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An Interview with DBT Creator Marsha Linehan, Ph.D.

May 01, 2011

Dialectical Behavior Therapy (DBT) is a comprehensive cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., ABPP over the past 25 years. Dr. Linehan is a Professor of Psychology, an Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Behavioral Research and Therapy Clinics, a consortium of research projects which develops new treatments and evaluates their efficacy for severely disordered and multi-diagnostic populations. Dr. Linehan spoke with us about her work.

How did you develop the concept of DBT?

To develop the DBT concept, I went through hundreds of treatment manuals to study effective treatment. I found the skills that have evidence that they work. DBT combines acceptance and change. It’s common now, but wasn’t when I started. There is a dialectic tension between accepting reality and changing reality, and you really need to have both of those to go forward.

Pure acceptance and support are not terribly therapeutic for many disorders and a straight focus on change is not effective; you really have to accept things before you can change them. This is a balance of validation and acceptance of change. 

You’ve taken a group of clients with a reputation for being somewhat treatment-resistant and created a therapeutic approach that’s non-judgmental. Philosophically, that is very much in-line with our holistic approach here at Skyland Trail. Why do you think it’s important to avoid judgment in therapy?

It’s hard to like someone you’re judging and hard to treat someone you don’t like. When you judge people, it does nothing to change things—you can only change things by figuring out the causes of them. Judging doesn’t figure out the cause, but instead it blames people—and blaming rarely gets you anywhere. So getting therapists to stop being judgmental is the big-ticket item for us. 

Why is it important that clients seek out counselors who have received training from Behavioral Tech?

If you have a treatment that’s been shown to be effective, then to do it you have to be trained—there is no good reason to believe someone can do this if they aren’t properly trained. If you’re not doing it by the book, then it’s no longer evidence-based treatment.

What has been happening is that therapists are going to workshops with no supervision, and then say they’re trained. Then people [clients] come to them for DBT, and it doesn’t work and they believe it’s their last ditch effort. Then they [the clients] say it doesn’t work and they are hopeless and in despair.

This is why we want people to get intensive training from professionals who know the treatment.  Otherwise, people are calling it DBT, but not providing it—We know this is happening all over the country and it’s very disappointing.

Your work has helped countless individuals learn the coping skills necessary to help change their lives. It must be so rewarding to see how effective DBT can be.

It’s very rewarding; I get letters from people around the world who have learned these skills. It’s very meaningful when I hear I’ve helped someone. It’s also important to be able to provide treatment for a group of people who no one thought they could treat, people who are experiencing unbelievable pain and suffering.

But the fact that we’ve done good doesn’t mean we can’t do better. Now, we’re continuing our research and trying to identify what the most important parts of DBT treatment are. 

DBT Programs at Skyland Trail