Saturday, February 26, 2011

Marsha, Marsha, Marsha

I spent a portion of the last six months of my internship traveling around the country interviewing for a job. I came close a few times. One was particularly exciting: a community college in Oregon was hiring an assistant director of their counseling center. As I was for every other job I got an interview for, I was named the runner up. Runner up wasn't going to get me employed.

So my internship was coming to a close and I was become a little concerned. I call a friend, who calls a friend, who calls me back. They told me about this clinic in Cambridge that has a post-doctoral training program. I made a few phone calls and before I know it, I'm on Harvard Square for an interview. 

The whole interview experience was a hoot. It was a hot humid day, I was recovering from a minor surgery, and the person I interviewed was interested in giving me a hard-hitting stress interview. It took me nearly a year to forgive the psychologist who interviewed me. In the end, he became one of my favorite mentors. I'll have to leave this story for a future blog post.

In the end I was offered a part-time postdoctoral fellowship that paid just over the poverty level. I made a few other phone calls and arranged for another part time job at a local counseling center. I was busy--and barely made enough money to pay my bills--but I had the pieces I needed to get my post-degree hours in so I could sit for my license.

Apparently I interviewed for a fellowship that involved working with adolescents who were highly suicidal and engaged in self-injurious behavior. Who knew? I remember hearing something about Dialectic Behavioral Therapy (DBT) in my doctoral program. That was my main role in my fellowship: working with adolescents in an intensive day treatment program as well as in an outpatient clinic doing DBT.

Marsha Linehan and her followers can sometime take on the aura of a cult. Sometimes it feels that those "on the inside" think that DBT is the only treatment--the only way--to work with people. They have done some fantastic research. That's for sure. They've done some fantastic research in highly controlled settings with highly controlled patient populations. In real-world practice, DBT provides a useful tool to use in combination with other useful tools. Empirically supported treatments work a bit differently when they are taken out of the lab.

Below is a great clip of Dr. Linehan explaining DBT. She said something early in the clip--something important and worth highlighting (and is the point of this blog post). At 1:04 Linehan says "I love her so much." What? A psychologist loving a patient? That's not supposed to happen, right?

To date I have four examples of psychologists who I have heard talk about loving patients: Marsha Linehan, Irene Stiver, Robin Cook-Nobles (a former training supervisor and mentor), and Judy Jordan (another mentor who deeply influenced my training).  Check out the companion blog entry to this one called "A Few Notes on Love."

I think talking about love is an important dialogue for psychotherapists--and it's something that I'd like to hear Linehan talk more about. As a fellow, and then later as a psychologist in private practice, I've heard scores of psychologists, social workers, psychiatrists, and counselors talk with contempt about their patients. I watch in horror as these folks lose their ability to see the humanity in those that they work with and reduce their patients down to a list of bothersome symptoms.

One of the gifts of what Linehan offers in DBT is acceptance--acceptance of patients--acceptance of feelings--and acceptance that people are doing the best they can. Many get blinded by the tools, language, structure, and research of DBT. They loose the basic humanity--the acceptance and love--of the the patient.

Here is Linehan's entire talk. It's worth watching--especially the parts where you catch her humanity, acceptance, and love.


  1. I remember this video too! when I heard the "I love her so much", I burst into tears. I never thought a therapist could be like that.

    I did a lot of readings on the therapeutic relationship after what happened between me and my first therapist, which was completely a mess. That therapist looked nice, but insisted on the zero self disclosure and it made me feel like being observed like some trial subject. I didn't blame her. I thought that was what therapy was.

    One day (after a few visits), when I mentioned her husband's name at the end of an email simply wanted to say happy valentine's day, she freaked out and said she couldn't work with me any more and even cc'ed the e-mail to her supervisor...I was completely shocked and felt so confused, embarrassed and hurt... I still feel bad now when I think of that, and I still wonder if I truly did something wrong. Did I cross the line? But I really didn't mean to stalk her neither did I thought about making friends with her. All I did was having googled her name before the first visit, that's how I found her husband's name via her wedding announcement (I explained this to her later..but still).

    1. Thanks for stoping by, Anonymous. You might be interested in this article that recently appeared in the New York Times.

      Do you Google your Shrink?