Marsha Linehan and Dialectical Behavioral Therapy

Content Warning: Please be advised that this article mentions topics like suicide, self-harm, trauma, and other potentially triggering subjects. Read with discretion. 

One of the more modern pioneers in behavior is Dr. Marsha Linehan, a psychologist who created a behavioral solution based on Buddhism and mindful thought called dialectical behavior therapy (DBT). Since its creation, DBT has been a spreading therapy technique used to treat mental health conditions and symptoms. Also, dialectical therapy can assist with issues such as borderline personality disorder and self-harm. Institutions like Behavioral Tech LLC train thousands of therapists worldwide to administer it. Understanding the development behind this type of therapy may help individuals further comprehend how this therapy modality functions.

Marsha's Early Life 

Marsha Linehan was born in 1943 in Tulsa, Oklahoma. As one of the middle children of six, she grew up surrounded by successful role models. She admits to having felt inadequate in comparison, but her family didn't start to see concerning symptoms until high school when she would spend much of her time in bed with headaches. Dr. Marsha Linehan was diagnosed with schizophrenia as a teen. She was treated with inpatient therapy at the Institute of Living in Connecticut for her mental health symptoms. 

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 felt she was misdiagnosed with schizophrenia. 

If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support. 

While in the treatment center, Marsha believed that she was not getting better, and her symptoms worsened with the treatment she received.

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, Marsha 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.

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.

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 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. 

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.

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 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 feel 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. 

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. 

On that day, Marsha described feeling 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 felt 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 feeling 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. 

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.

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Counseling Options 

In many ways, Dr. Marsha Linehan's methods and realizations have supported many individuals living with personality disorders, anxiety, depression, and many other mental health struggles. Her therapy modules allow individuals to take control of their treatment, actively participate in skills, and learn lifelong methods of supporting themselves.  

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.