The Many Layers of Complexity in DBT: Reconstructing a Crucial Theme in the Therapy of "Jane"

Abstract

This article presents my responses to two Commentaries on my DBT case of "Jane" (Marks, 2022): one by Gillian Galen, Blaise Aguirre, and Julianne Wilner Tirpak (2022); and one by Allison Ruork (2022). While both Commentaries acknowledge that my therapy with Jane was ultimately quite helpful to her, both point to the turbulent and conflictual nature of a substantial portion of our therapeutic relationship. Galen et al. attribute this struggle in part to the DBT equivalent of "countertransference" dynamics in my therapeutic relationship with Jane; and Ruork attributes this struggle in part to my under use of the DBT concept of "secondary targets." I found both of these perspectives very on target, and they stimulated me to reconstruct a crucial theme in the therapy from excerpts of therapy process in sessions 14-24 of my case study of Jane. I end the article by reflecting on the value of writing up systematic case studies with sufficient descriptive clinical detail so that valuable secondary analyses can be conducted, like those by Galen et al., by Ruork, and by me based on the former two.