Do I need to rethink my feelings about DBT?

I don’t usually post links to other articles here. That’s generally not my style. And judging from the content of this one, it’s probably going to get posted many other places.
I just have to share some of my reactions somewhere.

Here is the article
You may need to make a free NYT account to be able to read it.
tldr version: Marsha Linehan reveals her personal history of self-injury

DBT was not helpful for me. With other therapy types that have not helped I never really felt anger towards the big names that created it. I don’t have strong feelings towards Aaron Beck as a person even though there are some complex emotions going on for me about CBT. Things have been different with Linehan though.

Her name has been all over my experience of the therapy. When I was in DBT I worked in her workbook, which I pursed a copy of. In hospitals when DBT was shoved down my throat I used xeroxes of the same workbook.

After I quit DBT my (non DBT) therapist pressured me to take home DVDs of Linehan’s to watch. If I refused to continue the DBT therapy, she thought maybe the DVDs would help. They just made me angrier. I have pages of typed notes picking apart every detail of those DVDs. Some of them were obnoxious and irrelevant such as my criticisms of the lighting quality. Mostly I just felt that Linehan just didn’t get it. Combined with later viewings of youtube clips of her and videos of her I saw in school, I’ve developed a view of her as cold, mean and out of touch. The cultish language of DBT did nothing either to endear her towards me either. That she could possibly have a personal history of these problems was not something that ever would have occurred to me.

A lot of my anger towards this therapy, that was repeatedly forced upon me, became directed at her. She created this overhyped therapy that no one will believe is ineffective for me.

This article really turns a lot of my feelings upsidedown. I guess she’s not quite as out of touch as I thought. Some of these comments she made that seemed cruel make me think more now that she’s using humor as a way to deal with some fo these things.

I am not going to become a hardcore DBT advocate, but it does make me feel its worth a little more examination. Not so much as a treatment for myself (I’ve long ago ruled out the possibility of it being effective for me and strongly believe anyone who treats any therapy as a panacea is delusional), but in terms of general professional knowledge it could be useful. I still have theoretical objections and think DBT is backwards (behaviors should not be the first issue address with in a therapy, IMHO), but this gives it a little more credibility.

This news is certainly going to take over my therapy session today.

I’m still processing my thoughts about this. I don’t usually like to post here without digesting thoughts more, but I wanted to share while it was still fresh news. Feel free to add your thoughts on the matter.

Edit:
I walked into therapy and said “Hey, did you read the NYT today?”
S.M. replied “I haven’t finished reading it yet, but I bet you want to talk about the Linehan article”
He’s got me figured out.

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24 thoughts on “Do I need to rethink my feelings about DBT?

  1. I had a bit of the same reaction. I softened a tad to her revelation….

    However. I’ll never forget one of her videos when she said she wanted to help the people no one else wanted and how “easy” these suicidal people were to find. The audience laughed. She laughed. Even if she has a history, making fun or laughing at people’s struggles is incomprehensible to me.

    I can’t help be a skeptic as to why she’s decided to share NOW. The article made it sound like there was proof she was in the hospital as a teen, which I won’t dispute, but I guess I am just wary of being bamboozled.

    I agree 100% about the thought that DBT is a cure-all….especially outside of BPD.

    Reply
    • I think I was thinking of the same video while I was writing this. I think she has issues with empathy for sure, but this does make it a little easier for me to feel empathetic towards her, knowing that at least its misguided attempts at humor and not the complete misunderstanding and disconnect that I’d thought.

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    • Also I think I can understand why now. She’s a leader in the field. I’m sure she has tenure. At the place she’s at she can do almsot anything aside from research or professional misconduct and still maintain her position. I imagine she’s realized she has a level of security that she dosn’t have to hide anymore. Maybe she also has retirement plans coming up.

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  2. Interestingly, I read this article just now and came here to share it with you… and lo and behold, you beat me to it!

    I know there are stigmas against mental illness, know very well- you’ll just have to take my word on this, I don’t share other people’s business without their consent, but let’s just say some very close loved ones have dealt with the stigmas.

    I think about your situation sometimes though, and this may seem completely random and unrelated- but I was an obese person who lost a lot of weight and now I am finding that this gives me credibility with other obese people that people who have never been obese can’t ever attain. I even remember thinking “what could a thin person who has never been overweight possibly know about what I’m dealing with?” So now this has become my passion, to help other people with this issue.

    My loved one often says things like “therapists don’t understand me. they are just out to make money. they don’t really care to help anyone.” I have to wonder if he might feel differently if there was someone he could talk to who would actually understand some of what he is going through.

    When you read the article, you rethought your position on this type of therapy (which I have never heard of because it’s out of my realm.) When I read the article, I thought about your status of living with this “in the closet” and wondered if maybe there is good argument for re-thinking that.

    Hope that didn’t come off as intrusive. Obviously nobody knows how to live your life better than you, but there certainly is something to be said for being a person who’s “been there/done that” when it comes to credibility.

    Reply
    • Linehan and I are in very different situations. There’s not really a shortage of people with my type of history trying to get into this field. I’ve very explicitly heard people comment about people trying to get in this field for the “wrong reasons” and heard talk to grads schools making efforts to filter people like that out. The thing about mental health issues is that if you have a high enough status you can come out and it isn’t as big a deal, because your position in life is secure. U of Wash isn’t going to fire one of their top tenured academics over this or give her any kind of trouble at all. If nothing else this reminds the public that this high profile person works there.
      The thing is very few people ever reach that sort of postion where they have that levels of status safety. It’s unlikely that I will ever reach that kind of place. The best I can hope for is getting enough security to be able to open up to a handful of close people. Maybe far enough along in my career some of those close people might even be people I work with.
      I agree that there is a benefit for people to know some of the humanity behind therapists, but I don’t think I’m going to be the person to lead the breaking down of that barrier. Instead I hope that my experience can help inform my research investigations to ask questions that others without this experience might not think of. So I can help in my own way without oversharing.

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    • I also don’t want all my actions to be viewed through the lens of my disorders. I’m already seeing some of thing happening on forums discussing this article. Saying that this explains some of her judgmentalness etc.

      When I talk about disorders that I have in professional situations, I want my academic speech to be viewed as academic, if I am open there will always be an uncomfortable double layer of meaning to worry about. I’ve seen academic situations where people start oversharing and it makes things uncomfortable and derails the conversation. I want to be able to talk about psychology without blatantly talking about myself. If people know too much they start reading things into it.

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  3. I’ve never had DBT, but it’s seriously mentioned to me everyday that I go to partial or a therapy session. I can relate to it being shoved down my throat. My gf even bought me a workbook because HER therapist said it’s something I should be doing. I thought some of the ideas listed for alternatives to cutting were really stupid. Draw on my skin with a red marker? Seriously? I’m supposed to start this DBT program in August that requires me to sign a year long contract with someone I never met. That’s just something I not willing to do and seems a little much. I don’t know very much about DBT other than what I can find online and the stuff I’ve skimmed through in that workbook but honestly all of that stuff just confuses me. After everything I’ve read, I still don’t get what it is. My therapy program has CBT but I don’t go to that group anymore because I think CBT is a little too unrealistic and idealistic. Then I feel like maybe this therapy just doesn’t work for someone with my issues or maybe I’m just too stupid to get it. I hate the mantra the CBT therapist says and writes all over the board. “Feeling is inevitable, suffering is optional.” Every time he says it out loud I cringe inside. I’m not sure what it is about the phrase that bothers me so much. I literally left one CBT group in tears because I was asked to share my opinion of this article he made us read together. It was all about finding the positive in a negative situation. It sounds good I guess, but I just don’t think that’s realistic. I said that I honestly thought it was a little simplistic and can’t be applied to every situation. He seemed offended and wanted me to explain. I said, “Well, what exactly am I supposed to find positive about never being adopted? Or living in 42 foster homes? What can you find positive about things like rape or death or cancer?” That’s when everyone in the group decided they needed to persuade me that the positive thing about not being adopted is that I get to look forward to creating my own family by having children. Needless to say I exploded into tears and ran out of the group. I’m kind of just rambling now. Basically I’m trying to say that I loathe CBT and I’m confused by and terrified of DBT.

    Reply
    • Somethings are negative and trying to put a happy spin on them in really a insult to the individuals pain.
      I hate the things they list instead of SI. No holding an ice cube is not going to help anything.
      If you want to do it don’t worry about the 1 year contact thing. Don’t let that be what holding you back. It’s not legally binding. Just bullshit. It means nothing. If you want to try it for a week and bail you have every right to.

      Reply
    • I think that’s appalling. You are also very accurate and insightful about how the group dynamics function to try and please the moderator. I have experienced this too. Honouring your own experience is vitally important. There is no positive in having had so many foster homes. Honour and respect that. I admire your tenacity. Trust yourself.

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  4. No, you don’t have to rethink your ideas around DBT. Linehan has cornered a market and is making a fortune out of rolling out this pernicious, judgemental, silencing nonsense. She has the need to be accepted and validated and unfortunately she has done this by going out of her way to become part of an establishment that brutalised her and one in which she would have felt extremely frightened and misunderstood. Good little Martha, she’s so regulated now. It’s actually very sad in a way.

    The very fact that she has built a life and a career out of validating pejorative, unscientific smear labels like BPD is in and of itself slightly grotesque.
    As Dana Becker says “the distress is real, the diagnosis is fiction.”

    Radical Acceptance and Mindfulness were chosen by her to include in her ‘therapy’ as they were the up and coming thing in the field at the time. Survivors often find DBT horrifically invalidating and offensive. It’s often delivered in a highly controlled and power differentialed environment. It’s the ultimate insult to anyone who’s suffering. The ultimate “we know better by virtue of the fact that we’re not in the distreSs you currently are.”

    I think it has the capacity to radically damage people and train them into a self policing state of constant monitoring and checking. Welcome to the Borg!

    Trust your gut, DBT may sound on first look like a light fluffy warm thing, but scratch the surface and it’s very obviously a system in which non compliance is punished and ‘boundaries’ are enforced which actually mean rejecting, manipulating and controlling peoples behavior and how they express themselves, particularly in distress.

    It has been labelled ‘doing bollocks therapy’ or ‘diabolical behaviour therapy’ by survivor activist Louise Pembroke. It compunds the idea that there’s something inherently wrong with the person thats receiving it and that they need to be taught how to be diferent.

    It may be wrapped up in a nice shiny bow but its used to bully, coerice and hoard people into programmes that prevent them from clogging up the mental health system with distress that is legitimate but that they dont want to hear about.

    Spent a liftime being told there was something wrong with you? DBT will confirm this subtly but powerfully by being complicit in the notion that you are ‘dysregulated’ and need to learn new ‘skills’.Yuck. It’ll be something else in 20 years time.

    People need to fight back, this is not a therapy, it demands ‘behavioural modification’ but won’t do anything to address the very real distress that many people feel and that deserves a respectful space in which the person can be accepted and supported without coercion.

    Linehan’s outing was not necessarily of her own choosing. It makes it even more tragic that she would inflict this on others having suffered herself. I believe that she really does think she’s helping and if it works for you go for it.

    However if it doesn’t help or you simply arent’ interested and want choices in the help or support you receive then it’s simply not good enough that this is force fed to people who are often feeling much too vulnerable to refuse it even thought it’s not what they want. Sound familiar? Don’t drink the cool aid. Say no to the nun.

    Reply
    • Thank you! Very well put! I found this blog because I am currently in therapy and wondering if it’s making anyone else feel as crazy as I do?! I’ve come to the conclusion that I am a square peg and I should stop allowing people to try and round my corners so that I fit into their round holes. My daughter has Autism. She’s beautiful, smart and amazing. I think I will be doing her a great service by showing her how to be independent and unique. I have come a long way with my dependence issues and now I feel that on my own I can do the self care that I need to do and make the healthy choices I need to make for myself instead of trying to conform my admittedly eccentric behavior and personal opinions into something that works for someone else. I just don’t think I’ll ever be able to be a half of a “typical” couple. Oh well, considering the divorce rate in this country, are the “typical” couples really all that happy?

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    • Thank u. I hav just been given the lovely label of emotionally dysfunctional PD or BPD and told that DBT is the thing that’ll change my life. Having been for the assessment, I’ve decided it is not for me and am now having to justify to my doctor why I wont go through with it! Your comments hit the nail on the head for me about there being something not quite right about DBT, at least not for me. I went for the assessment and then a couple of individual sessions but I felt that there was some odd power thing going on e.g. you do what we say, we can cure you and only us. I mean having to sign a contract! If it works for some then great but dont present it as a cure-all. When CBT came out, that was the promised cure for all neuroses and psychoses even, but its hype has died down. Those with BPD usually have no self-esteem/self-worth and you are then labelled as dysfunctional and told that only DBT can help you now – surely that is psychologically damaging in itself!

      Reply
    • I certainly won’t deny that it helps some people. The seems though that for some it can make though worse though when the therapy approach is a mismatch for an individual’s situation. I think people need to be more careful about applying DBT as a one approach fits all method.

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  5. I just wanted to say that I am so glad to find someone else who admits they dislike DBT and found it unhelpful. I quit DBT on Monday and I haven’t been so relieved by a decision in years.

    Reply
    • Trust yourself. It’s not the panacea it’s marketed as and it’s underlying value system starts from a place of pathology. For folks who have survived abusive and shaming pasts DBT can do further damage by repressing trauma, diminishing the value of being able to express valid anger/rage or grief in a safe environment and teach people to police their emotions and view themselves as fundamentally flawed, damaged and volatile. It’s a controlling behaviour modification programme that does little but teach people perceived to be behaving badly to be good boys and girls.

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  6. You don’t really explain why you don’t like Linehan and her theories. There’s really a lot to it so it is interesting that you seem to dismiss every aspect. I believe the therapy has helped thousands of peopl.

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  7. I also have found DBT to be very helpful and actually shocked by all the DBT bashing going on here…. but it got me wondering why that would be. I think it depends entirely on the level of training and intelligence of the people who offer the therapy. My experiences have been mostly very good- but only when it was from one of the most prestigious mental health institutions in the Northeast US- and some of the complaints people have mentioned (safety contracts, etc) were not used at that hospital with me. After I left there, I did join another DBT group run by some random place that was very, very disappointing. Sloppy, uninspired, and I felt like I understood DBT better than the people running the group. But its Linehan’s business right? People pay for the training and then can run these groups, whether or not they are actually good at doing it. Sorry about everyone’s bad experience here… its really too bad. I just wouldn’t knock it entirely.

    Reply
    • I agree that a large part of the problem with DBT is that people run off to apply it with very little training. It’s set up in a way that makes it easy to do damage when done by those without enough training. It’s also just not for everyone and too often people are forced into it as their only option.

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  8. I also hate DBT! I have BPD/ DID, and I did a few years of Schema therapy on and off, and absolutely loved it. It was validating, gave me names to describe the abuse and it taught me how the abuse turned into BPD. Just being validated alone, helped me recover a lot. I stopped self-harming because I truly believed I didn’t deserve it any more. I became a lot more healthy and stable, and felt very empowered now that I understood my disorder and abuse.

    I wasn’t treated like ‘a Borderline’. I was treated like a human being with an abandonment and abuse schema. Just taking that label away and viewing myself as a human being and not a label was amazing.

    I then went to a therapy group that used DBT from the Marsha Linehan book, and wow, what a mistake. So traumatizing and stressful.

    It triggered memories that I wasn’t able to deal with, and offered no talking therapy to help me cope. Schema therapy was much more gentle.

    I even relapsed back into self-harming and my dissociation went through the roof. It was invalidating and I felt I was being pushed back into having the BPD label and I felt dehumnaised again. The distraction techniques worsened my dissociation

    I’ve seen ML write some really messed up things about the cause off BPD. That we are ‘born sensetive’ and it’s how we react to things. I have yet to meet a person with BPD who hasn’t suffered severe abuse, sexual, emotional or physical, or abandonment. I am sick of reading about biology.

    Abuse, abandonment or any form of childhood trauma will cause chemical changes in the brain. There have been loads of studies in it. The brain gets caught in ‘fight or flight’ response and damages the amygdala and then turns into BPD behaviour. This is the area that control emotions, anxiety, mood. Narcissists are just as ‘sensitive’ as BPDs, just that we all display it differently.

    While Schema therapy taught me the tools to help myself and it was a very loving and gentle process, DBT made me into an unfeeling robot.

    The self-soothing advice was ridiculous. How can you expect someone who has self-harmed since childhood to start lighting candles? You have to teach someone to care for themselves, explore where that self-loathing comes from. It’s a slow process.

    I got to the point where I was constantly monitoring myself and being critical of my responses. It was very boring and my life felt mechanical.

    And don’t get me started on her whole ‘finding God’ bullshit. As an atheist who also struggled with religious delusions as part of my DID, I was very triggered by that aspect of it.

    Also the part about empathizing with you abuser and thinking what their life has been like. WTF!

    Luckily as I’d had Schema therapy I was able to rebuild myself, but it was hard. I can’t imagine what it must be like for people who go through it first.

    You can learn Mindfulness on your own, go to a class or read about it. And combine it with Schema therapy.

    Read: Reinventing your Life by Jeffrey Young and Change for the Better by Elizabeth McCormick.

    Reply
    • Thank you for sharing this. I had a similar awful experience with DBT. I engaged in more self-harm in the first 6 months of DBT than I did in the 5 years leading up to it.

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  9. It sounds to me that most of the people who “hate” DBT have not actually received DBT.

    If you left feeling invalidated – then it definitely was not DBT.

    Sounds like the ‘haters’ (which makes perfect sense given what you’ve experienced with ‘not good’ DBT treatment) had a portion of the treatment (mostly just skills group) probably administered incorrectly. There’s lots of people doing bad DBT out there. It’s why there’s a push to certify people in the treatment.

    I’ve really looked this stuff up. Comprehensive DBT (which is what the many research studies showed helped) involves a highly specialized individual weekly component of therapy with a DBT therapist (only), the weekly skills (which if you are not at least liking the group is probably being done incorrectly), in-between session telephone contact with your individual therapist, and your individual DBT therapist should be meeting weekly with other DBT therapists weekly in a consultation team to make sure that they are all doing the therapy properly and figuring how to work harder and better for you, as the patient. If these things are not in place – then it definitely was not DBT. I guess those things could be in place and you could still get ‘bad DBT’ – but it is less likely.

    If a DBT therapist is always saying you’re willful – it’s probably that they don’t know the treatment well and cannot accept responsibility for maybe not figuring out what works for you in the treatment or how they are not administering the treatment properly. Lots of therapists are too proud to say they made a mistake (also anti-DBT) and instead blame others. I remember my therapist just saying things like, “I probably did not assess this well enough” and “I just got to find the ways in which you could get motivated to do … [whatever it was that she thought would be helpful].” I remember one time feeling like I was being talked out of DBT, and I was like…. what the heck? – and she said, ‘you know I’m just doing a technique that sometimes actually helps people commit to the treatment but it’s not working with you and I want you to know that I think I can help you in this.’ I was always being told what I was feeling made sense – because it does! When I learned to self validate my life became a heck of a lot easier. To me – that’s DBT – super validating. Anyway… in that way it worked. I don’t have the same problems nearly as bad as I ever did before.

    I remember my DBT therapist saying DBT and (her I guess too) believes things like – patients are doing the best they can, patients want to improve, etc. One of the things I was told is that DBT also has this belief that either the treatment fails (assuming it’s been administered properly) and/or the therapist fails – patients do not fail – so what did I have to loose?

    It really sucks when something that I have found so helpful sounds like it has been given so poorly to people. But… it’s probably like lots of things in health – you can have a doctor not be giving you the right thing or giving that thing to you incorrectly.

    Best wishes

    Reply
  10. I wish DBT had been around when I felt suicidal. I climbed and clawed my way out, after growing up with a parent w/BPD. I was hospitalized twice, attempted once. When I hit grad school, DBT had been out for a few years, and I decided to look into it. Since then, I’ve taught it for nearly 10 years, and have trained in many situations. I agree that LInehan comes off as impersonable, sarcastic, smarmy and a whole lot of other things. I think, because I have been there, I’m able to put a different feel to the groups I do. I can give perspective from both sides, and I think that helps.

    Are there people I can’t help? Sure. Are there people that DBT won’t fit for? Absolutely. For those people I’ve worked with who are ready for this type of therapy and are willing to immerse themselves in it, it seems to work well. Not everyone wants that, is ready for it, or is able to do it. I think we need to screen people for this better, and be more upfront about what it’s like and what is expected. I’ve also modified the “canon” DBT stuff a little bit to include a few things that I think need to be there – discussions of boundaries and “thinking traps” – AND I make sure to do it in a way that does not stigmatize. (Mainly because we ALL need this stuff – myself included.) I wrote an intro to DBT for people who want to know more, and I allow people a “get to know you session” for the group before they commit.

    One client told me that it feels like a cult. I have to agree with her – I think it can be very cultish, and I think we need to be careful of that. I think it’s very easy to fall into the “DBT will help you no matter what” mindset, and honestly, we can’t guarantee that. I let people know that it will help improve their chances of getting what they need, but that there are no guarantees. I also tell people that I can’t “fix” them – first of all, I couldn’t anyway, but more importantly, I don’t want to. I don’t think people I work with need fixing. I think validating their experiences, helping them find effective ways to live their lives, and letting them know that they’re not alone are critical. DBT helps with that – but so do a lot of other things. I don’t claim that DBT is a cure-all or a panacea. It’s one method of therapy that has helped a lot of people. A lot of people don’t like it, and that’s ok. I’d encourage those people to find something they feel more comfortable with and then do it – no therapy is a one-size-fits-all magic bullet,

    I think it helps, but again I’ve been on both sides of the equation. I wish it had been around for me when I needed it. As a therapist, I try to do it in a way that is inclusive, nonjudgmental, and validating. If it’s not that, then it probably won’t work.

    Reply

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