Thursday, March 3, 2011

My Training with Marsha Linehan

DBT
Marsha Linehan.
I had the privilege of studying under Marsha Linehan in Seattle, Washington at the University of Washington. She is a brilliant behaviorist and also an unashamed Buddhist. And I am an unashamed evangelical Christian. Our world and life views clash, especially when it comes to absolute truth. Linehan holds that truth is always changing. It consists of a thesis, an antithesis and then a synthesis. Philosophically, Linehan and I differ as far as the Bible being absolute truth; but I have been able to understand certain dialectics that exist in the treatment of Borderline Personality Disorder such as:

 Emotional Vulnerability v. Self-evaluation
 Active Passivity v. Apparent Competence
 Unrelenting Crisis v. Inhibited Grieving
Linehan, Dr.Marsha; Cognitve Behavioral Treatment of Borderline Personality Disorder, (New York, London: Guilford Press, 1993) p. 67 figure 3:1.
Her skills training manual is outstanding.When I teach mindfulness to my borderline clients who are Christians, I concentrate on the reflective wisdom books, especially the Psalms.
The God of the Bible is a Loving, Holy God who makes Himself known to those who receive Jesus Christ as Savior (John 1:11, 12).
In the Old Testament He is known as El-Shaddai, Jehovah and One who is a Strong Refuge for those who know Him and seek His help. In the New Testament He is the Father of Mercies and the God of all Comfort (2 Corinthians 1) who comforts His children in all their troubles, afflictions and in their darkest hours.I believe that the God of the Bible, as made known through His Son, Jesus, by the Holy Spirit is far superior to any religion; having said that when I do DBT therapy and teach skills training I constantly use the DBT approach

What about Dialectical Behavior Therapy (DBT)?
Steve is a certified DBT therapist; actually, he was personally instructed in DBT by Dr. Marsha Linehan. He and a coworker were the first in the area to set up and run a DBT group. It was very successful for a number of years.Steve also has done personal therapy with scores of those who suffer Borderline Personality Disorder. He subsitutes some of the Budist principles which are inherent in DBT with Christian priniciples of biblical meditation and contemplation.
At this point, Steve is considering opening a DBT group in which would be on line using Google Earth.He also has success in doing DBT phone therapy.
Please call me at 616.427.0775 or email me at camimovement@yahoo,com


Borderline Personality Disorder
The main tenet of the bio-social theory is that the core disorder in Borderline Personality Disorder is emotion dysregulation. Emotional dysregulation is viewed as a joint outcome of biological disposition, environmental context, and the transaction between the two during development.
The theory asserts that borderline individuals have difficulties in regulating several, if not all, emotions. The systemic dysregulation is produced by emotional vulnerability and by maladaptive and inadequate emotion modulation strategies. (Linehan, Marsha, Skills Training Manual for Treating Borderline Personality Disorder. (1993) New York, London, Guilford Press}, p.2
What about Dialectical Behavior Therapy (DBT)?
Steve is a certified DBT therapist; actually, he was personally instructed in DBT by Dr. Marsha Linehan. He and a coworker were the first in the area to setup and run a DBT group. It was very successful for a number of years.Steve also has done personal therapy with scores of those with Borderline PersonalityDisorder. He substitutes some of the Buddhist principles which are inherent
in DBT with Christian principles of biblical meditation and contemplation.At this point, Steve is considering opening a DBT Group in Palm Beach County, FL. He also has success in doing DBT phone therapy.
Pretreatment targets orientation to treatment and agreement on goals.
First stage targets
1. Decreasing suicidal behaviors
2. Decreasing therapy-interfering behaviors
3. Decreasing quality-of-life-interfering behaviors
4. Increasing behaviors skills
A. Core mindfulness skills
B. Interpersonal effectiveness skills
C. Emotion regulation skills
D. Distress tolerance skills
E. Self management skills
Second stage targets
5. decreasing post-traumatic symptoms
Third stage targets
6. Increasing respect for self

Table 5.2 Linehan Behaviors that Interfere with Quality of Life

1. Substance abuse (examples “alcohol drinking; abuse of illicit or prescription drugs).

2. High risk or unprotected sexual behavior (examples: unsafe sex practices; abusing others sexually; excessively promiscuous sex; sex with inappropriate persons).

3. Extreme financial difficulties (example: overwhelming unpaid bills, difficulties in budgeting; excessive spending or gambling; inability to manage public assistance agencies).

4. Criminal behaviors that if not changed may lead to jail (examples: shoplifting; setting fires).

5. Serious dysfunctional interpersonal behaviors (examples: choosing or staying with physically, sexually, and/or emotionally abusive partners; excessive contact with abuse relatives; ending relationships prematurely; making other people feel so uncomfortable that few friends are possible; incapacitating shyness or fear of social disapproval).

6. Employment or school related dysfunctional behaviors (examples: quitting jobs or school prematurely; inability to look for or find a job; fear of going to school or school related work; inappropriate career choices; getting fired or failing in school excessively.

7. Illness-related dysfunctional behaviors (examples: inability to get proper medical care; not taking necessary medications; overtaking medication; fear of physicians; refusal to treat illness.

8. Housing related dysfunctional behaviors (examples; living in shelters, in cars, or in overcrowded housing; living with abusive or incompatible people; not finding stable housing engaging in behaviors that cause evictions or rejections from housing possibilities)

9. Mental Health-related dysfunctional behaviors (examples: going into psychiatric hospitals; shopping; not finding ancillary treatments.)

10. Mental-disorder-related dysfunctional behaviors (examples: behavior patterns that meet criteria for other severe or debilitating Axis I or Axis II behaviors in the DSM IV manual.
If you are interested in DBT counseling from a certified DBT therapist please go to the link below