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Marsha Linehan, PhD

"We are better off accepting what life has to offer, rather than living under the tyranny of having to have things we don't yet have.”

Influence on SDC Framework Focus

Linehan’s emphasis on embracing the present while recognizing that growth requires change has shaped the Self-Directed Change Framework's® guiding principles.

Her influence is reflected in the SDC graphic, “Begin with the End in Mind - Mapping the Territory,” which incorporates the concept of “5 Key Strategies that Ensure Success.” These strategies: Learn Mindful Awareness, Build Distress Tolerance, Increase Emotional Self-Regulation, Enhance Interpersonal Skills, and Commit to Structure & Practice, all draw heavily from Linehan’s work.

A poster of this helpful graphic along with a short training (coming soon) can be found in the ChangeWorks Bookstore. Look for it in the Structure of Experience section of the “ChangeWorks Collection.” Find it here. 

For an even closer look, add Dr. Linehan’s Building a Life Worth Living: A Memoir and other works to your library today. Find it here in the ChangeWorks Bookstore.

Key Contributions and Concepts

Dr. Marsha Linehan is a psychologist and researcher best known for developing dialectical behavior therapy (DBT), a treatment originally designed for individuals with borderline personality disorder (BPD). Her work has provided an evidence-based approach to address complex emotional and behavioral dysregulation. 

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a structured, evidence-based psychotherapy developed by Dr. Marsha Linehan in the late 1980s. Originally designed to treat individuals with borderline personality disorder (BPD) and chronic suicidality, DBT has since been adapted to address a wide range of mental health issues, including mood disorders, eating disorders, and substance use disorders. DBT combines cognitive-behavioral therapy (CBT) techniques, mindfulness practices, and a dialectical philosophy that balances acceptance and change.

DBT consists of four treatment components that provide comprehensive support to clients:

  • Individual Therapy: A one-on-one therapeutic relationship where the client works to identify and address specific challenges, with an emphasis on understanding and changing problematic behaviors.
  • Skills Training Groups: Group sessions focus on teaching clients practical skills in four core areas—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
  • Phone Coaching: Therapists provide real-time support to help clients apply DBT skills during crises or challenging situations.
  • Consultation Teams: Designed for therapists, these teams offer professional support, reduce burnout, and maintain adherence to DBT principles.

The primary goal of DBT is to help clients build a life they consider worth living. This is achieved by addressing four key areas:

  • Reducing self-destructive and high-risk behaviors,
  • Increasing mindfulness and self-awareness,
  • Improving emotional regulation and distress tolerance, and 
  • Enhancing interpersonal relationships.

A defining feature of DBT is its emphasis on balancing acceptance (validating the client’s experiences and emotions) with change (helping clients adopt new strategies to address challenges). This dialectical approach cultivates a collaborative and compassionate therapeutic relationship while empowering clients to work toward meaningful transformation.

Mindfulness Skills

 Mindfulness skills are a fundamental aspect of DBT. These skills are used to enhance clients' ability to regulate emotions, tolerate distress, and improve interpersonal effectiveness. In DBT, mindfulness focuses on practicing present moment awareness without judgment, which helps clients break patterns of automatic reactions and develop more adaptive responses to challenging situations. DBT mindfulness practice includes for example: 

  1. Observing thoughts, emotions, and sensations,
  2. Describing experiences using factual language,
  3. Participating fully in activities, 
  4. Practicing non-judgmental awareness,
  5. Focusing on one thing at a time, and 
  6. Doing what works in each situation.

Distress Tolerance Skills

Distress tolerance skills in DBT are techniques designed to help individuals cope with intense emotional pain and difficult situations without engaging in harmful behaviors. These skills focus on accepting reality as it is and finding ways to survive crises without making things worse. They have been conceived to contribute to increased emotional stability and provide a foundation for longer-term change and growth.

 

Distress tolerance skills include several specific techniques:

  1. TIPP skills (temperature, intense exercise, paced breathing, paired muscle relaxation),
  2. Distraction techniques (ACCEPTS: activities, contributing, comparisons, emotions, pushing away, thoughts, sensations),
  3. Self-soothing using the five senses,
  4. Improving the moment (IMPROVE: imagery, meaning, prayer, relaxation, one thing in the moment, vacation, encouragement),
  5. Pros and cons analysis, and 
  6. Radical acceptance.

Emotion Regulation Skills

In dialectical behavior therapy (DBT), emotional regulation is a core component that helps clients develop a healthier relationship with their emotions. Through targeted skills training, clients learn to identify, understand, and effectively manage their emotional experiences. The primary goals of emotional regulation in DBT are to improve control over emotional responses, reduce the intensity of negative emotions, enhance the ability to experience positive emotions, decrease emotional vulnerability, and learn to experience emotions without becoming overwhelmed.

By consistently practicing these skills, clients often experience significant improvements in their emotional well-being. The benefits typically include enhanced mood stability, reduced impulsivity, and a greater overall sense of well-being. Ultimately, mastering emotional regulation empowers clients to navigate their emotional landscape more effectively, leading to more balanced and fulfilling lives.

Interpersonal Effectiveness Skills

Interpersonal effectiveness in DBT focuses on improving relationships and communication skills. These skills are used to help clients navigate social interactions more effectively, assert their needs, set boundaries, and maintain healthy relationships. Improving interpersonal effectiveness involves balancing priorities, wants, and needs with maintaining relationships and self-respect. Interpersonal effectiveness skills include:

  1. DEAR MAN skills for objective effectiveness (describe, express, assert, reinforce, mindful, appear confident, negotiate);
  2. GIVE skills for relationship effectiveness (gentle, interested, validate, easy manner); and 
  3. FAST skills for self-respect effectiveness (fair, apologies, stick to values, truthful).

Significance and Impact: Interpersonal effectiveness skills play a crucial role in helping clients improve their relationships and social functioning. These skills contribute to reduced conflict, increased social support, and improved self-esteem.

Behavior Chain Analysis

Behavior Chain Analysis is a structured technique used in DBT to examine the sequence of events leading to and following problematic behaviors. This method helps clients understand the complex interplay of thoughts, emotions, and actions that contribute to their difficulties. By systematically breaking down the chain of events, clients can identify key points for intervention and develop more effective coping strategies. Through this detailed analysis, clients gain insight into their behavioral patterns and learn to recognize opportunities for change, ultimately developing more adaptive ways of responding to challenging situations.

Biography

Marsha Linehan was born the third of six children in Tulsa Oklahoma. As a child she did well in school, but in her teenage years she struggled with depression, low self-esteem, and self-harming and was diagnosed with schizophrenia. She spent two years as a patient at the Institute for Living in Hartford, Connecticut. Later in life, she said that her difficulties were more closely aligned with borderline personality disorder (BPD) than schizophrenia.

After she was discharged from the Institute Marsha Linehan committed herself to rebuilding her life. She studied psychology and received a bachelor’s degree in 1968, an M.A. in 1970, and a PhD in clinical psychology in 1971 all from Loyola University in Chicago. Her doctoral research focused on behavior therapy and understanding the role of reinforcement in shaping behaviors.

Following her graduation, she took a post-doctoral internship from 1971 to 1972 at The Suicide Prevention and Crisis Service in Buffalo, New York, followed by a Post-Doctoral fellowship in behavior modification at Stony Brook University. Marsha Linehan then went back to Loyola University from 1973 to 1975 as an adjunct professor. During this time she was also an adjunct professor in psychology at the Catholic University of America in Washington, D.C. where she did research on suicidal behaviors, self-harm, and treatment strategies for patients who were thought to be “treatment-resistant.”

In 1977, Linehan joined the faculty at the University of Washington as an adjunct assistant professor in the Psychiatry and Behavioral Sciences Department.  She retired from the University of Washington in 2019 where she was the Director of Behavioal Research and Therapy Clinics, a consortium of research projects developing and evaluating treatments for severely disordered and multi-diagnostice and suicidal populations. 

While at the University of Washington, Linehan developed dialectical behavior therapy (DBT), which incorporates acceptance and mindfulness. She frequently used her own experiences of mental illness for study. Her research was primarily in borderline personality disorder, the application of behavioral models to suicidal behaviors, and drug abuse. 

Marsha Linehan’s contributions extend beyond the development of DBT. She has reshaped how clinicians and society view mental health struggles, particularly in individuals who have often been misunderstood or marginalized. Her work continues to evolve and inspire, providing tools for healing and growth worldwide.

Marsha Linehan is a devout Catholic and a practitioner and teacher of Zen Buddhist meditation. 

Helpful resources about Dr. Linehan and DBT can be found at: 

https://depts.washington.edu/uwbrtc/our-team/marsha-linehan/

Book Store

 

Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993; Guilford Press)

  • This seminal work presents the theoretical and practical foundations of DBT for treating BPD.

Skills Training Manual for Treating Borderline Personality Disorder (1993; Guilford Press)

  • This manual provides detailed instructions for implementing DBT skills training.

DBT Skills Training Manual, Second Edition (2014; Guilford Press) 

  • This updated version offers comprehensive resources for implementing DBT skills training, including expanded content and new skills.

Building a Life Worth Living: A Memoir (2020; Random House) 

  • Linehan's autobiography details her personal struggles with mental health and the development of DBT.