Marsha Linehan: What is Dialectical Behavioral Therapy (DBT)?
Last week the New York Times ran a fascinating piece on Marsha Linehan, Professor of Psychology at the University of Washington and the original developer of Dialectical Behavioral Therapy (DBT), a modification of standard cognitive behavioral therapy (CBT), but including elements of acceptance and mindfulness. Her work has been designed specifically for people who harm themselves, for those diagnosed with borderline personality (BPT), and those who suffer from pervasive suicidal thoughts and/or attempts.
For the first time in her life, the mental health expert disclosed her own story (that we also discussed on the blog yesterday), which involved hospitalization at the age of 17 that lasted longer than two years.
Benedict Carey, author of the interview with Linehan, writes:
No one knows how many people with severe mental illness live what appear to be normal, successful lives, because such people are not in the habit of announcing themselves. They are too busy juggling responsibilities, paying the bills, studying, raising families — all while weathering gusts of dark emotions or delusions that would quickly overwhelm almost anyone else.
Now, an increasing number of them are risking exposure of their secret, saying that the time is right. The nation’s mental health system is a shambles, they say, criminalizing many patients and warehousing some of the most severe in nursing and group homes where they receive care from workers with minimal qualifications.
Moreover, the enduring stigma of mental illness teaches people with such a diagnosis to think of themselves as victims, snuffing out the one thing that can motivate them to find treatment: hope.
“There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life,” said Elyn R. Saks, a professor at the University of Southern California School of Law who chronicles her own struggles with schizophrenia in “The Center Cannot Hold: My Journey Through Madness.” “We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.”
These include medication (usually), therapy (often), a measure of good luck (always) — and, most of all, the inner strength to manage one’s demons, if not banish them. That strength can come from any number of places, these former patients say: love, forgiveness, faith in God, a lifelong friendship.
Linehan developed DBT as a result of her own transformation that occurred in 1967, while she prayed in a small Catholic chapel in Chicago. She describes the moment in a stirring video that accompanies Carey’s interview. In fact, I watched it five times because I was so moved by it. But here’s the abridged version included in the interview:
One night I was kneeling in there, looking up at the cross, and the whole place became gold—and suddenly I felt something coming toward me… It was this shimmering experience, and I just ran back to my room and said, “I love myself.” It was the first time I remembered talking to myself in the first person. I felt transformed.
Linehan, then, takes this “radical acceptance,” as she calls it, and incorporating it into the techniques of cognitive behavioral therapy meant to change the harmful behavior of a self-cutter or a person who battles chronic suicidal ideations. In essence, DBT strives for a balance between acceptance and change, or integrating contradictory philosophies (“you are loved the way you are,” however, “you must strive to change”). I like to think of it as practicing and learning to live the Serenity Prayer: accepting the things we cannot change, finding the courage to change what we can, and using our therapists and guides to help us distinguish between the two.
On the website of Behavioral Tech (Dr. Linehan’s website), I found this helpful description of DBT:
“Dialetics” is a complex concept that has its roots in philosophy and science….[It] involves several assumptions about the nature of reality: 1) everything is connected to everything else; 2) change is constant and inevitable; and 3) opposites can be integrated to form a closer approximating to the truth (which is always evolving).
I was impressed with Linehan’s courage to disclose her story because, just as with Kay Redfield Jamison, I think it is especially difficult for experts in the mental health field to come forward. Ironically, the stigma in academic circles can be especially thick, almost as thick as Hollywood.
So, thank you, Dr. Linehan.
Borchard, T. (2011). Marsha Linehan: What is Dialectical Behavioral Therapy (DBT)?. Psych Central. Retrieved on March 19, 2018, from https://psychcentral.com/blog/marsha-linehan-what-is-dialectical-behavioral-therapy-dbt/