Marsha Linehan: Dialectical Behavioral Therapy
Marsha's early life
Her treatment included medications and electroconvulsive therapy, which caused memory loss and cognitive issues. At 17, she was locked into an isolated room in the treatment center in response to her self-harm and suicidal behavior. She physically harmed herself and had frequent suicidal thoughts. At the time, treatment centers did not fully understand or research borderline personality disorder, and Marsha suspected she was misdiagnosed with schizophrenia.
While in the treatment center, Marsha believed that she was not getting better, and her symptoms worsened with the treatment she received.
Marsha Linehan’s research on borderline personality disorder and suicidal behavior
She left the institute at 18 and self-diagnosed with borderline personality disorder (BPD) based on her suicidal behaviors and severe emotional dysregulation. She then attended Loyola University in Chicago, where she studied behavioral psychology, graduating in 1968. She continued to finish an MA and a Ph.D. in experimental and social personality psychology, and lectured on behavioral sciences to her clinical community. Her primary research in this field was reducing suicidal behavior, which eventually evolved into her interest in and the eventual creation of the cognitive behavioral treatment known as dialectical behavior therapy (DBT).
Dr. Linehan's career
After graduation, Linehan completed post-doctoral work at The Suicide Prevention and Crisis Service, now known as the 988 Lifeline, while working as an adjunct assistant professor at the University of Buffalo. She finished her post-doctoral studies on behavior modification through Stony Brook University before returning to Loyola University as an assistant professor.
Dr. Linehan's contributions
While there, Dr. Linehan continued to lecture at the Catholic University of America before leaving to join the Psychiatry and Behavior Sciences Department at the University of Washington, where she has worked and produced research on behavioral models for multiple decades. Her distinguished scientific contributions to the field of clinical psychology have had a significant favorable influence on suicidal populations, and two treatment manuals by the American Psychopathological Association.
Dr. Marsha Linehan's awards and accolades
During her career, Dr. Linehan has been awarded several times for her distinguished contributions and research projects developing behavioral research skills training for therapy clinics. Among these awards includes the Lifetime Achievement Award for her work with suicide victims, and the Outstanding Educator Award for Mental Health Education. Much of her studies have made their way into various scientific journals. Her books and publications are focused on her treatment manuals for borderline personality disorder, including the DBT workbook.
What is DBT?
Dialectical behavior therapy is a type of cognitive behavioral therapy (CBT) that is primarily used to treat various personality and mood disorders but can also treat those experiencing destructive behavioral patterns. The DBT workbook involves four modules, which include worksheets and skill suggestions, including the following:
- Mindfulness
- Emotional control
- Distress tolerance
- Interpersonal effectiveness
It teaches individuals to be conscious about their behaviors and recognize their triggers from the events leading up to the behavior, before making a conscious decision about a coping skill. DBT was designed for people who have already tried several treatment methods or skills and aren't seeing results. It focuses on those who experience profound emotions and immense emotional distress.
From borderline personality disorders to mainstream mental health
DBT is a modified form of cognitive-behavioral therapy (CBT) created in the 1980s to help those who were suicidal or living with borderline personality disorder. However, the treatment now supports a wide variety of diagnoses and symptoms. Sessions can be held in group and individual settings and utilize tools like chain analysis and diary cards to track behaviors.
The benefits of DBT
Studies of DBT show it is an effective strategy that offers problem-solving skills, assertiveness training, and healthy behavioral skills. Patients experiencing personality disorders may struggle with interpersonal skills, including setting boundaries. DBT can teach individuals how to set boundaries healthily, improve positive connections, and start healthy conversations.
A key component of dialectical behavior therapy
A few critical acronym skills are taught as well, including:
- FAST: A skill for keeping self-respect in a social situation
- GIVE: A skill for improving healthy relationships
- DEARMAN: A skill for asking for a favor or request from someone else
- TIP: A skill for reducing emotional distress through physical actions
Each skill is taught by the therapist or group provider, and clients will learn how to practice in the session with roleplay and guided exercises. Afterward, they may be prompted to complete homework using the skills they learned in the session. A DBT workbook is a helpful compliment to this therapy, and each client may graduate at the end of their learning process.
Dr. Linehan's personal mental health struggles
Dr. Linehan struggled immensely when she was treated for her mental health conditions, and many who treated her were unsure how she became such a prolific researcher, writer, and therapist. However, Marsha believes her early challenges allowed her to empathize with her patients and those she supports because she has experienced similar symptoms. She has experienced self-harm and suicidality and used skills to combat these experiences.
Some may believe that doctors and therapists who have experienced specific symptoms may be able to understand better how to treat them. Freud and Carl Jung were among the psychologists and theorists who struggled with mental health concerns.
Overcoming mental health disorders with dialectical behavior therapy
Linehan hopes that her mental health struggles and accomplishments may give others hope that it can be possible to make very effective changes and succeed, even with a personality disorder. In 2011, Marsha decided to go public with her past mental health difficulties for the first time. She returned to the Institute of Living, where she was first treated for mental illness, and told her story.
Despite misdiagnosis at a young age, she has become successful and has helped many people learn methods of controlling symptoms. She created a system that worked for her in hopes it would also help others. In this way, she encouraged patients' introspection so that they can advocate for their own treatment needs.
Linehan's "eureka" moment
While Dr. Linehan spent decades studying psychiatry and trying to understand her condition, her "eureka" moment came in 1967 while recovering from a psychiatric episode. After enrolling at Loyola, she tried to reconnect with her Catholic faith and spent much time praying at the chapel there. During one of these praying sessions, she had an experience that left her feeling transformed. While she still struggled with feelings of devastation, especially after a bad romantic breakup, she found that she no longer wanted to engage in self-harm.
Linehan's personal experience and dialectical behavior therapy
On that day, Marsha described experiencing a sense of acceptance of who she was and how she was feeling. Examining her behaviors helped her understand the root of what was causing them. She interpreted that her urge to self-harm related to the fact that the person she wanted to be, and the body she was in, didn't match in her mind, which left her perceiving that she was missing out or failing.
Radical acceptance was a skill she developed and put within DBT to teach others the process of accepting. The basis of radical acceptance was accepting that life can be worth living with emotional pain, and that trying to change what cannot be changed may be more detrimental than accepting that it is challenging.
Marsha Linehan's philosophy on suicidal thoughts and acceptance
She believed that suicidal thoughts often stemmed from a desire for emotional pain to end instead of a desire not to live. With radical acceptance, the pain could have room to exist alongside an urge to get better and make changes. She wanted to help other patients like herself, understand acceptance and be able to utilize it to handle the most challenging emotions they experienced.
Counseling options
Reaching out to a therapist may be beneficial if you're experiencing challenging emotions, difficulty with acceptance, or anxiety. DBT has become a widespread therapy modality, with many trained therapists. If you feel intimidated or unsure about beginning therapy in person, you can also try online DBT. According to multiple clinical studies, dialectical behavioral therapy transfers effectively to online methods, and is as effective as in-person therapy in treating various mood disorders and mental health symptoms.
Online therapy can give you the option of browsing through multiple therapists to find one trained in the methods you'd like to practice. A site like BetterHelp may allow insight into who you work with before you start your sessions. You can also receive worksheets, and journaling prompts through an online therapy platform.
Takeaway
Marsha Linehan, a professor of psychiatry at the University of Washington, has contributed much to the field of clinical psychology. She used her personal mental health challenges to develop a treatment called dialectical behavior therapy (DBT) to support others experiencing similar symptoms and concerns. DBT is often used to treat people living with borderline personality disorder, and it can be a short-term or long-term treatment that helps with emotional distress and provides related skills training.
If you're interested in learning more about DBT but don’t feel comfortable with traditional in-person therapy at this time, you might consider online therapy. With BetterHelp, you can be matched with a therapist who has experience with DBT or other treatment modalities. Take the first step toward getting support and contact BetterHelp today.What was Marsha Linehan diagnosed with?
During her adolescence, Marsha Linehan was diagnosed with schizophrenia and placed into residential care at the Institute of Living in Hartford, Connecticut. During her time there, Linehan struggled to overcome suicidal behaviors. After leaving the Institute in 1961 at 18 years old, Linehan did not continue to take psychiatric medication to manage her mental illness. In later interviews, Linehan commented that she believes she may have been incorrectly diagnosed, as many of the symptoms she experienced in adolescence met the criteria for a diagnosis of borderline personality disorder (BPD).
BPD did not exist as a diagnosis when Linehan was institutionalized, which may have contributed to the likely incorrect diagnosis she received. Linehan would later develop dialectical behavior therapy (DBT), a derivative of cognitive-behavioral therapy. DBT grew out of a series of failed attempts to apply cognitive-behavioral treatment to those experiencing suicidal ideation. Today, DBT is used to treat suicidal behavior as well as many other conditions, including BPD.
Where is Marsha Linehan now?
As of 2024, Dr. Linehan is a Professor Emeritus of Psychology in the Department of Psychology at the University of Washington and Director Emeritus of the University’s Behavioral Research and Therapy Clinics. She is retired from the University and Behavioral Tech, LLC, an organization she founded to provide DBT training to mental health professionals.
Who invented DBT?
DBT was invented by Dr. Marsha Linehan, an American clinical psychologist. DBT evolved from Dr. Linehan’s efforts to apply standard behavior therapy practices to individuals challenged by high levels of suicidal ideation. Her early work focused mainly on those experiencing chronic suicidal thoughts, but restrictions surrounding federal grant funding required clinical trials to be related to a specific diagnosis. Dr. Linehan elected to work with those diagnosed with BPD, a condition that has high rates of suicidality. She developed a theoretical framework that integrated the principles of Zen, in which she was professionally trained, and traditional practices of behavior therapy. The development of this framework led Dr. Linehan to include the philosophical concept of dialectics, which highlights the process of combining two opposing concepts, a necessary component for treating borderline personality disorder.
Where did Marsha Linehan get her PhD?
Dr. Marsha Linehan received her Ph.D. in 1971 from Loyola University in Chicago after previously receiving a master’s and bachelor’s degree in Psychology from the same institution. After receiving her degree, she completed a postdoctoral clinical internship at Suicide Prevention and Crisis Service, Inc. in Buffalo, New York. Her education culminated with the completion of a postdoctoral fellowship in behavior modification at SUNY-Stony Brook.
How is DBT different from CBT?
A commonly cited difference between DBT and CBT can be found in their philosophical underpinnings. CBT prioritizes stoicism, logic, and reason when treating mental health conditions. On the other hand, DBT is rooted in mindfulness skills derived from Zen practices, prioritizing acceptance of both pleasant and unpleasant facets of reality. DBT also places more emphasis on emotional and social factors, which are considered inconsequential in many structured forms of CBT.
What is unique about people with bpd according to Linehan’s theory?
Dr. Linehan’s biosocial theory suggests that individuals with BPD have an innate tendency toward emotional sensitivity. She theorized that individuals who are born with high levels of sensitivity are more likely to experience adverse feelings in a variety of contexts, making it harder to learn appropriate emotion regulation strategies. Dialectical behavior therapy, a psychotherapy designed for treating borderline personality disorder, relies heavily on helping patients develop emotional regulation strategies to combat high emotional sensitivity.
What is a life worth living in DBT?
Dr. Linehan refers to building a “life worth living” as the ultimate goal of DBT. Those with borderline personality often experience depression and suicidal thoughts that are difficult to correct using conventional behavioral treatment. Treatment of borderline personality disorder typically targets the hopelessness and helplessness experienced by those with the condition, seeking to bolster positivity and emotional regulation. In this way, DBT attempts to help those with BPD develop a desire to live and experience life.
What are the negatives of DBT?
Although DBT is currently considered the gold standard for the treatment of those with borderline personality disorder by most researchers within clinical psychology, it is not without criticism. Some mental health professionals note significant limitations of the treatment, including:
- DBT requires a significant time commitment, often at least six to twelve months.
- The sheer number of skills learned in DBT may be overwhelming to some, discouraging them from completing the therapy.
- DBT requires homework that is similar to what is found in many academic settings, which may not be well-suited for everyone.
- DBT lacks formal trauma processing, which may be a necessary component of treatment for some clients.
- The integration of both Western and Eastern philosophies may be objectionable to some.
- DBT requires substantial training to administer, and mental health professionals must apply considerable effort to ensure that DBT techniques are applied correctly.
What is a paradox in DBT?
The treatment of someone with borderline personality disorder, or borderline tendencies, and other conditions through the use of DBT often produces paradoxical thought processes or emotional reactions, which is a central tenet of the therapy. For example, a patient might be encouraged to accept things about themself that they previously found unacceptable. After working to accept whatever trait the patient previously rejected, they may find that it is substantially easier to achieve a change process associated with that trait. Paradoxically, by shifting their focus away from change and toward acceptance, the patient is able to achieve greater change than they could when focusing on it directly.
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