Psychologist Dr. Marsha Linehan developed dialectical behaviour therapy (DBT), which is generally the first-line treatment of choice for borderline personality disorder, a condition that she herself has. It’s very skills-based, and many of the skills are more broadly applicable than just for BPD. The focus of this post, though, is some of the foundational concepts in her book DBT Skills Training Manual (affiliate link).
The name DBT is based on dialectics, which are opposing ideas that are true at the same time. One of the key dialectics in DBT is accepting the way you are but recognizing the need for change. This kind of fits in with what I wrote about self-improvement recently, that we should be good enough as we are. We can learn and gain skills and grow, but that can all be built on a foundation of good enough.
People are doing their best
People are doing the best they can.
I like how this separates the work from outcomes. Getting bad results doesn’t necessarily mean you’re not trying. It may well mean you’re using the wrong tools for the job. Blaming yourself for not being good enough or not trying hard enough can end up distracting you from the need to expand your toolbox.
Solving problems
People may not have caused all of their own problems, but they have to solve them anyway.
It can be oh so frustrating when other people are the direct cause of at least some of your problems. It can also be frustrating if therapy is pushing you to solve problems that don’t stem from you. I like this statement because it’s about acceptance so you can move forward. There’s no blaming you for problems that come from other people, just acceptance that no one but you is going to be able to deal with them now that they’ve been dumped on you. Acceptance doesn’t necessarily feel nice, but I think there’s a lot to be said for it in contrast to resistance.
Looking for the causes
Figuring out and changing the causes of behavior is a more effective way to change than judging and blaming.
Judging and blaming are not forward-moving processes. They look backward, and what’s in the rearview mirror isn’t always very pretty. But effective change doesn’t come from looking in the rearview; it comes from looking forward through the windshield to determine where to go.
Patients don’t fail at therapy
Patients cannot fail at therapy (but the therapy can fail the patient).
This isn’t in quotes because I can’t find the exact source, but the idea is right. I think it’s fabulous, because it goes so totally contrary to what one might expect. Sure, the patient has to show up and put in the work, but it comes back to the first point about trying the best you can; you trying is not the only thing that needs to happen to achieve a desired outcome. You need the right tools, and the therapist and therapy are there to give you those tools.
There can be a variety of reasons that you might not get the right tools. It could be that the match with the therapist isn’t good enough for communication to be effective. Perhaps the tools the therapist is trying to help you develop aren’t actually the best fit to solve the problem. Maybe the basic outlook of that form of therapy doesn’t get into the kind of tools that you need.
Mental Myths
In DBT Skills Training Handouts and Worksheets, 2nd ed., Marsha Linehan also described a number of feeling rules that we commonly have that are actually just mental myths. Do any of these sound familiar to you?
- I don’t deserve to get the things that I want/need.
- Asking for help makes me a weak person.
- I should only ask for something if I know ahead of time that the person will say yes.
- Making requests of others is selfish.
- Saying no to others is selfish.
- Others’ needs are more important than my own.
- If I can’t fix this myself there must be something wrong with me.
- In a given situation, there is a certain way I should feel.
- Negative feelings are harmful.
- Some emotions are wrong or stupid.
- If others don’t approve of my feelings, then there must be something wrong with them.
- My emotions define who I am.
- I can always trust my emotions.
I like all of these ideas because they seem very wise, and grounded in humanness. I drop the problem-solving one and the failing at therapy one in people’s comments fairly regularly.
Are there any basic principles of any form of therapy that have really stood out for you?
Related posts
- Applying DBT Skills (Guest Post)
- Book Review: The Dialectical Behavior Therapy Skills Workbook
- Finding Wise Mind in DBT
There’s more on DBT in the Therapy Basics Toolbox mini-ebook, available on the Resources page.
Those are wonderful quotes Ashley – thanks for sharing. I particularly love the one about patients not being able to fail at therapy. I always figure you have nothing to lose by going to therapy. Great post as always 🙏
Thanks! I agree, there’s nothing to lose by giving therapy a try.
That’s a very good point. I must admit my company covers mine. There are of course many free hotlines that one can call. Not quite the same but just talking can do wonders. Also if someone really needs to see a therapist the one on the phone should be able to refer a suitable candidate. That’s usually a good place to start. Thank you for making me a think a little more deeply 🙏
No offence taken whatsoever. I enjoy having my privilege pointed out to me. It makes me a better person. You have done that for me today so thank you. I admire your spirit for speaking up about it 🙏
Barriers to care sap energy from people without reserves of energy. In our automated age with instant inventory updates, care providers and insurance companies could surely become more effective at listing openings accurately.
Yeah, it really shouldn’t be that hard.
Very good point.
I like these! And I’ve felt blamed for “failing therapy” before, particularly CBT. Now I know I’m on the spectrum, it’s really not surprising that CBT didn’t work for me, but I didn’t know that back then.
Hopefully the autism-focused version will work out better.
Super post! Those all apply to everyone across the board, really. Wise counsel for everyone. As for ” Patients cannot fail at therapy (but the therapy can fail the patient).” it came up in several articles without a precise attribution. That is the first thing I was taught when I started studying psychology.
Oh cool!
Whoah…..
Thanks so much for these posts. They give great insights and always makes me think. Love the knowledge you share. Awesome read.
Thank you!
I agree Ashley, I think I tried to read a lot when working with patients, learning about the different therapies. It’s important to make patients aware that they don’t fail at therapy and that perhaps the tools we use aren’t right for them.
Yes, and mental illness is so complex, it’s no wonder the same tools aren’t going to work for everyone!
True:)
I just liked the thought there…
“that people are doing the best they can.”
It might not seem it at times from others perspective when all they see is perhaps failure… or someone who cannot get out of their bed that day…and deal with life …and maybe it just looks like we are messing stuff up even. And it’s not a person’s fault for seeing that, as that is all they have to go on…
But in that person’s head, perhaps they are fighting a number of battles that nobody else can see. These battles often are against our own expectations and inner critics, and our own abusers, sometimes there are many parts of us all fighting within the same head…and these battles can take enormous energy both mentally, emotionally and then even physically too to fight.
Often when we are borderline we tend to live on the two extremes, it’s like the edge of the wrong end of the knife…and that little edge between the two, is where we try to keep it together, but we easily slip and fall off either side.. so to speak, then go one way, and then often go the other to the extreme to compensate, but often misjudge and go too far and over compensate… so whereas a normal brain is like a canal boat chuckling along the middle of the river at a nice even slow kinda pace, we are like a speedboat with sails… and dotting all over the place, at different speeds, diagonally, and the wind in our sails which we are not even supposed to have are then making it hard to go one way or the way we should go…
Nobody else sees the mental/emotional energy it took, to perhaps keep it together a particular moment, hour, day perhaps when we wanted to completely give up, cave in…
Those with ptsd/cptsd like myself too, are dissociating and reliving trauma often and then having to deal with that on top of normal activities and triggers.
People only can go by and see results, but what they don’t see is all the little steps and effort over time and many perhaps step backwards even and getting back up again each time it took to get where they are today.
They don’t see the times when we tried not to do something we knew was bad or caved into some addiction we were fighting…and they can’t see the choices that we personally are having to choose from for whatever reason.
There is just so much going on within a person, even more so with someone who has mental illness or suffering mental health issues in some way.
So the fact that this woman Marsha Linehan says: “people are doing the best they can”… when you or anyone just accepts that one thing about others and ourselves too…
That is just a massive thing right there!
It is huge… its like taking a massive weight from yourself and everyone else.
I am in long-term therapy with a Dr N Jenner, he is on wordpress, and he really does go the extra mile for his clients.
Most of all he doesn’t give up on you even when you have given up on yourself… which I had practically.
I’m glad you’ve found a good therapist.
I like the boat analogy. If someone is passing judgments on who gets to a particular dock on time, they’re not going to realize that the speedboat inadvertently got sucked into a whirlpool and barely made it out alive, and they’re also mot going to realize that someone was in a canoe with a single paddle and their arms are ready to fall off. Yet they’re both doing the best they can.
Progress isn’t linear—
This reality can be comforting when time on task in therapy and doing the work don’t directly translate into evident healing or growth. It takes so much time to rewire a brain. We were used to solving problems with our brain. Now, the brain seems to be the problem, so we lose hope at lack of progress. The quote tries to inspire us to keep trying
I like that quote very much.
Great post! DBT has helped me tremendously over the years. I really like her quote that people are doing the best they can.
I found DBT to be so helpful because it had that feeling of self-acceptance. Sometimes emotions can be very overwhelming, and we do the best we can to stay calm and in control.
I totally agree.
I struggle with the radical acceptance part of DBT.
Yeah, it’s not easy.