Contents



Lessons from LinehanTranscript of audio at: James14 April 2018 Contents TOC \h \u \z <Introduction> PAGEREF _Toc511471282 \h 3<Linehan’s Story> PAGEREF _Toc511471283 \h 3<Dialectics> PAGEREF _Toc511471284 \h 5<Impact of Linehan’s Work> PAGEREF _Toc511471285 \h 5<How DBT Developed> PAGEREF _Toc511471286 \h 6<DBT Skills Groups> PAGEREF _Toc511471287 \h 7<Mindfulness> PAGEREF _Toc511471288 \h 7<Interpersonal Skills> PAGEREF _Toc511471289 \h 8<Emotion Regulation> PAGEREF _Toc511471290 \h 8<Distress Tolerance> PAGEREF _Toc511471291 \h 9<Science> PAGEREF _Toc511471292 \h 9<Heart and Soul of DBT> PAGEREF _Toc511471293 \h 10<Unorthodox Approach> PAGEREF _Toc511471294 \h 12<Who DBT is For> PAGEREF _Toc511471295 \h 12<Influence of Willigis J?ger> PAGEREF _Toc511471296 \h 13<Who is Linehan> PAGEREF _Toc511471297 \h 14<Proudest Achievement> PAGEREF _Toc511471298 \h 14<An Encounter> PAGEREF _Toc511471299 \h 14<More to Do> PAGEREF _Toc511471300 \h 15<Signing Off> PAGEREF _Toc511471301 \h 15References PAGEREF _Toc511471302 \h 17 <Introduction>The treatment of people at high risk of suicide is an area that has not in general been popular with researchers. But it’s a field that American psychologist Dr Marsha Linehan has devoted her life to. A few years ago, she gave a round of interviews, following a talk in which she disclosed something she had kept under wraps throughout her professional life. The dark, personal past that she revealed had ironically propelled her into a stellar career. In this programme, I want to explore the therapy she developed; to uncover how she came to create it; to find out who inspired her, what she is most proud of - and what she still hopes to achieve.<Linehan’s Story>But first, let’s return to the talk she gave which caused such a media stir. According to those present, Linehan, an accomplished speaker, was teary and poised that day[1]. She spoke about it to Matthew Bannister for the BBC programme Outlook:[0:57]I did just about everything I could think of to get out of it. But, at the end of the day, I realised that I just could not die a coward. If it hadn’t been for that, I would have not ever said a word. [2] She told the story of her own mental illness as a teenager back in the early sixties. She had become socially withdrawn and then bedridden with headaches. Eventually, she was sent to a psychiatric hospital. There, she was confined to a seclusion room - a small cell with a barred window. Self-harming and suicidal, she was heavily sedated and subjected to electric shock treatment. Her notes record that for most of the twenty-six months she was there, she was one of the hospital’s most disturbed patients.It was in Linehan’s resolve to recover that the seeds of her career were sown. And half a century later, she hoped and believed that sharing her experience could help others to see that recovery was possible. From her Outlook interview again:[1:57]Well, I’ve always been very spiritual all my life … and so while I was in the Institute of Living - which was the hospital I was in … I made a vow to God that I would get out of hell - so that was step one - and when I got out, I’d go back and get others out. And probably more than anything else in my life, the belief that I could get others out if I could get out gave me a focus for my life. [3] And it was to the Institute of Living, in Hartford, Connecticut, that Linehan had returned to reveal the suffering she had endured within its walls.It’s not unusual to make a dramatic resolution in a testing time, as the teenage Linehan had done. What has been impressive has been the dedication of her follow-through. She went on to pursue treatment development research with an astonishing fixedness of purpose and without apparently ever losing sight of her original goal.'The treatment I developed actually has its focus as building lives worth living,'[4] she said last year when she sat down to record a series of videos for the website Borderliner Notes. 'We’re not a suicide prevention programme - we’re a life worth living programme.'The dedication in the front of her 2014 book of worksheets reads: When I am on retreats, each afternoon I walk and wring my hands, saying to all the mental health patients of the world: ‘You don’t have to wring your hands today. I am doing it for you.’ Often when I dance in the hallway of my house or with groups, I invite all the mental health patients of the world to come dance with me. [5] Linehan is a woman of passion, comfortable in her own skin; a dedicated scientist and a compelling speaker on a mission to communicate what she is about.She grew up in Tulsa, Oklahoma, and, after her recovery, went to Loyola University in Chicago where she studied psychology, preferring it to medicine and psychiatry because of the greater emphasis on research training. She wanted to be sure that the treatment methods she was learning and developing actually worked. [6] For the past forty years, she has been a professor at the University of Washington in Seattle. Approaching her seventy-fifth birthday, and with four lifetime achievement awards among the dozens of honours that have been bestowed on her, she is still actively teaching and researching. She spoke to Family Action Network in 2015 about the passion that has driven her:[4:36]It was high risk for suicidal behaviour that my heart was set on and the idea was to get people out of hell. A person that wants to be dead one can think of as already in hell and what they are trying to do is get out of hell. My job is to climb down with them and get them out. I don’t bring them out; I get behind them and teach them how to walk the steps out of hell. I consider it sort of teaching people how to climb a ladder. [7]<Dialectics>Her reticence to disclose her own early struggles over the course of her career contrasts with her characteristic candour. But then, a dialogue of opposites - referred to as dialectics - is a defining characteristic of the therapy she invented: Dialectical Behaviour Therapy, or DBT. Accepting tensions between opposites has allowed Linehan for instance to base DBT both on the assumption that everyone is doing the best they can and also that everyone has to do better. The implied conflict is something she refers to as ‘a little dialectical difficulty’. She offered an explanation of dialectics in a lecture published in 2014 by BehavioralTech, the company she founded, entitled Teen Extremes: Regulating Moods in the Age of Anxiety:[5:54]The reason the treatment is called dialectical behaviour therapy is because dialectics has to do with bringing about synthesis of opposites. It’s based on the idea that for everything that exists the opposite exists, and that in any conflict, you have to look for the synthesis of opposites and find how to bring things together. [8]<Impact of Linehan’s Work>Michael Maslar of Northwestern University introduced her at the Family Action Network event, saying: Decades ago, when Dr Linehan first started her work on DBT, she cast a stone into the water and the ripples have been expanding ever since. If you stay with DBT, it works its way into your life and into your very being. [9] DBT has its detractors and is sometimes referred to, affectionately or otherwise, as ‘Diabolical’ Behaviour Therapy. There are thousands across the globe, however, who have embraced it. T-shirts are bought emblazoned with the slogan: Marsha Linehan is my homegirl.One grateful DBT recipient is Selena Gomez - the young woman who tops the Instagram charts with 150 million followers - which would surely challenge anyone’s mental health. When the intensity of that limelight became too much for Gomez, she took a three month break and told Vogue last March that, during that time, DBT had completely changed her life.<How DBT Developed>It was back in the late 1970’s that Linehan first began developing her treatment. She was a zealous advocate of behaviour therapy and set out to use it. But, initially, things did not go to plan - she described her first trial, in fact, as a catastrophic event. This from a lecture she gave at The University of Washington in 2007:[7:46]So what happened was, I came in with my focus on change to a person who’s extremely upset. So imagine yourself when you’re at your most upset - when someone then comes in and, rather than listening to you, validating you, soothing you, or saying: ‘Yeah, that’s really awful,’ says: ‘OK, let me help you change right this minute.’Which is essentially what happened. At which point arousal went up, sense of being out of control went up and the high arousal, out of control meant no learning, no collaboration. So this was a shock, but, ever flexible, I switched to acceptance. Except that when I went to acceptance the very same thing happened. The more acceptance I did, it was like:‘Wait a minute, you’re not validating my pain - you’re accepting my pain. If you knew how bad it was you would try to help me.’And I’d say: ‘Don’t worry, I will. Let me go to change.’I’d switch back to change, at which point I’d have to switch back to acceptance. And I’m going back and forth and back and forth … and what came out of that was a treatment that actually was developed to balance acceptance with change - where the therapist had to actively accept the client where they were - and with suicidal clients accept the unbelievable risk that you are sitting there with. So the therapist had to practice acceptance while at the same time, and really simultaneously, focussing on helping the client change. [10] She found that she needed a spaciousness of mind, as she puts it; the ability to dance with the client with movement, speed and flow.Other psychologists, such as Carl Rogers, had already recognized that when therapists accepted their clients as they were, therapy went better. Linehan was now integrating this approach into behaviour therapy – and she wanted to go further, by helping clients to accept the challenging reality they often experienced. But this was not going to be easy, since she realized that she was not herself always able to accept, in the moment, the reality of her own life. Her response to this challenge was to take a sabbatical and go on retreat for six months. She started at Shasta Abbey in California, where she fell into a Buddhist monastic routine, accepting and dropping chores as instructed, and so practicing putting her own desires aside. Then, at a Benedictine monastery in Germany, she developed a deeper understanding of so-called ‘radical acceptance’, which she describes as acceptance with mind, body and soul.In Borderliner Notes, she shared how this influenced her therapy: [10:44]I try to teach clients suppressing what you want is not the way to go. You have to radically accept that you want something you don’t have and it’s not a catastrophe. I am now convinced that it is the practice of radical acceptance every moment that will transform you - I don’t have the slightest doubt it would transform everyone. But it has to be a regular practice. And radical acceptance doesn’t mean that you don’t try to change things, because you only have to radically accept the moment that you’re in and the past - but you can try to change the next moment. But I think it’s hard to change something if you don’t accept it in the first place. [11]<DBT Skills Groups>Within DBT are four sets of skills: mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.<Mindfulness>John Cabot-Zen had integrated the concept of mindfulness into medical treatment, and, following her sabbatical in 1985, Linehan lead the way in integrating it into psychotherapy, making it the core skill in DBT. Here is what she had to say in her Teen Extremes talk:[11:52]The first part is learning just to be in this one moment. Because so much suffering is from the future and the past, I say to patients all the time: ‘Listen, this is enough suffering. Listen, you can’t suffer the past, it’s too much, the present’s enough … and then you go into the future and you start suffering the future - that is way too much suffering for any person. So we gotta get you down to just suffering this one moment.’[12] Mindfulness, DBT style, means learning to observe without interpretation, to describe and to participate. She explains why participation is important:[12:32]Then we have participating, which is learning how to throw yourself in and become one with. All of my clients, almost without exception, experience themselves as outsiders or as disconnected from others. But everybody is connected, that’s a myth - we’re all connected. The problem is getting people to experience they’re connected. So we do a lot of work on that by getting people to throw themselves in, become one with etc. [13] No one could accuse Linehan of not participating. Not only does she throw herself wholeheartedly into teaching and lobbying, but she can also be found singing and high kicking in cowboy boots on stage at conferences when the opportunity presents.She shared another insight about mindfulness at the Awakening to Mindfulness conference in San Diego in 2009, when she said: ‘It’s important to keep in mind that we’ve really made a mistake when we’ve started to equate mindfulness with meditation. Meditation is the path to mindfulness but the goal is mindful living.’<Interpersonal Skills>The interpersonal effectiveness skills in DBT were added because Linehan found that many of her clients were not able to ask for what they wanted. She therefore offers tools to help communicate needs - without harming the relationship and without losing self-esteem.<Emotion Regulation>Next are the skills for regulating emotions. Linehan points out that emotions function not only to communicate, but also to urge us to action, which is why, when emotions are dysregulated, we can run into trouble. Awareness of feelings has been shown in itself to be regulating, so if you want to destress, learning to notice your own internal reactions and responses is a good place to start.<Distress Tolerance>Finally, come distress tolerance skills. She spoke about the purpose of these in a lecture at the University of Washington in 2016:[14:26]The next problem was: I discovered that my clients had very low distress tolerance, frequent crisis, high arousal - and it made sustained work on anything almost impossible. At the time I was developing this, distress tolerance was not a topic of research unfortunately - coz I would have just stolen all that research and used it. I treat patients who have the most unbelievably tragic pasts that you could possibly imagine. I had to teach them distress tolerance, which is basically the ability to tolerate distress without impulsively moving to suicide or other destructive behaviours. The average suicidal person also, and particularly the ones I was treating, often feels they are alone, they feel lonely - that’s one of the major problems - they feel unconnected, unrelated, not loved by anyone, not acceptable, they have extraordinary amounts of shame … so I realised that I had to teach them to experience on their own their connection with others and the universe and their essential goodness … and also their essential validity, which means they too have a right to raise their hand and ask a question. They belong on this earth just like the rest of us do. [14]<Science>Linehan published her first treatment manuals in 1993[15] [16], but didn’t feel her work was done. In an interview for the film Treating Borderline Personality Disorder, she said candidly:'We have to be completely clear about something - which is that this treatment is not very good. It’s the best, but it’s not good.'A keen advocate of scientific method, she continued to run trials to refine DBT. Years later at that 2016 Washington lecture she joked: ‘The minute new research comes out I just change my theory, so that’s how I keep up.’She spoke about her passion for science to Borderliner Notes:[16:25]I’m a big believer in evidence-based treatment. In other words, I’m a believer in having treatments that have been found in scientific investigations to actually be effective ... The problem with psychological interventions is that historically they have been viewed as more art than science. Medicine at one point was also viewed as more art than science and medicine went from art to science ... It’s just a battle that we haven’t won yet ... [17] There was also a pragmatism in embracing science. Some DBT practices were unorthodox - such as not hospitalising suicidal patients. Here she is in 2015 talking to the Association of Psychological Scientists, the APS: [17:13]We took inpatient way down and simultaneously got fewer suicide attempts. So that to me is a powerful statement that we’ve got to move to outpatient treatment for suicidal behaviour. And we have to figure out a way to deal with the fear of psychotherapists. And the only way we’re going to deal with the fear of psychotherapists is to have enough data that we can defend them in court … Data is our salvation. The reason I don’t worry that much, I tell my students all my time, I say look - when I go to court I will show the data.[18]<Heart and Soul of DBT>She describes DBT as, at its heart and soul, a problem-solving treatment, with validation - validation being the recognition and acknowledgement by the therapist of any nugget of wisdom and good sense within the client’s response. It is the main tool the therapist has for demonstrating acceptance.‘It’s not about validating the invalid,’ she told NEABPD [19], in 2009. ‘It’s based on the premise that it is there. And so far, when I’ve looked, I’ve found it.’Like most other DBT skills, validation is offered equally to both therapist and client. Clients learn how to validate others as part of DBT’s interpersonal effectiveness module, and also how to recover from the effects of being invalidated, i.e. from verbal put-downs. Among the other skills that DBT incorporates are willing hands - the upturning of your palms on your lap which makes anger mysteriously difficult to sustain; mnemonics for self-care and mnemonics for having constructive conversations; templates for problem solving, and templates for evaluating pros and cons. Linehan has, in fact, a raft of tips and tricks up her sleeve - I counted around seventy - collected, magpie-like, over the course of her life. She has documented, meticulously, not only the skills themselves but also how to teach them. In 2014 she spoke to the American training organisation NICABM and described how she motivates clients:[19:18]You’re functioning now as a salesperson and you’re trying to sell a new behaviour to the client. And to sell behaviour, you’ve got to have a rationale for why in the world it would be effective and why it’s going to help them. It’s like selling cars, except you’re selling behaviour. Therefore, you have to have a good story of why it would work. You can give experiences of yourself - of how it worked with you or how it’s worked with other people that you’ve worked with … Often the problem is that what you are asking of the client is painful or difficult ... Most people need to be sure that you understand their excruciating pain and how difficult everything is and the minute you start acting like things are easy to do, you’ve lost.[20] The threads that connect DBT to and from other therapies and philosophies are numerous. Linehan cheerfully admits that she has imported skills as needed from other sources - particularly evidence-based behavioural therapy treatments and mindfulness. ‘I stole every one of them,’ she said in her APS talk. [21] ‘The reason DBT is good is because I steal from the best. But you know,’ she added, ‘you have to be smart to know who the best is, so that’s not bad.’The fact that DBT is a framework which pulls in from elsewhere has allowed it to adapt. Presented as skills training, it is positive and nonjudgmental. At the Awakening to Mindfulness Conference, Linehan said:‘What teaching a skill does for you is it gets a client to see it as practice and something they can learn ... as opposed to something they should already be able to do.’In Borderliner Notes, she spoke about the therapist/ client relationship.[20:55]I’m very against the notion that therapy is re-parenting. The whole one-up one-down I’m very against. That’s why we talk so much about therapists having humility and the transactional nature of therapy - that not only are therapists influencing clients, but clients are influencing therapists and it’s a back and forth influence …. It’s a relationship of equals. [22]<Unorthodox Approach>Developing a therapy of her own gave Linehan some freedom to be unorthodox. She was determined to enable clients to learn to use skills not just in therapy but in real world situations. She therefore made it a defining feature that therapists take calls out of hours for coaching.‘It does you no good to learn behaviour with a therapist if you can’t use it anywhere else,’ she pointed out, speaking to an audience at the University of Washington in 2013[23].She also recognises the humanity and fallibility of therapists, and so another defining feature is team support. The team is there not to discuss the client’s behaviour, but to discuss the therapist’s behaviour as she puts it, and to improve the therapist’s skills.Linehan is often both light-hearted and forthright, and you might be forgiven for thinking this is personal style, and it may be - but it is also something she consciously cultivates and encourages in her students. In the same lecture she went on to say this:[22:28]We have two kinds of communication styles. One is irreverence - treading where angels fear to tread style - and the other is the warm, reciprocal style that almost all therapists are taught. The reason that irreverence actually turns out to be very important is there’s a lot of research that novel stimuli create deeper learning - and irreverence is novel stimuli. [24]<Who DBT is For>Linehan found it necessary to focus on a particular condition in order to get her studies funded, and many of her patients met criteria for borderline personality disorder, which lead her to become interested in that condition. DBT has been shown to reduce levels of suicide attempts and self-harm, but also to be effective in treating addiction, depression, anxiety, eating disorders, borderline personality disorder and post-traumatic stress disorder.But the application of DBT skills extends much wider than that. The University of Washington runs a skills training group for the friends and family of their adolescent clients. DBT skills have been taught in schools and rehabilitation centres and Linehan would also like to teach them in prisons.In her 2016 Washington lecture, she said: ‘Anyone can use the skills; you don’t need to have a mental disorder.’<Influence of Willigis J?ger>In 2015, Linehan travelled to Holzkirchen in Germany to speak at the Benediktushof - a centre for meditation and mindfulness. She was there to join others in celebrating the ninetieth birthday of Catholic priest and Zen master Willigis J?ger. Of all the speaking requests she had received in her career, this was the one that meant the most to her. It was to study with J?ger that she had come, thirty years before, when she cast her searchlight beyond the bounds of academia to find the knowledge she needed.‘In truth’, she told her audience, ‘he could be a co-author of practically everything I’ve written.’She spoke about J?ger’s patience and imaginative guidance; his late night violin playing; his teachings about radical acceptance and his openness in sharing his own journey - something she has not only taken on board but encourages in the therapists she trains.[24:47]Willigis had this unbelievable ability to be kind and to also go to the core of a problem. The most important thing I remember him saying to me - which I have said to many patients - at that time in my life, I was very often sad, lonely and in tears. And for sure could not find what I was looking for. So I asked Willigis one time: ‘What is wrong?’ And he said: ‘Marsha, you’re just homesick.’ I can’t tell you how useful that line has been with the many people I treat who are homesick. [25] After her work with J?ger, Linehan went on to become a Zen master and continues to lead retreats. In her talk, Linehan drew many parallels between Zen and behaviour therapy. ‘They both put a very large focus on the present,’ she said. ‘DBT does not go back to the past to figure out how you got that way. It focuses on what is maintaining your problems now.’Both Zen and DBT emphasise the importance of practice - in Zen, practice of meditation and compassion; in behaviour therapy, practice of new behaviours. In both, there is a key relationship - between teacher and pupil or therapist and client - and both acknowledge that avoidance of suffering can lead to more suffering.She observed that Zen and science, coming from very different starting points, appear remarkably to have come to much the same conclusions.<Who is Linehan>The self is not a concept that either DBT or Zen focuses on, accordingly to Linehan, but, ever dialectical, she is not beyond a little self-examination.In her interview with the University of Washington Daily, Linehan said: 'I'm passionate about the fact that science is good. But it turns out, in essence ... I'm a teacher more than I am a scientist.'[26]And to BorderlinerNotes, she commented: ‘The spiritual part of myself is the core of myself - more central than anything else about me.’[27] On retreat, she had felt that her spirituality was truly understood - an experience which was transformative. And it was the spiritual experience of Linehan the troubled teen, and her promise to God at that time, to build a life - and lives - worth living, which was the driving force behind an astonishing career.<Proudest Achievement>So how would she sum up her impact? In her 2013 Washington lecture, she said: ‘I think sometimes when I’m dead and buried, and people look back on my career and say what did she contribute, they’re going to say this: <it was> the focus on increasing the skills and motivation of therapists.’To the APS, she said that her proudest achievement was not developing DBT, as people might think, but her graduate student training programme, which treats adolescents who are at high risk for suicide. ‘We’ve managed to manage the fear of students,’ she said.<An Encounter>In an address to the NEABPD in 2011, Linehan spoke about the rewards of her work:[28:01]I was giving an invited address somewhere and after the address a woman walked up to me and she said: ‘I would just like to meet you.’ She took my hand and while she was holding my hand she said: ‘I just want to tell you that I was an ordinary mother, but my daughter - she needed a special mother. And I came and took the class that your graduate students taught, on DBT skills for friends and family, and I became a special mother. And when I became a special mother my daughter was transformed.’ I feel chills when I say this to you, because that is worth all the work that I’ve done in my life. That is what it’s all about. It’s about having an effect and helping the people that need it so desperately. [28]<More to Do>Linehan is keen to be joined in her work by others. In her APS talk, she spoke about the strategic planning groups she runs to organise research into DBT and research in the field of suicide.[29:18]We invite all the researchers in the world to come. You have to agree - one: you will be collaborative; two: you won’t steal anybody’s ideas; you will not withhold any good ideas you have - and you have to agree to do the dishes at my house. My only goal was to get the field up and running. I can’t go without a field left behind me and for most years in the United States I have been the only clinical suicide researcher in the United States. I can’t die if that’s the case so I had to do something about that. [29] She would also like to establish whether hospitalising people for suicidality is effective or, in fact, generally counter-productive. This from her Teen Extremes talk:[30:05]'There is not a shred of evidence - not even one study ever published - that shows hospitalising someone keeps them alive for even five extra minutes. One of my big goals before I die myself is to do a big study to evaluate this.’[30]<Signing Off>Endings can be tough after working with clients intensively over a long period. She spoke about this in a 2014 interview with Daniel Flynn for HSE Ireland:[30:36]Most of our clients end at one year. Many of our clients at the end of one year believe they need a whole lot more therapy. And often the therapist agrees. So we have everybody all upset that you have to end at the end of one year. In our research studies, this had become a major problem, except we then came up with a fabulous solution ... We would tell everyone, listen: If you leave, you can come back in six months, but our guess is when you leave you are like a butterfly in a hand and you are going to fly. And I can’t count the people who have called us up and said: you know, you were right, I flew. [31] But if you do still need help, you might be lucky enough to have eMarsha. In press, as I write this piece, is a paper Linehan has co-authored with other researchers at Washington, evaluating an app to support DBT - complete with the conversational agent who is her electronic namesake. [32]But I will let the real Marsha have the last word, with a few thoughts from that same interview about life after therapy:[31:47]It’s really important to keep working to try to get what you think what you need and not to give it up and think: OK, I’m doomed to a life of unhappiness ... so you’ve got to keep your eyes open. And to a certain extent you have to wear rose-coloured glasses. But you know, most people don’t know this, but I’ll give you a little tip. There’s actually a lot of research on this. It turns out that depressed people see reality more accurately than happy people, because happy people distort. So a little distortion goes a long way in life. So trust yourself that you need what you think you need. Keep trying to get it - in other words, you can’t just sit back and wait for it to find you - but also, be willing to take half a cake when you don’t get the whole cake. Put on a pair of rose-coloured glasses. You’ll be fine. [33] References[1] Potter, Anne Marie. 2011. Getting Out Of Hell: A Suicide-Prevention Therapy That Saved My Life [online]. Hartford Courant. [2] BBC World Service. 2012. Outlook. Available at: . 13:51 -> 14:05 [3] Ibid. 20:45 -> 21:35 [4] Linehan, M. 2017. Building Lives Worth Living [online]. Borderliner Notes. HYPERLINK "" [5] Linehan, M. 2014. DBT? Skills Training Handouts and Worksheets, Second Edition. The Guilford Press. [6] White-Ajmani, M. 2010. Champions of Psychology: Marsha M Linehan [online]. Association for Psychological Science Observer. HYPERLINK "" [7] Linehan, M. 2015. Balancing Acceptance and Change: DBT and the Future of Skills Training [online]. Family Action Network. , 9:17 -> 9:45. [8] Linehan, M. 2014. Teen Extremes: Regulating Moods in the Age of Anxiety. BehavioralTech. Available at: , 9:39 -> 10:26 [9] Linehan, M. 2015. Balancing Acceptance and Change: DBT and the Future of Skills Training [online]. Family Action Network. . [10] Linehan, M. 2007. Suicidal Individuals: Evaluation, Therapies, and Ethics [online]. Allen L Edwards Psychology Lectures, University of Washington TV. 29:47 -> 31:55 [11] Linehan, M. 2017. How She Learned Radical Acceptance [online]. Borderliner Notes. HYPERLINK "" [12] Linehan, M. 2014. Teen Extremes: Regulating Moods in the Age of Anxiety. BehavioralTech. Available at: , 23:40 -> 24:15 [13] Ibid. 25:28 -> 25:55 [14] Linehan, M. 2007. Dialectical Behavior Therapy (DBT): Where We Were, Where We Are and Where Are We Going [online]. University of Washington TV. 11:37 -> 14:29 [15] Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press. [16] Linehan, M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. [17] Linehan, M. 2017. The Ongoing Battle for Evidence-Based Treatment [online]. Borderliner Notes. HYPERLINK "" [18] Linehan, M. 2017. Award Address: Suicide: Where We Are, Where We're Going, and What's Keeping Us From Getting There [online]. The Association for Psychological Science. 33:26 -> 34:18 [19] Linehan, M. 2009. Marsha Linehan NEA-BPD Event [online]. American National Education Alliance for Borderline Personality Disorder. [20] NICABM, 2017. How to Get to the Heart of Resistance with Marsha Linehan [online]. 1:40 -> 3:51 [21] Linehan, M. 2017. Award Address: Suicide: Where We Are, Where We're Going, and What's Keeping Us From Getting There [online]. The Association for Psychological Science. [22] Linehan, M. 2017. The Need for a Relationship of Equality between Therapist and Client [online]. Borderliner Notes. 0:58 -> 1:31 [23] Linehan, M. 2013. Suicidal Individuals: Evaluation, Therapies, and Ethics, Part 2 [online]. University of Washington TV. HYPERLINK "" [24] Ibid. 36:19 -> 36:51 [25] Linehan, M. 2015. Marsha Linehan zum 90. Geburtstag von Willigis J?ger [online]. Benediktushof - Zentrum Meditation und Achtsamkeit. 16:08 -> 18:28[26] Katz L. 2012. Leading the Way out of Hell. The Daily of the University of Washington [online]. [27] Linehan, M. 2017. How She Learned Radical Acceptance [online]. Borderliner Notes. HYPERLINK "" [28] Linehan, M. 2011. Marsha Linehan and Dialectical Behaviour Therapy [online]. National Education Alliance for Borderline Personality Disorder. 1:46 -> 2:42 [29] Linehan, M. 2017. Award Address: Suicide: Where We Are, Where We're Going, and What's Keeping Us From Getting There [online]. The Association for Psychological Science. 19:34 - 21:12 [30] Linehan, M. 2014. Teen Extremes: Regulating Moods in the Age of Anxiety [online]. BehavioralTech. , 16:54 -> 17:46 [31] Flynn, D. 2014. Marsha Linehan – Interview [online]. HSE Ireland. 24:07 -> 25:47 [32] Schroeder, J et al. 2018. Pocket Skills: A Conversational Mobile Web App to Support Dialectical Behavioral Therapy. Proceedings of the ACM Conference on Human Factors in Computing Systems [33] Flynn, D. 2014. Marsha Linehan – Interview [online]. HSE Ireland. 29:13 -> 30:24 ................
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