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Marsha Linehan on Dialectical Behavior Therapy
- By Marsha Linehan
- Published 05/25/2008
- Addiction Research
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Marsha Linehan
Marsha M. Linehan is a Professor in the Department of Psychology, and Director of the Behavioral Research & Therapy Clinics (BRTC), University of Washington. 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.
View all articles by Marsha Linehan
Wise Counsel Interview Transcript
Interviewer: David Van Nuys, Ph.D.
Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by MentalHelp.net, covering topics in Mental Health, Wellness, and Psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist, and your host.
On today's show we'll be talking about Dialectical Behavior Therapy with my guest, Dr. Marsha Linehan. Marsha Linehan, Ph.D is a professor of Psychology.
Marsha Linehan, Ph.D. is a Professor of Psychology, Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington, and she is also Director of the Behavioral Research and Therapy Clinics there. 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 Psycho-pathological Association, a diplomat of the American Board of Behavioral Psychology and is currently President of Division 12, Society of Clinical Psychology, American Psychological Association.
Now, here is the interview...
Dr. Marsha Linehan, welcome to the Wise Counsel Podcast!
Dr. Marsha Linehan: Well, thank you. Thank you for inviting me.
Dr. David: Yes. Now, you've developed an approach known as Dialectical Behavior Therapy or DBT for short. Maybe we can start by having you tell us just what DBT is.
Dr. Marsha: All right. DBT or Dialectical Behavior Therapy is an integration of two major approaches. The first approach is the approach of cognitive-behavioral therapy.
Dr. David: OK.
Dr. Marsha: So, it contains within that sort of standard cognitive-behavioral therapy or behavior therapy. As behavior therapy changes and improves, DBT changes right along with behavior therapy, cognitive-behavioral therapy and improve.
Dr. David: OK.
Dr. Marsha: Then it balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative primarily from contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients.
The acceptance end of the treatment is two-part. It's a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it's called "dialectical" is because it's a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time.
Dr. David: Yes, when I first heard the term "dialectical, " of course, I immediately thought of Hegel and Karl Marx and so I wasn't quite sure of what the relationship was but they did talk about synthesis and antitheses and then the... Have I got that right?
Dr. Marsha: Yeah, it's the theses...
Dr. David: Theses and antitheses.
Dr. Marsha: The antitheses and then the synthesis. The notion is, "everything contains within it its opposite, " which really means that nothing exists really without an opposite of it. Even if you take something as mundane as a box, there couldn't be a box if there wasn't a non-box, a no-box, a not-box, because a box is very defined as it's this so there's obviously something that's not a box.
Everything that exists has its opposite and Dialectics looks at the tension between; what exists and its opposite, or the theses and the antitheses or the opposite, and looks at the transaction between them, and that tension and that transaction which always brings about change.
Dr. David: In terms then of your therapeutic work and your therapy model, what are those two poles of tension?
Dr. Marsha: Oh, there are many. There are many, many, many poles. One of the most fundamental poles is that within every unwise act, there is some inherent wisdom. Taking heroin, which is long term, a dysfunctional, destructive behavior in our culture. Within there, is the wisdom of, "You feel better immediately." So there is dysfunction and function always coexisting together.
The tension is finding the synthesis of; "Are there other ways for example?" or "How to radically accept that if one's in great pain, getting out of pain is reasonable" while at the same time accepting that if one is in great pain, getting out of great pain by doing something that will continue to pain in the future is not reasonable. You're always looking for a synthesis, where is a point that without rejecting the other side.
Dr. David: Mmm-hmm. This is part of that radical acceptance then?
Dr. Marsha: Yeah.
Dr. David: It's accepting the polarity of both ends, which as a person with Jungian leanings, that makes a lot of sense to me.
Dr. Marsha: Yeah, so the therapist is constantly saying, "Where is the synthesis?" and meanwhile, teaching the client to also say the same thing, "Where is the synthesis here?"
Dr. David: I liked your example of heroin because, I think another one of the positive dimensions potentially there for the person who takes heroin is seeking of a transcendent experience, a seeking of oneness with God even.
Dr. Marsha: I'm waiting to have a client who says that's the reason they're taking it.
Dr. David: Nobody says that...
Dr. Marsha: Not yet.
Dr. David: Yeah. Do you sense now that it could be in there somewhere? Maybe I have...
Dr. Marsha: Not in my clients, but I accept that there are people out there who are taking drugs for that reason, and of course, the synthesis is to radically accept that desire and also accept that there may be other equally effective ways to do that.
Dr. David: Yeah. As you begin to articulate this approach and make it unique, was it targeted towards certain kinds of problems?
Dr. Marsha: Well, I started out at the beginning, which was back in the 1970's, really trying to develop an effective treatment for people who wanted to be dead. My real target and focus was the person who found life so painful and the anguish so insurmountable that they truly wanted to be dead.
I went to work with this group of people and I thought that I could treat them with the existing, of-the-day cognitive behavior therapy which I had learned on post-doctoral fellowships. I was out not only to save the world but quite confident that I could do it.
Dr. David: Good for you!
Dr. Marsha: Within not too long a period of time, the first year or so, the treatment fell apart, it didn't work. I discovered that the people I was working with... Mainly because I wanted to give the worst of the worse, so I'd called all the hospitals and said "Give me the most suicidal, the person who's tried to kill themselves multiple times and all of that.
They came in, and what I discovered was that these people had so many problems. They were such an ever changing set of problems, so that one day it was one thing, and another day another. If you worked on one problem, another problem was more intolerable. You try to work on that problem and the person says, "Well, I'm going to kill myself, this is all hopeless."
What happened was, I discovered that, if you have a lot of problems, you can't work on all problems simultaneously, so you really have to radically accept some set of problems to work on something out. But I had no technology, I had no way. That was not part of behavior therapy. Acceptance, when I started, was simply not part of the treatment.
Dr. David: Right.
Dr. Marsha: The acceptance based treatments didn't have change. I was stuck with, "I could either have a change based therapy," which behavior therapy is, and it's very good at; cognitive behavior therapy. Or I could go to an acceptance based therapy and they were good because they didn't help people very much with change.
Dr. David: Was the difference between the two, that the behavioral approach specified stages along the road of change?
Dr. Marsha: Behavior therapy primarily says, "You've got a problem, let me help you solve it." It never really said, "Maybe you could tolerate that problem, maybe you cannot change everything." Behavior therapy at the beginning, I was in the kind of a little bit of the beginning of the first wave.
Behavior therapy was developed in the 60's and I was trained in the 70's. Behavior therapy is really about, "Listen, we can change things. We can do this." It really wasn't about, at that time, "There is something that either one must accept or that it is wise to accept."
Behavior therapy started with easier problems, and I was dealing with people who've had tragic, unbelievable tragic lives with childhoods that not only could not be changed, but it was unreasonable to think you would ever think of your childhood without crying and that day wasn't on the horizon. People, who led lives with such problems, that you could not intervene in and make OK in any reasonable period of time.
What I realized was that I was dealing with a group of people who later emerged, I did not know whether it's beginning but it emerged later because in 1980 a new diagnosis was added to the diagnostic field; Borderline Personality Disorder.
When I read about that, which I had not previously heard of, I developed the entire treatment for highly suicidal people, then found out about Borderline Personality Disorder. Then I discovered that all the people I've been treating make criteria for that.
~ ~ ~
Continued: see Wise Counsel Interview Transcript, and listen to podcast
Interviewer: David Van Nuys, Ph.D.
Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by MentalHelp.net, covering topics in Mental Health, Wellness, and Psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist, and your host.
On today's show we'll be talking about Dialectical Behavior Therapy with my guest, Dr. Marsha Linehan. Marsha Linehan, Ph.D is a professor of Psychology.
Marsha Linehan, Ph.D. is a Professor of Psychology, Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington, and she is also Director of the Behavioral Research and Therapy Clinics there. 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 Psycho-pathological Association, a diplomat of the American Board of Behavioral Psychology and is currently President of Division 12, Society of Clinical Psychology, American Psychological Association.
Now, here is the interview...
Dr. Marsha Linehan, welcome to the Wise Counsel Podcast!
Dr. Marsha Linehan: Well, thank you. Thank you for inviting me.
Dr. David: Yes. Now, you've developed an approach known as Dialectical Behavior Therapy or DBT for short. Maybe we can start by having you tell us just what DBT is.
Dr. Marsha: All right. DBT or Dialectical Behavior Therapy is an integration of two major approaches. The first approach is the approach of cognitive-behavioral therapy.
Dr. David: OK.
Dr. Marsha: So, it contains within that sort of standard cognitive-behavioral therapy or behavior therapy. As behavior therapy changes and improves, DBT changes right along with behavior therapy, cognitive-behavioral therapy and improve.
Dr. David: OK.
Dr. Marsha: Then it balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative primarily from contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients.
The acceptance end of the treatment is two-part. It's a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it's called "dialectical" is because it's a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time.
Dr. David: Yes, when I first heard the term "dialectical, " of course, I immediately thought of Hegel and Karl Marx and so I wasn't quite sure of what the relationship was but they did talk about synthesis and antitheses and then the... Have I got that right?
Dr. Marsha: Yeah, it's the theses...
Dr. David: Theses and antitheses.
Dr. Marsha: The antitheses and then the synthesis. The notion is, "everything contains within it its opposite, " which really means that nothing exists really without an opposite of it. Even if you take something as mundane as a box, there couldn't be a box if there wasn't a non-box, a no-box, a not-box, because a box is very defined as it's this so there's obviously something that's not a box.
Everything that exists has its opposite and Dialectics looks at the tension between; what exists and its opposite, or the theses and the antitheses or the opposite, and looks at the transaction between them, and that tension and that transaction which always brings about change.
Dr. David: In terms then of your therapeutic work and your therapy model, what are those two poles of tension?
Dr. Marsha: Oh, there are many. There are many, many, many poles. One of the most fundamental poles is that within every unwise act, there is some inherent wisdom. Taking heroin, which is long term, a dysfunctional, destructive behavior in our culture. Within there, is the wisdom of, "You feel better immediately." So there is dysfunction and function always coexisting together.
The tension is finding the synthesis of; "Are there other ways for example?" or "How to radically accept that if one's in great pain, getting out of pain is reasonable" while at the same time accepting that if one is in great pain, getting out of great pain by doing something that will continue to pain in the future is not reasonable. You're always looking for a synthesis, where is a point that without rejecting the other side.
Dr. David: Mmm-hmm. This is part of that radical acceptance then? Dr. Marsha: Yeah.
Dr. David: It's accepting the polarity of both ends, which as a person with Jungian leanings, that makes a lot of sense to me.
Dr. Marsha: Yeah, so the therapist is constantly saying, "Where is the synthesis?" and meanwhile, teaching the client to also say the same thing, "Where is the synthesis here?"
Dr. David: I liked your example of heroin because, I think another one of the positive dimensions potentially there for the person who takes heroin is seeking of a transcendent experience, a seeking of oneness with God even.
Dr. Marsha: I'm waiting to have a client who says that's the reason they're taking it.
Dr. David: Nobody says that...
Dr. Marsha: Not yet.
Dr. David: Yeah. Do you sense now that it could be in there somewhere? Maybe I have...
Dr. Marsha: Not in my clients, but I accept that there are people out there who are taking drugs for that reason, and of course, the synthesis is to radically accept that desire and also accept that there may be other equally effective ways to do that.
Dr. David: Yeah. As you begin to articulate this approach and make it unique, was it targeted towards certain kinds of problems?
Dr. Marsha: Well, I started out at the beginning, which was back in the 1970's, really trying to develop an effective treatment for people who wanted to be dead. My real target and focus was the person who found life so painful and the anguish so insurmountable that they truly wanted to be dead.
I went to work with this group of people and I thought that I could treat them with the existing, of-the-day cognitive behavior therapy which I had learned on post-doctoral fellowships. I was out not only to save the world but quite confident that I could do it.
Dr. David: Good for you!
Dr. Marsha: Within not too long a period of time, the first year or so, the treatment fell apart, it didn't work. I discovered that the people I was working with... Mainly because I wanted to give the worst of the worse, so I'd called all the hospitals and said "Give me the most suicidal, the person who's tried to kill themselves multiple times and all of that.
They came in, and what I discovered was that these people had so many problems. They were such an ever changing set of problems, so that one day it was one thing, and another day another. If you worked on one problem, another problem was more intolerable. You try to work on that problem and the person says, "Well, I'm going to kill myself, this is all hopeless."
What happened was, I discovered that, if you have a lot of problems, you can't work on all problems simultaneously, so you really have to radically accept some set of problems to work on something out. But I had no technology, I had no way. That was not part of behavior therapy. Acceptance, when I started, was simply not part of the treatment.
Dr. David: Right.
Dr. Marsha: The acceptance based treatments didn't have change. I was stuck with, "I could either have a change based therapy," which behavior therapy is, and it's very good at; cognitive behavior therapy. Or I could go to an acceptance based therapy and they were good because they didn't help people very much with change.
Dr. David: Was the difference between the two, that the behavioral approach specified stages along the road of change?
Dr. Marsha: Behavior therapy primarily says, "You've got a problem, let me help you solve it." It never really said, "Maybe you could tolerate that problem, maybe you cannot change everything." Behavior therapy at the beginning, I was in the kind of a little bit of the beginning of the first wave.
Behavior therapy was developed in the 60's and I was trained in the 70's. Behavior therapy is really about, "Listen, we can change things. We can do this." It really wasn't about, at that time, "There is something that either one must accept or that it is wise to accept."
Behavior therapy started with easier problems, and I was dealing with people who've had tragic, unbelievable tragic lives with childhoods that not only could not be changed, but it was unreasonable to think you would ever think of your childhood without crying and that day wasn't on the horizon. People, who led lives with such problems, that you could not intervene in and make OK in any reasonable period of time.
What I realized was that I was dealing with a group of people who later emerged, I did not know whether it's beginning but it emerged later because in 1980 a new diagnosis was added to the diagnostic field; Borderline Personality Disorder.
When I read about that, which I had not previously heard of, I developed the entire treatment for highly suicidal people, then found out about Borderline Personality Disorder. Then I discovered that all the people I've been treating make criteria for that.
~ ~ ~
Continued: see Wise Counsel Interview Transcript, and listen to podcast
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1 Response to "Marsha Linehan on Dialectical Behavior Therapy"
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said this on 17 Nov 2008 5:40:43 PM EST
I am interested in getting DBT training. I have an Ed.S. in Counseling and Guidance (adolescents and adults) and have personally benefited from DBT. Can you give me more information?
Thank you. Jo Hall Ed.S.. |
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