Marsha Linehan speaks out about DBT
June 24, 2011 3:09 PM   Subscribe

This post was deleted for the following reason: Poster's Request -- frimble

Admitting to a history of mental illness is very brave, even among the world of mental health professionals. Bravo to Marsha for stepping up. Patients with borderline personality disorder are among the most maligned in the mental health (and medical) system, so it's especially brave to count yourself among them.

Just a small correction, DBT is very effective but evidence suggests it is no more effective than other borderline PD-specific treatments.
posted by Bebo at 3:27 PM on June 24, 2011 [2 favorites]

I'll tell you why what she did worked.

She accepted them where they were before she showed them how to change.
posted by St. Alia of the Bunnies at 3:41 PM on June 24, 2011 [19 favorites]

Thank you for the link to this article. I'm printing it out to put on the coffee table in my library (I'm the Patients' Librarian at a mental health institute).
posted by gillyflower at 3:47 PM on June 24, 2011 [1 favorite]

Sounds like this is going to be first in a series, according to the NYT health blog.
posted by epersonae at 3:48 PM on June 24, 2011

This is a fascinating article. I'll be interested in reading the rest of the series.
posted by immlass at 4:02 PM on June 24, 2011

"Dr. Linehan was closing in on two seemingly opposed principles that could form the basis of a treatment: acceptance of life as it is, not as it is supposed to be; and the need to change, despite that reality and because of it."

Thanks for posting this -- really fascinating.
posted by scody at 4:18 PM on June 24, 2011 [7 favorites]

Thanks for posting this.
posted by zennie at 4:43 PM on June 24, 2011

> Just a small correction, DBT is very effective but evidence suggests it is no more effective than other borderline PD-specific treatments.

This is not an accurate representation of the article. It actually says the following:

In summary, dialectical behaviour therapy and specific
forms of psychodynamic psychotherapy seem to be
superior to treatment as usual in some clinically relevant
problems of borderline personality disorder...At present,
there is no clear evidence that one specific form of
psychotherapy is superior to another. In several
studies comparing specific forms of psychotherapy, however,
power was not sufficient to detect possible differences.

No clear evidence to suggest that DBT is more effective than other treatments /= evidence suggests DBT is no more effective than other treatments.

posted by quiet coyote at 6:07 PM on June 24, 2011 [1 favorite]

She saved my life. I will always count her as one of my heroes.
posted by JLovebomb at 6:14 PM on June 24, 2011 [3 favorites]

Are you one of us?
The patient wanted to know...
"...Because if you were, it would give all of us so much hope.”
“I’m a very happy person now,” she said in an interview at her house near campus, where she lives with her adopted daughter, Geraldine, and Geraldine’s husband, Nate. “I still have ups and downs, of course, but I think no more than anyone else.”

Wow. What a very touching article. What an amazing and powerful woman. So glad she has come forward, and thanks for sharing.
posted by salvia at 6:45 PM on June 24, 2011 [1 favorite]

This is a very brave and courageous woman. She has helped a LOT of people, saving them from personal hell. Mental illness is so, so, under-treated in America and around the world. It's a scourge that results is so much human misery - to those who are mentally ill, and often to those that are impacted by their actions. The social costs are staggering. Maybe if we start to find ways to put a $$$ number on the downstream social costs, we'll see more action, and policy in the direction of prevention and cure.
posted by Vibrissae at 6:49 PM on June 24, 2011 [1 favorite]

She is an excellent role model. The public needs to understand that people who suffer from mental ilness are still people, and can lead normal lives. My partner works with a young man who is schizophrenic, and I'm always secretly proud of him for taking control of his life and trying to better it, all the while being out and open about his condition.
posted by shesaysgo at 7:46 PM on June 24, 2011

I'm somewhat familiar with the idea of radical acceptance via Tara Brach, but hadn't read that much about Linehan. She's awesome!
posted by infinitywaltz at 9:51 PM on June 24, 2011

What a deeply inspiring article. So glad Marsha Linehan had the courage to speak about her own journey to mental health. I deeply respect her compassion, integrity and dedication to helping others with her innovative therapy, DBT, that has real, practical results. Brava!
posted by nickyskye at 6:04 AM on June 25, 2011

It's a huge shame that this kind of focused therapy is so difficult to get access to for the majority of people with borderline personality, because it is the only thing that works. The public mental health system (in which I worked) is set up to treat people with Axis I disorders such as schizophrenia or bipolar, conditions which can be treated effectively with medication. Axis II disorders (personality disorders) are best managed with therapy, which the public system is not really set up to provide, particularly in the case of borderline personality, which requires a specialist therapist.

This, I believe, is at the root of why mental health practitioners have negative attitudes towards people with borderline personality. It can be very obvious from the beginning what the person's true diagnosis is, but there aren't any resources for the person to get the treatment they really need. So practitioners end up treating these people with whatever they do have (antidepressants or whatever), knowing it's not really going to get to the root of the problem. So there's a certain amount of frustration with one's own inability to help the client/patient that goes into the negative attitude.

And there's also the adage that 20% of your patients are going to take up 80% of your time, and a high number of that 20% tend to be people with borderline personality. When you're in a position in which you are massively overworked and underpaid (i.e. publicly funded care or providing services to people in poverty), that gets frustrating as well.

I'm not defending the attitudes of mental health workers (and I have been guilty of it myself), but I'm giving my explanation for why they tend to occur.

Typical situation with a client of mine with borderline personality: eventually, the psychiatrist and myself reached the conclusion that any more changes to medication were absolutely not going to help this individual, and that she needed to seek therapy. I presented this to the client and she refused therapy, screaming at me at the top of her lungs for quite a while. I was forced to tell her that if she continued to refuse to follow the recommendations of her doctor, he would eventually refuse to treat her and her spot would be offered to someone else. She stayed away for about 4 months, at the end of which time she came back and told me how much better she was doing now that she was seeing a therapist. And she apologized for her behavior to me. Eventually, she said she didn't need our services any more because she had her therapist and medication from her family doctor. But this was after three years of scenes like the screaming one. In a tough job, it really is a remarkably difficult situation to deal with.

Again, as I said at the beginning, I desperately wish more people had access to quality therapy, but it's seen as not cost-effective to both public policy makers and insurance companies, regardless of the fact that in the case of borderline personality, it does save a lot of money on medication and hospitalizations.
posted by threeturtles at 8:46 AM on June 25, 2011 [7 favorites]

I just posted in another thread about how I received a "crash course" in DBT during a partial hospitalization program, but it was so weirdly truncated to accommodate a constantly changing roster of patients with depression, bipolar and anxiety. Once I did the research on my own and learned about the acceptance/chage dialectic, the point of the program became much more clear. My roommate when I was inpatient had BPD, and I can see how this could help her so much. I've actually been teaching some of the skills to my kids, especially my anxious OCD one.
posted by Biblio at 1:48 PM on June 25, 2011

It's so hard to fight your way out from inside something like that. But to overcome your struggles not only enough that you can function day-to-day but also provide light to innumerable other lost souls...

It's nothing short of wonderful. Thanks, Marsha. I'm glad you were finally able to like yourself. I hope you know a lot of other people like you, too.
posted by Eideteker at 9:11 AM on June 27, 2011

“I was in hell,” she said. “And I made a vow: when I get out, I’m going to come back and get others out of here.”

That's what got me. These are the words of a true hero. I'm getting out, but I'm coming back for you. Thank you for this.
posted by jpolchlopek at 11:30 AM on June 29, 2011 [8 favorites]

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