Building A Life Worth Living by Marsha M. Linehan
building-a-life-worth-living – pdf
Big Ideas
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The Heroic Vow, To escape hell and help others do the same.
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DBT = Dialectical Behaviour Training.
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DBT Skills, The four categories.
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Thinking vs. Acting.
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Willingness & Radical acceptance.
“Like the speech I gave at the Institute for Living that June day, this book is the story of my time at the institute, how I came to make that vow, how I managed to climb out of hell myself—and how I managed to find ways to help others get out of hell, too.
My life is something of a mystery because, to this day, I have no idea how I descended into hell so swiftly and completely, at the age of eighteen. I hope that my success in getting out of hell and staying out will bring hope to those who are still in hell. My basic belief is that if I can do it, others can do it, too.
My story has four threads, woven closely together.
The first is what I know of my descent into hell, and how that led to the vow to get out of hell and then to get others out.
The second is my spiritual journey—the journey that saved me. It is the story of how I ultimately became a Zen master, a path that profoundly influenced my approach to developing DBT, most particularly as it led to my bringing mindfulness into psychotherapy.
The third is my life as a research professor—how that shaped my ability to reach my goal, and the difficulties I faced along the way to overcome the mistakes I made and the multiple rejections I experienced.
The fourth is the story of the enormous power of love in my life… The power of accepting the kindness and love of so many people who were always ready to pull me up. And, in turn, the power of loving others, which pulled me up from falling in its own way. …
My story is also a story of both faith and how important luck can be. It is a story of never giving up. It is a story of failure after failure, but of somehow always getting up (or being pulled up) again and again, and carrying on. It is a story of persistence, of acceptance—a big part of DBT is saying yes.”
~ Marsha Lineman from Building a Life Worth Living
Marsha Lineman is the creator of something called “Dialectical Behavior Therapy.”
I got this book after Peter Attia described how he transformed his life via wisdom from Marsha’s philosophy. He discussed her work in the final section of his book Outlive in which he discusses the importance of emotional health for one’s longevity.
As Angela Duckworth puts it on the cover, this book is: “A brilliant memoir by one of the greatest pioneers in psychotherapy history.”Although there were a few other books on the subject I could have started with, I felt drawn to Marsha’s memoir for a couple reasons.
First, Tal Ben-Shahar was in my mind. In our Heroic Chat with Masters, he said that he thinks (auto)biographies are the best self-development books you can read.
Second, Marsha’s story is INCREDIBLE—truly Heroic. She spent over TWO YEARS in a mental health institution as a young woman. She made a vow to God that, if she was able to escape her personal hell, she would do everything she could to help others escape their personal hells.
THAT is what led to her creating Dialectical Behavior Therapy—which was originally created to help people with suicidal ideation and self-harm behaviors and has been extended to help people deal with a range of issues.
Marsha has trained over 10,000 therapists worldwide in DBT. In 2011, the editors of Time magazine named DBT one of the 100 most important new science ideas of our time. The book is PACKED with Big Ideas and I’m excited to share some of my favorites so let’s jump straight in!
THE HEROIC VOW & QUEST
“‘In reality, the seeds of DBT were planted in 1961,’ I continued, ‘when, at age eighteen, I was admitted here, to the Institute of Living.’ …
I did not know what happened to me. No one knew. My experience at the institute was one of descending into hell, an out-of-control storm of emotional torture and absolute anguish. There was no escape. ‘God, where are you?’ I whispered each day, but got no answer. I find the pain and turmoil hard to describe. How do you adequately describe what it is like being in hell? You can’t. You can only feel it, experience it. And I did. I felt this inside myself, and it came out finally as suicidal behavior.
But I survived. And toward the end of my time at the institute, I made a promise to God, a vow, that I would get myself out of hell, too.
DBT was, and is, my best effort to date at keeping that vow. This vow has controlled most of my life. I was determined to find a therapy that would help these people, people who were so often deemed beyond saving. And I did. I have felt the pain that my clients feel as they wrestle the emotional demons that tear at their souls. I understand what it is like to feel terrible emotional pain, desperately wanting to escape by whatever means.”
Imagine this… Our 18-year-old hero-in-training is admitted to an institution to help address her suicidal tendencies. She spends an AGONIZING TWO YEARS there. As we briefly discussed in the intro, she made a vow, that, if she was able to escape hell, she’d do everything in her power to help others escape hell as well. Fast forward FIFTY years (literally)—from 1961 to 2011.
Our hero has transformed her life and fulfilled her vow. She is one of THE most respected therapists in her field—creating THE FIRST, most effective treatment for suicidal individuals.
But… Except for a few close friends, NO ONE knows her personal story. So… Where does she tell her origin story and the origin story of her therapy that has saved countless lives? At the same institution where she spent her years in hell.
Note: I got goosebumps typing that. Feel into the power of that for a moment.
There’s SO MUCH we can discuss there. I want to highlight a couple of things.
First, Abraham Maslow made a similar vow (albeit without the terrible suffering) as a young man. Learn more about his vow in our Notes on Future Visions.
Second, when I think of making a vow, I always think of wisdom from Daisaku Ikeda. In Buddhism Day by Day, he says: “In any field of endeavor, making a vow is the foundation for achieving something great. If for whatever reason a person gives up halfway or backslides, his or her commitment hasn’t been based on a vow. Halfhearted desire doesn’t amount to a vow.”
And, finally, I think of the hero’s journey. The foreword to the book is written by Dr. Allen Frances of Duke University. It’s wonderful. He tells us: “Many people come up with good ideas but don’t have what it takes to get them into the world. Marsha had the charisma, energy, commitment, and organizational skills to turn dream into reality.”
Then he says: “In myths the world over, heroes must first descend into the underworld, where they are faced with a series of epic challenges to be overcome before they can prevail in their heroic life journey. Once they succeed, they return to their country bearing some special new secret of life. Marsha has plunged into an unbelievably challenging journey of self-discovery, far away from family support, and returned bearing precious insights to help turn abject misery into lives worth living.”
Back to you… How have YOU suffered? And… How can you continue to do the hard work to reduce your own suffering SO THAT you can help *others* do the same. That’s one of the most powerful ways to be Heroic. The Buddhists call this being a bodhisattva—we strive for our own “enlightenment” such that we can help OTHERS achieve their own joy in life.
Let’s make a vow to do that. Together. TODAY.
DBT = DIALECTICAL BEHAVIOR THERAPY
“Two things make DBT unique. The first is the dynamic balance between acceptance of oneself and one’s situation in life, on the one hand, and embracing change toward a better life, on the other. (That is what ‘dialectics’ means—the balance of opposites and the coming to a synthesis.) Traditional psychotherapy focuses primarily on helping people change their behaviors, replacing negative behaviors with positive behaviors. …
The solution I arrived at was to find a way to balance both acceptance and change, a dynamic dance between the two: back and forth, back and forth, back and forth. This balance between pursuing change strategies and pursuing acceptance strategies is a basis of DBT, and unique to DBT. This emphasis on acceptance as a counterbalance to change flows directly from the integration of Eastern (Zen) practice, as I experienced it, and Western psychological practice.
The second aspect of DBT that makes it unique is the inclusion of mindfulness practice as a therapeutic skill, a first in psychotherapy. This, too, came from my experience with Zen practice. At the time (the mid-1980s), mindfulness was something of an arcane subject, often dismissed as too ‘New Agey’ to be taken seriously, particularly in academic circles. Now, as I’m sure you know, mindfulness is everywhere, not only in psychotherapy but also in health care, business, education, sports, even the military.”
DBT is short for “Dialectical Behavior Therapy.”
Marsha tells us that the word dialectic can be defined as “a method of examining and discussing opposing ideas in order to find the truth.”
She says: “I like to think of it as ‘the tension, or synthesis, between opposites.’”
And: “Dialectical Behavior Therapy seemed an appropriate name, reflecting as it does the tension between seeking change in a person and encouraging them to embrace acceptance.”
So, to repeat: the dialectic of DBT is between SEEKING CHANGE *and* ACCEPTANCE.
Marsha also says: “Dialectics allows opposites to coexist: you can be weak and you can be strong, you can be happy and you can be sad. In the dialectical worldview, everything is in a constant state of change. There is no absolute truth, and no relative truth, either; no absolute right or wrong. Truth evolves over time. Values that were held in the past might not be held in the present. Dialectics is the process of seeking the truth in the moment, drawing on a synthesis of opposites.”
Marsha walks us through how important mindfulness is to DBT. She was inspired by the Buddhist monk Thich Nhat Hanh and his great book The Miracle of Mindfulness but wasn’t ready to make mindfulness a central part of her work until she saw how another Heroic psychologist Ellen Langer described it in her book Mindfulness.
For the record, Marsha defines mindfulness as “the act of consciously focusing the mind in the present moment, without judgment and without attachment to the moment.”
She says: “Mindfulness practice is the repeated effort of bringing the mind back to awareness of the present moment; it includes the repeated effort of letting go of judgments and letting go of attachment to current thoughts, emotions, sensations, activities, events, or life situations.”
DBT SKILLS: THE FOUR CATEGORIES
“DBT skills fall into four categories, each of which is designed to solve a different set of problems. The first two offer the path to acceptanceof reality as it is, while the last two, taken together, are change skills that help clients embrace the changes they need to make in their lives.
- Mindfulness skills, which help reduce pain and increase happiness.
- Distress tolerance skills, which teach you how to tolerate crisis situations so that you can effectively find a solution to whatever is causing the stress.
- Emotion regulation skills, which, as the name implies, teach you how to control your emotions so that you don’t react to what’s happening around you without reflection and don’t say things or do things that make the situation worse.
- Interpersonal effectiveness skills, which help you to be effective in relationships with others—relationships with people close to you and with people you interact with day to day, at work, for instance.”
DBT “skills” fall into those four categories: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
Marsha reminds me quite a bit of my Yoda, Phil Stutz. They have a LOT in common. They both revolutionized their respective fields and both of their philosophies are super-practical. What Phil calls “Tools,” Marsha calls “skills.”
Marsha discusses this in the context of “distress tolerance.”
And, she says: “The goal of DBT is to help people find the path to getting out of hell. I know it works, because I’ve seen it happen for clients countless times. More important, that’s what research studies—mine and other people’s—demonstrates. But it is not an easy journey, going on that path. This is what I tell my clients:
If you want to get out of hell, you have to get through the fire to the other side. It’s like you are in a house, and it’s on fire. There are flames all around, especially at the front of the house, surrounding the door that is the only way out. Your impulse is to retreat into the house, try to find someplace safe. But, of course, you will just die there. You’ve got to find the courage to go through the flames at the front of the house, the flames around the door. Then you can get to the other side. You have to go through your anger, open up to your therapist, keep going through the pain. It isn’t overnight that you are going to feel better. But you will.”
When I read that passage, I thought of Winston Churchill’s wisdom: “If you’re going through hell, keep going.”
YOU CAN’T THINK YOURSELF INTO…
“I called this process ‘opposite action,’ an emotion regulation skill for dealing with fear. (Opposite action is a change skill.) In opposite action, you force yourself to do the thing you don’t want to do. Saying to yourself, ‘People do like me’ or ‘I’m not fat’ doesn’t really change how you feel. You have to act. I had a client whose problems mostly involved hating her own body. Telling her that her body was just fine didn’t help. I had to get her to act differently, to act as if she had a beautiful body. When she did, she carried herself in public with assumed poise and confidence and she felt beautiful. It worked. It is like that mantra ‘Fake it until you make it.’ It is also the equivalent of Aristotle’s notion that acting virtuously will make you virtuous. …
Repeat opposite action as often as you can, over and over, every chance you get. Some of the time, opposite action works immediately. But most of the time you have to practice a lot before the emotion you are trying to control (fear, for example) abates.
I developed a line that encapsulates this worldview: You can’t think yourself into new ways of acting; you can only act yourself into new ways of thinking.”
“Opposite action.”
THIS was the idea that Peter Attia talked about in Outlive that got me to get the book.
For him, the context was getting himself to spend time with his family when he KNEW that was the right thing to do but he didn’t *feel* like doing it. He would have rather worked. But… He practiced taking the “opposite action” and it significantly changed his life.
Phil has a Tool for this as well. In fact, it’s the first Tool he discusses in his first book: The Tools. He calls it “Reversal of Desire.”
He tells us that we need to know that our infinite potential exists outside of our comfort zone AND we need to know that, by definition, when we exit our comfort zones we feel uncomfortable.
Then, when we feel life’s inevitable discomfort, we need to say: “BRING IT ON!”
Or, as Marsha would say: take “opposite action.”
Let’s do that. TODAY.
WILLINGNESS & RADICAL ACCEPTANCE
“Radical acceptance is akin to willingness, Gerald May’s beautiful concept that originally pointed me in this direction. Willingness is when you allow the world to be what it is. And, no matter what it is, you agree to participate in the world.
When I’m trying to explain willingness, I say that life is a lot like playing cards. Imagine that you are in a card game. You get dealt a hand of cards, as does everybody else. Now, what’s the objective in a card game? The objective is to play the cards you get. Right? That’s the game. You get the cards, you play them.
So you get your cards; other people get their cards. And one of the players gets mad about their cards, doesn’t like them, throws them down and says, ‘I don’t like my cards. I want different cards.’ You say, ‘Well, those are the ones you got dealt.’ And he says, ‘I don’t care. It’s not fair!’ You say, ‘Well, those are your cards.’ He won’t listen. ‘No! I’m not playing these cards.’
What would you think? Would you want to play with that player? Probably not. And who do you think is going to win the card game? Not the person who threw their cards on the floor. In order to have a chance at winning the game, you have to be in the game, playing the cards you are dealt. Accepting that reality is willingness.
I used this phrase in an earlier chapter, but it captures the essence of willingness and radical acceptance so beautifully that I will reuse it here: If you’re a tulip, don’t try to be a rose. Go find a tulip garden.”
When I read that, I thought of some parallel wisdom from Jim Collins and his great book, Beyond Entrepreneurship 2.0.
He tells us: “You can look at life as a search for that one big winning hand, or you can look at life as a series of hands well played. If you believe life comes down to a single hand, of course, you can easily lose. But if you see life as a series of hands, and if you play each hand the best you can, there’s a huge compounding effect. Bad luck can kill you, but good luck cannot make you great. As long as you don’t get a catastrophic stroke of bad luck that flat-out ends the game, what really matters is how well you play each hand over the long haul. How will you play this hand and the next—and every hand you’re dealt?”
Here’s to radically accepting all the cards we’ve been dealt and playing our next hand with as much joyful wisdom, discipline, love, courage, gratitude, hope, curiosity and zest as we can as we build a life worth living and help others do the same.
It’s Day 1. We’re ALL IN.
Let’s go!