Marsha M. Linehan

Marsha M. Linehan (born May 5, 1943) is an American psychologist and author. She is responsible for the development of Dialectical Behavior Therapy or DBT. The purpose of Dialectical Behavior Therapy was first designed for the treatment of Borderline Personality Disorder, but it has been found to be useful in the treatment for other diagnoses as well. Linehan’s DBT module has been adapted to assist in the treatment of clinical depression, anxiety, anger, impulsivity, and periods of cognitive dysfunction as well as suicide, areas of impulse control such as substance abuse, eating disorders, problem gambling, and over spending. An adaptation of Linehan’s work is being currently used in treatment of individuals with developmental disabilities, mental illness and with Juvenile Offenders in Washington State.

DBT is based much after behaviorism theory, while implementing areas of Cognitive Behavioral Therapy or CBT as well and eastern zen practices. From combining both Eastern Zen and western Cognitive Behavior Therapy, Linehan discovered Dialectics, an approach in which thesis is paired with anti-thesis bringing synthesis. Linehan's DBT works with helping people move past the tendency to bounce back and forth from one extreme to another. These extremes usually occur on three axes: from emotional vulnerabliltiy to self-invalidation, from active-passivity to apparent competences, and from unrelenting crisis to inhibited grieving (Linehan 7-10).

Education and Awards
Linehan was born in Tulsa, Oklahoma, and later attended Loyola University in Chicago in 1968 where she graduated Cum Laude with a B.S in Psychology. Following earning her bachelors degree, she continued her education at Loyola University and was able to accomplish earning her M.A in 1970 and Ph. D. in 1971, both in Psychology. During her time at Loyola University, Linehan served as lecturer for the psychology program. After leaving Loyola University, Linehan started her post doctorate internship at The Suicide Prevention and Crisis Service in Buffalo, NY between 1971-1972. During this time, Linehan served as an adjunct assistant professor at State University College of Buffalo. From Buffalo, Linehan completed her Post-Doctorate fellowship in Behavior Modification at the State University of New York in Stony Brook. Linehan then returned to her alma mater Loyola University in 1973 and served as an adjunct professor at the university until 1975. During this same time frame Linehan also served as an Assistant Professor in Psychology at The Catholic University of America from 1973 to 1977. In 1977, Linehan took a position at the University of Washington as an Adjunct Assistant Professor in the Psychiatry and Behavior Sciences department. While at the University of Washington, Linehan has furthered her career and is now a Professor of Psychology and a Professor of Psychiatry and Behavioral sciences. Linehan has earned several awards for her work. She has been recognized for her research and clinical work dealing with the behavioral sciences, including the Louis I. Dublin award for Lifetime Achievement in the field of suicide in 1999, The Outstanding Educator Award for Mental Health Education from the New England Educational Institute in 2004, and Career Achievement Award from the American Psychological Association in 2005.

Linehan’s DBT module
In the development of Linehan’s treatment model of DBT she came up with four skill modules to aid the patient reach a state of what she calls wisemind. This state of mind is area between the rational, and emotional state of mind. In the rational mind, the individual is solely focused on the facts and observations, and a suppression of emotions occurs. Oppositely, in the emotional state of mind the patient can be experiencing such high levels of emotions that she/he does not see the positive/negatives of their behavior; this is also identified as emotional hijacking. In the emotional mind the individual tends to ignore the facts leading to a cognitive distortion of their thoughts and experiences in their environment.

Mindfulness
Mindfulness is considered the most important part of Linehan’s DBT skill module. The mindfulness skills focus on "what" and "how" skills; "what" the individual needs to do in order to be mindful and "how" to do this. For example, a typical approach to developing the "what" skill would include an intent and attempt to observe, describe and participate in open dialogue. The "how" skill may require non-judgement, one-mindfulness, and collaboratively determining what is effective.

Interpersonal Effectiveness
Interpersonal Effectiveness skills that are used in DBT sessions focus on assertiveness in saying no, making a request, and coping with problems. The purpose of the Interpersonal effectiveness skills are to allow the individual to increase the likelihood of goals being met, while maintaining self respect and keeping the relationship.

Distress Tolerance
Distress Tolerance is the skill set for accepting, finding meaning for, and tolerating distress. This area of DBT focuses on learning to bear the emotional pain resulting from distressing circumstances and events in the individual's life. An important focus in Distress Tolerance is the idea of radical acceptance. Linehan describes radical acceptance as a means by which to free oneself from suffering, and requires a choice to let go of fighting with reality. These skills in "letting go" promote acceptance without judgment or evaluation of the self, others or the situation in general. In theory, focusing on the acceptance of reality rather than the approval of reality will foster a clearer understanding of controllable vs. uncontrollable factors and help facilitate manageability of emotional pain.

Emotional Regulation
Emotional Regulation assists individuals with reducing their vulnerability to an emotional state of mind. This is accomplished by providing methods to identify and label emotions, finding barriers in changing emotions and applying distress tolerance skills. The other key component of this skill set is to find ways to increase positive emotional events through healthy living and participation in activities that increase self-confidence.

Publications
Linehan has authored three books, including two treatment manuals: Cognitive-Behavioral Treatment for Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder. She has also contributed to and has been published extensively in scientific journals.