing, effects and consequences

(Klein & Miller, 2011)

Glimpse of a Session

Identify and label

Emotions

Identify Obstacles
to changing
emotions

- Mindfulness to
current emotion
-Taking Opposite
Action
 Supervision & Ethical
Issues
Supervision played a huge role

It helped unpack the series of doubts,

insecurities and a way through

Discussion of ethical issues such as

management plan put in place – risk to client
and staff.
 Outcomes

Sera was moved out of the facility and relocated

to another city to live with her mother.

The therapeutic alliance lasted 3 months.

Sera became more aware of how she could

regulate her emotions and the impact actions
have on others.
 Reflections

Growth as a therapist.

More aware of own insecurities and anxiety

when working with high risk client.

Building of resilience.

Enabled me to reach out more for support

instead of managing it on your own.