Ten: Marsha Linehan

Dr Marsha Linehan, renowned for her creation of a pioneering treatment for bpd, has spoken out about her own mental health difficulties. 

I was surprised, more at the revelation itself than her announcement of it.  Since I was first made aware of it maybe five years ago, I have held a rather disparaging attitude towards the therapy programme which became known as "DBT", or Dialectical Behaviour Therapy.  Primarily, my experience of this therapy took place during my admission to the Crisis Recovery Unit of the Royal Bethlem (Maudsley) Hospital.  The philosophy of DBT underpinned much of the work staff at the CRU tried to engage patients in, some more successfully than others.

It didn't work for me.  I resented what I saw as the "holier than thou" top-down way in which groups were conducted and the ward was run, and failed to see how I could be educated to better regulate my emotions when I felt I had perfect insight into my thought patterns and did not agree that splitting them off and beginning to change them could have any real impact on the way I felt.  Moreover, I was wary of the intentions and motives of the staff and was at times extremely defensive -  I was prone to "intellectualising" and could not resist getting into endless arguments over the logical fallacies I noticed in the cognitive exercises we were asked to perform.  I was (and still am) skeptical of the principle that changing behaviour can make profound and long-lasting changes to attitude and mood, particularly for people who have great difficulties with trust and find a six month admission period insufficient to form the relationships necessary to really engage in the work.  It is for this reason that I think the consistency and prolonged duration of psychotherapy has been most helpful in getting me to discover and examine parts of myself that lead me to self-destruct.

But back to Marsha.  Her admission that she had, as a young woman, struggled with the very difficulties she subsequently attempted to treat, made me wonder if I should reconsider my view of DBT.  At the very least, I am no longer able to understand it as the arrogant, proselytising model of good "health" I had so despised before.  I find it impossible to overstate the importance that feeling really heard and understood has for me in trusting someone enough to let them help me.  I am able to recognise this in psychotherapy, where A's integrity (or otherwise) is a constant feature in my assessment of our work.  That she has more or less consistently managed to sustain a genuine connection with me accounts in my opinion for much of the change she has helped me to achieve.   Since it is emotional work, I suppose it is unsurprising that "emotional" reactions not only to individuals but to treatment models themselves could play a large part in determining the responsiveness of patients, particularly those as wary as myself. 

This is well and good in hindsight. Unfortunately, at the time of my CRU admission, I was unable to recognise, or voice, the part of my frustration with the treatment that  emerged from distrust.  I only hope Marsha's courageous decision to speak out about her own experiences will help others to accept help, and feel less alone.