Dr. Marsha Linehan Explains Dialectical Behavior Therapy

In her new book, Building a Life Worth Living: A Memoir, Dr. Marsha M. Linehan, the developer of Dialectical Behavior Therapy (DBT), explains how she developed the life-saving therapy.

The following excerpt published in Psychology Today was adapted from the book:

The goal of any behavior therapy is to help individuals change behaviors, in particular behavior patterns that significantly disrupt their life at home and in the workplace, and to replace them with more effective alternatives. DBT is different; it’s designed to help individuals who are at high risk for suicide, are difficult to treat, have multiple serious mental and behavioral problems, and often are on the “no admit” lists of hospitals.

Dialectics is a cornerstone of DBT, but it’s far from the only element. The therapy encompasses distress tolerance skills, mindfulness, and radical acceptance. The practice involves an intimate relationship between therapist and client and therapist teams that support providers.

Dialectics allows opposites to coexist, you can be weak and you can be strong; you can be happy and you can be sad. In the dialectical worldview, everything is in a constant state of change. There is no absolute truth, and no relative truth, either: no absolute right or wrong. Truth evolves over time. Values that were held in the past might not be held in the present. Dialectics is the process of seeking the truth in the moment, drawing on a synthesis of opposites.

Many of us tend to see reality in polarized categories of “either/or” rather than “all” or “this and that.” We are often stuck in either the thesis or the antithesis, unable to move toward synthesis. We are not able to believe in both of these propositions: “I want to be with you, and I want time alone.” Or, “You forgot to pick me up at the ferry, and you still love me.” All of us face this. It is the inability to ask certain questions that gets us into trouble: “What am I leaving out here?” and “Where am I being extreme?”

The therapist must help to find the syntheses of opposites, to look for what is being left out. I have spent many sessions saying to myself, “Look for the synthesis. What am I missing?” A patient wants to go to the hospital. I don’t want him in the hospital. A battle ensues. What is the dialectic? The patient thinks he is likely to commit suicide if he doesn’t get into the hospital (a point I completely fail to understand); I believe he is likely to commit suicide if he does go into the hospital (a point the client completely disagrees with). What is the synthesis? We have to find a way for him to be safe either way. We have a problem to solve.

Excerpted from “How Marsha Linehan Developed the Central Feature of Dialectical Behavior Therapy,” published in Psychology Today. Read the full article online.

Source: Psychology Today | How Marsha Linehan Developed the Central Feature of Dialectical Behavior Therapy, https://www.psychologytoday.com/us/articles/201912/walking-tightrope | Copyright Sussex Publishers, LLC

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