Marsha M. Linehan

(1943–).
An American psychologist who developed dialectical behavior therapy, an evidence-based, cognitive-behavioral therapy for treating severe mental disorders.

Marsha Linehan was born May 5, 1943, in Tulsa Oklahoma. The third of six children of an oilman and a socialite mother, she was a precocious child and an excellent student and pianist, but she was deeply troubled, constantly comparing herself to her attractive, talented siblings. No one took much notice until Linehan's senior year in high school when she became bedridden with headaches.

Indeed, Linehan survived a suicide attempt upon arriving back in Tulsa and a second after moving to a YMCA in Chicago. Following another hospitalization, she got a job as a clerk and began taking night classes at Loyola University and praying at a Catholic retreat center. An intense spiritual experience led to a transformative self-affirmation, which she later termed “radical acceptance.” Linehan earned her B.S. in 1968, her M.A. in 1970, and her Ph.D. in psychology in 1971, all from Loyola. “Radical acceptance” became a cornerstone of her work as a clinical intern at a suicide clinic in Buffalo, New York, and later as a researcher.

During a postdoctoral program in behavioral modification at the State University of New York, Stony Brook, Linehan began developing her ideas for the behavioral treatment of severely suicidal patients: an acceptance of life as it is and the need to change in spite of and because of that reality. She set out to test her ideas on people whose suffering she understood so well—those with borderline personality disorder (BPD), the diagnosis she would have given herself as a young woman. BPD is a poorly understood mental disorder characterized by neediness, emotional outbursts, self-harm, and suicidal urges. It carries a suicide rate 8%–10% and is notoriously difficult to treat. Linehan's therapy centered on patients’ acceptance of themselves and their intense emotions and the therapist's acceptance of their self-harm and suicide attempts as reasonable responses to their reality, with patients eventually committing to change their behaviors.

Dialectical behavior therapy

After several years on the faculty of The Catholic University of America, Linehan moved to the University of Washington (UW) in 1977. She continued to have panic attacks and suicidal urges during her first years in Seattle and came to realize that acceptance and change were not enough. Her treatment, which became dialectical behavior therapy (DBT), also required development of daily skills. She borrowed some components from other behavioral therapies and made significant additions of her own: “opposite action,” which requires acting opposite to one's feelings if the emotion is inappropriate; and Zen mindfulness meditation, which involves focusing on the breath and observing the emotions without acting on them. For the latter, Linehan trained under Gerald May and Tilden Edwards and became an associate Zen teacher at two schools.

“Dialectical” refers to the integration of “opposites” —acceptance and change. DBT deals with stabilization and behavioral control in the following sequence:

There are four stages to DBT treatment, with the above components forming the basis of stage 1 therapy:

Linehan has practiced clinical psychology since 1974 and has been a medical staff member of the UW University Hospital since 1981. In 1998, she founded the Linehan Institute of Behavioral Technology. The Institute owns Behavioral Tech LLC, founded by Linehan to develop effective models for transferring evidence-based treatments from research to the clinic. It trains mental healthcare providers and treatment teams to work with patients suffering from severe and complex disorders.

Linehan has been a professor of psychology and adjunct professor of psychiatry and behavioral sciences at UW since 1989. As of 2015, she was director of the UW Behavioral Research and Therapy Clinics, a consortium of research projects developing new treatments and evaluating their efficacy for severely disordered and multi-diagnostic and suicidal populations. Linehan also teaches mindfulness at workshops and retreats for healthcare providers. The primary focus of her research is the application of behavioral models to suicidal behaviors, drug abuse, and BPD and the development of models for the transfer of science-based treatments to the clinic. Her research has been grant-supported since 1974, including many grants from the National Institute of Mental Health, as well as the National Institute on Drug Abuse. Linehan is the author of hundreds of journal articles and book chapters and has authored or edited several books and manuals that have been translated into various languages. She has given countless conference presentations, workshops, and invited addresses and lectures and has served on the editorial boards of various journals. She also has served on boards and as an officer for several professional organizations. Her numerous honors and awards include the 2014 James McKeen Cattell Award of the Association for Psychological Science, for her lifetime contributions to psychology and mental health research. The American Association of Suicidology established the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior. Linehan shares a home with her adopted daughter.

See also Borderline personality disorder ; Cognitive-behavior therapy.

Resources

BOOKS

Lineham, M. M. DBT Skills Training Manual. 2nd ed. New York: Guilford, 2014.

Lungu, A., and M. M. Linehan. “Dialectical Behavioral Therapy: A Comprehensive Multi-and Trans-Diagnostic Intervention.” In The Oxford Handbook of Cognitive and Behavioral Therapies, edited by C. M. Nezu and A. Nezu. New York: Oxford University, 2015.

Miller, A. L., J. H. Rathus, and M. M. Linehan. Dialectical Behavior Therapy for Suicidal Adolescents. New York: Guilford, 2007.

Neacsiu, A. D., M. Bohus, and M. M. Linehan. “Dialectical Behavior Therapy Skills: An Intervention for Emotion Dysregulation.” In Handbook of Emotion Regulation. Vol. 2, edited by J. J. Gross. New York: Guilford, 2013.

Neacsiu, A. D., and M. M. Linehan. “Dialectical Behavior Therapy for Borderline Personality Disorder.” In Clinical Handbook of Psychological Disorders: A Stepby-Step Treatment Manual, edited by D. Barlow. New York: Guilford, 2014.

Ward-Ciesielski, E. F., and M. M. Linehan. “Psychological Treatment of Suicidal Behaviors.” In The Oxford Handbook of Suicide and Self-Injury, edited by M. Nock. New York: Oxford University, 2014.

PERIODICALS

Beckstead, D. J., et al. “Dialectical Behavior Therapy with American Indian/Alaska Native Adolescents Diagnosed with Substance Use Disorders: Combining Evidence Based Treatment with Cultural, Traditional and Spiritual Beliefs.” Addictive Behaviors 51 (2015): 84–7.

Langreth, Robert, and Rebecca Ruiz. “The Forgotten Patients.” Forbes (September 13, 2010): 32–6. http://depts.washington.edu/brtc/files/Forbes2010.pdf (accessed August 22, 2015).

Linehan, M. M., and C. R. Wilks. “The Course and Evolution of Dialectical Behavior Therapy.” American Journal of Psychotherapy 69, no. 2 (2015): 97–110.

WEBSITES

Behavioral Tech. http://behavioraltech.org/index.cfm (accessed August 22, 2015).

Carey, Benedict. “Expert on Mental Illness Reveals Her Own Fight.” New York Times (June 23, 2011). http://www.nytimes.com/2011/06/23/health/23lives.html?_r=3 (accessed August 22, 2015).

The Linehan Institute. http://www.linehaninstitute.org (accessed August 22, 2015).

“Marcia M. Linehan, Ph.D., ABPP.” University of Washington. August 4, 2015. http://blogs.uw.edu/linehan (accessed August 22, 2015).

“What is DBT?” The Linehan Institute/Behavioral Tech. http://behavioraltech.org/resources/whatisdbt.cfm (accessed August 22, 2015).