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Mental Disorders

An Interview with Marsha Linehan, Ph.D. on Dialectical Behavior Therapy

David Van Nuys, Ph.D. Updated: Oct 16th 2007

download this podcast read the transcript

Marsha Linehan, Ph.D.In this interview, Dr. Van Nuys talks with Dr. Marsha Linehan, who is widely known as the founder of Dialectical Behavior Therapy (DBT), an empirically validated form of psychotherapy useful for treating people who have borderline personality disorder, suicidal people, and other people who are in severe and chronic psychological pain.

Dialectical Behavior Therapy represents an integration of two traditions: the behavior and cognitive-behavioral therapy tradition which is focused on developing technologies of change, and the mindfulness tradition that comes out of various spiritual practices including Zen Buddhism and contemplative Christian practices. At the start of her career, Dr. Linehan set out to develop a treatment for chronically suicidal patients and found that many of them were so overwhelmed by significant problems that it was not possible to address them all. Instead of focusing solely on how patients could change, what was required was also to help patients to better tolerate their circumstances. She was familiar with Christian contemplative spiritual practices that emphasized surrender to God, but sought out alternative teachers (e.g., a Zen Buddhist and a Benedictine Monk) who could teach her a "technology of acceptance" that would be more free of particular religious overtones. After taking several months to immerse herself in acceptance practices, she began the task of translating them into a lanaguage that behaviorists could accept and DBT was born. Though at first she thought the therapy was for suicidal people, in 1980 when the diagnosis of Borderline Personality Disorder was added to the DSM, she realized that it was really a therapy made for treating BPD and similar sorts of issues.

Though DBT includes meditation-like practices, it is not about meditation, but rather a family of methods that help people to become less judgemental, more in the present moment, and more effective (where effectiveness is more important than being right). An important goal of DBT is to develop patient's wise minds through the teaching of interpersonal skills, emotion regulation skills, mindfulness and acceptance skills, and distress tolerance skills.

The therapy includes the word "dialectical" to emphasize that it is about the synthesis or integration of change and acceptance practices. It is necessary to learn how to accept and tolerate painful circumstance in order to be able to start to change it. Both acceptance and change are necessary components of the therapy and cannot be separated. Radical acceptance is a fundamental tenant of DBT. Through actions as well as words, the therapist conveys radical acceptance of the patient, and helps the patient to learn how to accept him or herself. Radical acceptance is a state where people places and things are accepted without judgement. Radical acceptance of self opens up a space for patients where they can begin to make better decisions about how to go about making their lives more tolerable.

The main change target of Dialectical Behavior Therapy is to help patients stop engaging in life threatening behaviors. If that goal can be achieved, then the focus of the therapy shifts to work on understanding and altering behaviors that interfere with patients' ability to attend and benefit from therapy. This second focus inevitably calls attention to the quality of the relationship between the patient and the therapist.

At this point in time, there are nine major studies demonstrating DBT's effectiveness for treating borderline personality disorder. Current research is looking at ways to identify the truly core components of the therapy so that the therapy process can be simplified. Besides DBT, there are several other promising therapies for treating BPD, including Transferance Focused Therapy, Schema Focused Therapy, and Mentalization Therapy.

Links Relevant To This Podcast:

About Marsha Linehan, Ph.D.

Marsha Linehan, Ph.D.

Marsha Linehan, Ph.D. is a Professor of Psychology, Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Behavioral Research and Therapy Clinics. She is also the author of four books and numerous scientific journal articles. Her primary research is in the application of behavioral models to suicidal behaviors, drug abuse, and borderline personality disorder. She is also working to develop effective models for transferring efficacious treatments from the research academy to the clinical community.

The treatment she has developed combines the technology of change derived from behavioral science with the radical acceptance, or "technology of acceptance," derived from both eastern zen practices and western contemplative spirituality. The practice of mindfulness, willingness, and radical acceptance form an important part of her treatment approach.

Dr Linehan has received many awards recognizing her clinical and research contributions. She is the past-president of the Association for the Advancement of Behavior Therapy, a fellow of the American Psychological Association and the American Psychopathological Association, a diplomat of the American Board of Behavioral Psychology and is currently President, Division 12, Society of Clinical Psychology, American Psychological Association.

    Reader Comments
    Discuss this issue below or in our forums.

    Failure in life is not final - Larry G. - Sep 9th 2010

    I had a very abusive childhood and have tried coping with drugs and alcohol.  Of course this has been unsuccessful  My father is a Psychopath, and mother is a narcissist (harsh terms, but true).  .  I have had my IQ tested and according to the US Army it is over 160.  BUT, I have worked menial jobs and have a lot of personal failure in relationships in my life.  I have been working the DBT treatment for two months and I can see hope for my future.  I am not driving myself crazy with the entire beat myself up stuff and the future is going to be bad.  I will keep with the program.  Only wished I had found it sooner.  I think that God lead me to her treatment.  I have hope in life and have hope especially in Jesus Christ.

    Much thanks Marsha!

    Larry

     

    DBT - - May 21st 2010

    I have been doing Dr. Linehan's DBT program for about 1.5 yrs now.  In addition, I also added some of Cathy Moonshine's DBT ideas with Dr. Linehan's.  Moonshine's explanations are much easier to understand and has activities (crossword puzzles) which helps to learn the skills and concepts.

    DBT is giving me a chance of a decent life - sarah wilson - Apr 24th 2010

    I have just started dbt and already find that it is easing my bpd.  ive had so much therapy...cbt, psycho dynamic...but finally im getting somewhere.  finally ive founda therapist that understands me...finally i think i may lessen and hopef in the end not meet the criteria for bpd...marsha linehan i will b forever in ur debt...id knight u if i cud bless ur wee cotton socks..

    Fianlly exhaling - Priscilla L - Dec 15th 2009

    Just made my 50th b'day.  I self diagnosed my self age 22 with ADHD, felt there was somthing else wrong though. I have been reading on psych stuff all my life cuz I knew something was different.  Never met my biological mom, then, I had no mother idaughter relationship. I knew my was rejection was from the the "womb" .  I did manage to have a deep religious upbringing (good cognitive therapy for the prevention of suicide). AT age 9my situation) dad kicked mein the stomach. My sister's bullied me I was always passive.  I married as a teen looking for love and someone to love.  I did nurture and raised a "Michelle Obama" type dutr who is highly successful and educated. She was my life line.  Just discoverd I was BPD all my life and needed DBT( by the grace of God.) It is true and it works.   I see myself in 85% of the symptoms.   However see no mention of some feeling they may have been initially rejected in womb.  This needs to be considered too.

    I want to attend the institution and program.  I am now officially studying to be a Psychologist or Therapist

    Hope in the darkness - - Sep 15th 2009

    I have BPD. i have been very active all my life, i am in mid thirties. but somehow last 3 years its been a spiral downwords, and i have slowly slowly shut myself from people, friends and have given up work too. i would like to know if there are courses on internet on DBT. so far i have been keeping myself afloat by self help, reading on the internet. Hearing Marsha Linehans interview and appraoch made me feel very hopefull.Thank you.

     

    Thank you - era bradley - Jun 16th 2009

    I am currently in the wellness project. The individual interviewing me has introduced Dr. Marsha's DBT concepts to teach skills to me.  I am impressed.  Also listening to the broadcast I am able to see I fit into this personality disorder.  Thank you.  

    Success Finally !! - Tammy - May 28th 2009

    I would like to start off by saying that I have PTSD (Post Tramadic Stress Disorder) caused from years of abuse by my ex plus childhood sexual abuse.  I do not have Bi Polar.  I have been to many councellers and am very thankful for their help but the thing that has helped me most and quickest is DBT !!!   I understand where I have gone wrong and how to fix it thanks to Marsha's work.  All I have to say is THANK YOU for helping me get my life back.  Life is so much better . Not only for myself but for all of my loved one . My two teenagers are very thankful too!!

    it's the therapist NOT the skills book - scientist - May 3rd 2009

    Individualized therapy in DBT has been the reason people get better NOT steadfastly following every exercise in her training books.Time after time patients remember the side comments when discussion digressed from her cookbook approach.  To think that she developed this approach from 22 very similar patients and 10 got better...well I need a lot more statistical research than that!  Her methods have not well documented and studied.  again, it seems to be the individual threapis-client relationship that works not her manual directed stock exercises. And the comment made that the patient got better after one month and how she loves this woman shows BPD at its best!

    How to approach Marsha Linehan for treatment and guidance - Abdul Karim Shaikh - Mar 27th 2009

    I am a professor in a local college, Hyderabad Sindh, Pakistan. I am through the worst phase of life as the treatment the psychatrist was providing was not working. By chance I went through an article in Times 9/1/09 describing Marsha linehan's theraphy and  conditions of BPD patients. I have started adopting the practice of Zen calm, focusing on my breath and believing the existance of wise mind. Otherwise I would have either suicide or murders. The dialema in my case is that I had gone during childhood through worst periods of family tragedies which I failed to comprehend and am still at odds with life.

    Can you help me to get the proper course for improving my condition.

    Love for Linehan - Pinki Tuscaderro - Mar 17th 2009

    Dr. Marsha Linehan is the best thing to ever happen to the field of psychology.  She is leading a revolution that is saving lives, like my own.  I have BPD, Major Depressive Disorder and Agoraphobia with panic disorder.  I have only been in DBT for one month and have made more progress than, well, this is the only time that psychotherapy has ever been helpful to me and I have been in the system for over half of my life.  The level of insight, patience and purposeful intent she has into the processes of Borderline functioning amazes me. I honestly believe that if it weren't for her work, I would either still be blindly stumbling through the streets & system from one misdiagnosis to another maladaptive coping skill or I'd be dead. Instead, I am a full time college student with honors and am committed to completing DBT Dr. Linehan is a true Healer. 

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