What Would Marsha Linehan Do?
I recently had the pleasure of completing an online DBT training course designed by Marsha Linehan, the founder of Dialectical Behavior Therapy (DBT).
I am not a mental health clinician, nor do I aspire to become one. I see myself more as a witness, facilitator, and coach for those I meet who share their story with us at Virgil Stucker and Associates (VSA).
Before we founded VSA in 2017, I worked for many years in direct care roles with adults facing down various mental health and addiction struggles. During those years, I felt called to reflect upon my own mental and emotional ups and downs. When you work with people who are themselves so vulnerable each day, you can't help but want to meet them from an authentic place in yourself as well.
This is an undertaking Linehan encourages of anyone working in mental health -- if you teach DBT, you should also live DBT. We all come to this work with unfinished business. It was in this sprit that I took Linehan's online DBT course early this Spring. I wanted to better understand the skills I saw so many people use and apply in their own lives. I wanted to try to internalize and apply some of those skills myself.
As I reflect on the course and think about the heart of the DBT philosophy, what spoke to me -- and what comes to mind first -- is the end objective of all the genius skills and hacks and techniques you learn: participation in your life. That is the end goal. Participation.
What is the opposite of participation? Absence. Disengagement. And isolation. Common company for mental illness and addiction.
Right now I am reading Dr. Gabor Maté's book, In The Realm Of Hungry Ghosts. His book - which I will review (and highly recommend!) in a future blog post - chronicles the extreme cases of addicted individuals he treats at a clinic in Vancouver, Canada. He is a visionary and someone who has witnessed many lives twisted by trauma, addiction, and mental illness. On page 29 of his book, he writes, "...the bare truth: people jeopardize their lives for the sake of making the moment livable."
This made me think about all the small ways I disengage or isolate myself from unlivable moments. Participation is hard.
All the little unlivable moments that happen to us cause us to develop defenses against future injuries and insults. For many, it can be the traumas of childhood that lead to addictive behaviors. For others, it is anxieties that prompt avoidance habits. Most of us are on a spectrum of avoidance and addiction as we attempt to deal with the regular challenges of everyday life. Setting those defensive impulses aside is hard work.
I found Linehan's objective of DBT to be moving and profound. Participation has nothing to do with symptoms or medications or diagnoses. Participation is key for all of us, no matter our path.
Participation is more than a passive showing up. It is an active engagement in ones own life. This end goal of DBT is an acknowledgement that our lives are one precious gift we're given. When I looked at my day or week from the perspective of participation, and rate myself, I felt surprised by all the ways I trade participation for a little relief from discomfort.
Marsha Linehan -- a clinician who, like Maté, has worked with thousands of individuals -- understands the extreme difficulty of participation for her patients. Surely, Maté and Linehan have seen people make countless mistakes and fail over and over. And yet, they both remain optimistic that participation in life is available to each of us, despite the extreme cases they have witnessed.
In his book, Maté writes, "The possibility of renewal exists so long as life exists. How to support that possibility in others and in ourselves is the ultimate question."
Linehan gives us a broad guide for how to approach our potential for participation and renewal. She begins her course outlining The Seven Assumptions of DBT, paraphrased here:
The Seven Assumptions of DBT
Everyone is doing their best.
All people want to improve.
All people need to do better, try harder, and be more motivated to change.
People do not cause their problems, but people have to solve their problems.
New behavior has to be learned in all relevant contexts and settings.
All behaviors are caused.
Figuring out cause is much better than trying to change via judgement or blame.
Linehan's online DBT course was a rich experience of insights, tips, techniques, research, and case studies. If you want to learn more about how to teach and practice mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness in yours or your patients lives, then I highly recommend this course. This blog post is an enthusiastic endorsement, and I have no financial or professional ties whatsoever to Psychwire or Marsha Linehan.
I have taken a lot of online courses - a lot. This was one of the best designed courses I have ever experienced - thanks to the variety of digital mediums used. There is a balanced combination of reading, listening, visuals, and engagement. The pace of the course was reasonable but demanding - you need to have time and space for reading, listening, and reflection to get the most out of the course.
If you have any course or book recommendations, drop me a line at email@example.com.