Wisdom from DBT Creator Marsha Linehan

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?