I Believe In Evidence-Based Treatment | MARSHA LINEHAN

Marsha Linehan, creator of the highly-regarded Dialectical Behavior Therapy (DBT), discusses Borderline Personality Disorder from the viewpoint of a clinician / researcher of the highest caliber.

[dontbepushy]

I was taught nothing about DBT, hadn't even heard of it until my 2nd internship. I feel completely ripped off.

[anthonynemo]

Say the woman who came up with DBT When i have never in 30 years seen any 1 with BPD being a cure. Made you a lot of cash Marsha and thank you for getting my music taken down, Very big of you. People used that information.

[rashedly]

it's so interesting that she's so right and effective (tm) about so many things but on this one she has such a huge blind spot. it would be so inevitably oppressive to have an "evidence based" requirement for psychotherapy beyond credentialling (which should always require research methods and critical thinking and competence testing) because there is a power dynamic to who gets access to the resources to prove that a therapy is evidence-based. there need to be university affiliations and money behind those studies and the fact of replicability means you need enormous numbers of people getting the same therapy to gain statistical significance and in many therapies which are not manualised, such as music psychotherapy (music therapy with a psychotherapy focus, which is a massively researched academic field), where you can't actually be doing precisely the same process with that kind of numbers of clients, you'll never get "evidence based" status. Then you don't get funded, and you don't get the endlessly building body of evidence that you get when you have the kind of research and ultimately state backing that DBT does. like DBT is the bee's fuckin' knees, it's just got an achilles heel in its ruthless behaviourism and it comes out here. /rant

[L-K-Jellyfish]

Medications can be easily regulated because they are material objects that are easily measured and recorded. Talk therapy is not easily measurable and therefore not as easily regulated. The administering of talk therapy as opposed to a chemical therapy also requires other invisible and unmeasurable qualities like mutual rapport. In that sense I do believe that psychoanalysis or therapy is an art and should not be disparaged for not being a hard science. I don't know how it would be possible to measure the effectiveness of psychotherapy without a way to also measure the skill and interpersonal rapport of each and every combination of therapist and client on a statistically significant scale.

As for treating the symptoms and not the root cause, I have heard the same thing levelled at psychiatric drugs which still do not affect everyone in exactly the same way.

[adelehammond]

the problem is mental illiness treatments dont work like phyisical health conditions since every single person with the same condition manfests differently
like cbt is heavily overestimed in its effectiveness

[BartAnderson_writer]

A lot of good ideas in DBT.
I'm very skeptical of the idea of "evidence-based" credentialing though. It's the application of a narrow understanding of science to a field where it's not appropriate.

[PreacherAtArrakeen]

i have different views on the topic. Yes, we don't want patients going to charlatans, especially those with severe behavioural problems. OTOH, for many, many people, talk therapy works well enough. I have an issue with how calculating Behaviorism is, and was never a fan of B.F. Skinner and the other Radical Behaviorists. Even the jargon puts me off.

[redskywalker]

I could not disagree more with her sentiment about only allowing evidence based practices. As a jungian I have helped many clients through deep and difficult things but this is not an evidence based treatment, nor does it need to be. The evidence is the countless thanks and referrals that I get every day, seeing people smile more over time . . . I feel confident in people's inherent discernment. Many of my clients have tried other therapies and appreciate a more open and relational approach which seems increasingly rare due to pressures to be "evidence based." I strongly feel that, despite the persistence of much snake oil in the world, that if therapies like Rogerian or Jungian did not deeply help people, people would not keep coming back.

[moneehallam]

This is the exact reason why Life Coaches should all be fired.

[katherinelalli]

They don't follow their so-called evidence-based treatment. They don't care about protocol. Ask the DBT therapist at Yale IOP how evidence-based they are. It's a big scam. They made my life so much harder and so much worse.