Working Toward Psychological Health

Prioritizing treatment goals based on a definition of psychological health.

Posted Jan 10, 2018

 Noah Silliman/Unsplash
Source: Noah Silliman/Unsplash

When working with individuals who have treatment-resistant depression and have an overcontrolled personality style, it’s a challenge to intervene effectively in the multiple symptoms they present. How does the therapist, together with the client, determine the primary goals for successful treatment?

Dr. Tom Lynch spent over 20 years developing Radically Open DBT (RO DBT), an evidence-based treatment for individuals with overcontrolled personality styles. RO DBT therapists work to reduce suffering by developing skills needed to move toward psychological health. Instead of looking for what’s wrong, the RO DBT therapist considers what’s healthy for all of us. In RO DBT, psychological well-being is a guide for treatment interventions.

Individuals with overcontrol have high personal standards and work hard at not appearing deviant. They are pro-social and often contribute to the good of society. Lynch notes that an overcontrolled coping style would include being detail-focused, restrained, perfectionistic, cautious, disciplined, structured, conscientious, reserved, planful, and dutiful. These characteristics are helpful ones in many ways, but their behavior may mask their emotional pain.

Overcontrolled clients do not need to better regulate their emotions, be more planful or try harder to achieve goals. Overcontrolled clients are more likely to benefit from an intervention that teaches them how to actively seek well-being. For well-being to be the guide for treatment, it’s important to define the concept.

Psychological health is theorized in RO DBT to have three core transacting features:

  1.  Receptivity and openness to new experience and disconfirming feedback in order to learn.
  2.  Flexible-control in order to adapt to changing environmental conditions.
  3.  Intimacy and connectedness with at least one other person.

Jessica is a 30-year-old teacher at a high school. She is intellectually above average and is considered quiet and reserved by her colleagues. At school, she interacts with co-workers but knows little about their personal lives. She suffers from chronic and treatment-resistant depression. She lives with her parents and has no friends. In the past two years, she has been hospitalized four times.

Using the model of psychological health, Jessica is limited in each of the three areas.

Receptivity and openness to new experiences and disconfirming feedback in order to learn. Jessica isolates and follows a strict routine each day. She believes that she doesn’t fit in with other people and that they don’t understand her. She has few opportunities to get feedback but when she does she discounts it because she believes she is unique in her struggles. She may end relationships with those who disagree with her.

Flexible-control in order to adapt to changing environmental conditions. Jessica maintains a certain reserve whether at work or in social situations. When she attends faculty get-togethers, she is guarded and stays only as long as she thinks she must. She finds it difficult to relax, chill out, and be playful when it is appropriate to do so.

Jessica can be counted on to get tasks done correctly. She is clear that there are right ways and wrong ways to do tasks and is adamant about the importance of following rules regardless of deadlines. She works hard and is dedicated to her job.

Intimacy and connectedness with at least one other person. Jessica has no one in her life that she experiences as being emotionally close. Her pattern with others is to be quiet and say very little, often responding to questions with just a few sentences. She sees chit-chat, “hanging out,” and goofing off as a waste of time. People describe her as difficult to approach and get to know.

How does a clinician address these goals? One size doesn’t fit all, as Dr. Lynch says. Treatments for those with an undercontrolled personality style focus on increasing self-control while individuals with an overcontrolled personality style need to learn to ease up and relax their self-control.

RO DBT includes careful sequencing of treatment interventions in addition to stylistic strategies and specific skills to address these characteristics of psychological health for those with an overcontrolled personality style. For example, Jessica could benefit from learning why social signaling matters, the art of non-productivity, and how to develop intimate relationships.