Good morning. Today is January 29 2023. And my teisho this morning, is I don't have a title really, well, I know what I'm talking about. I'm going to be talking about Marsha Linehan. Some people may know who she is. She's the developer of something called Dialectical Behavioral. Maybe it's just dialectic Dialectical Behavioral Therapy, or DBT. And so Marsha Linehan, and the concept of radical acceptance, and I've got way too much material. So I'm going to try to carefully take just the very best, and see if we can get through this in an acceptable amount of time.
As far as I can make out, Marsha Linehan was the first person to use the term radical acceptance back in 1993, when she was developing DBT. There are other people that sort of have it as part of their brand. And we could talk about that a little later. But I want to I want to begin by just telling you her story. And I found a good description of this in an article on the web. And the title of it is, it was it appeared in Psychology Today. And the title is How Marsha Linehan developed the central feature of dialectical behavior therapy. And this is directly from her. She said, I've done many hard things in my life. But the most devastating was coming to terms with a totally unexpected, complete breakdown, the disillusion of the person I had always been, I'd been a happy go lucky, confident, high school girl, popular among my classmates, often the one to initiate activities, organizing concerts, for example, or simply gathering a group for ice cream at the drugstore. Back when you hit ice cream at the drugstore, I was always careful to make sure everyone's needs were met that no one was left out. I was elected and nominated to important class roles. In junior year and senior year, I was the kind of girl who might be voted most popular or most likely to succeed. But then, as my senior year progressed, this confident girl began to disappear. I did not know what had happened to me, no one knew. At the age of 18, I was admitted to a psychiatric institution called the Institute of living in Hartford, Connecticut. My experience at the institute was a descent 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. The pain and turmoil are hard to describe. How do you adequately convey what it is like to be in hell? You can't. You can only feel it, experience it. And I did. I felt this inside myself and I didn't want to go on living anymore. Read other accounts of her time there she was. She was just impossible. You know that they couldn't do anything for her. And she spent a lot of time in a padded room banging against the walls. I've had some experience visiting a relative in in our wing. And it can be pretty hellish there. You hear people just screaming in agony. That's where she was. She says But I survived. And towards the end of my time at the institute, I made a promise to God, a vow that I would get myself out of hell. And that once I did, I would find a way to get others out of hell too. I'm getting a little for clumped here. And this is such a profoundly bodhisattva ik vow to take
she was she was determined. She was determined to find something that would help suicidal people, people who are deemed beyond Saving. And just to say a little bit about this population of suicidal people. There are a lot of mental patients that are just considered by almost all therapists to be beyond help, you just can't work with them. And this is exactly the population that Marsha Linehan set out to help. Because unknown to everyone, she was one of them. She said, 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, to desperately want to escape by whatever means. dialectical behavior therapy, therapy, DBT was an is my best effort to date at keeping my vowel
I think is really helpful to look at what she was able to do and look at the, the treatment for people who have, have this have this kind of psychological dysfunction. It's, it's generally what you discovered is the people who were suicidal, mostly fall into a category called
borderline personality disorder, or BPD. I've known a few people with that diagnosis. And they tend to be extremely emotional, and emotionally dysregulated. So everything is explosive. And you'll you'll see that as we go along. And she talks about her work with those that was that population, oftentimes very intelligent, and, you know, many, many excellent qualities. But they're so so easily upset that people have trouble working with them. And I know, psychologists who simply say I won't work with somebody who's got a personality disorder.
But of course, all of us have emotional reactivity. We all can fly off the handle or fall into a deep depression or get consumed with envy or jealousy. It's just human. You know, we're not. We're always variable. Volatile, we can be volatile. So just as it's helpful to look at some of the problems with addiction, and relate them to our own so called air quotes, normal lives, I think it's really helpful to look at look at what Marsha Linehan did
I want to read a little bit about what she said about borderline personality disorder. And this is from my second source from her. It's basically a transcript of interview at a some sort of convention. So it's an interview between her and Dr. Ruth Kaczynski is also a psychologist. And the title of it is how to apply mindfulness to your life and work dialectical behavior therapy, a new approach to street to treating extreme emotions. And Marsha Linehan says, borderline personality disorder, as a disorder really started being looked at by the psycho analysts back in the 30s. They saw a group of individuals with certain certain characteristic problems that their treatments were not very effective for at the time. Over the years, people have been looking at a category of people who I'm going to talk to you about in a moment. But the way the name borderline personality disorder came about was due to how we think about disorders. This was a treatment that was viewed as on the borderline between psychosis and neurosis. This is actually how the term came in. But the term has never really identified exactly what the disorder is. And we no longer have these sorts of continuum categories of mental disorder that we used to have. That is a continuum between neurosis and psychosis. However, the name has stuck I'm going to first say to people put the name to the side, it's a technical name that we can't get rid of right at the moment, although a lot of people are trying to, of course, psychology is full of all the definitions and the DSM, the manual that determines what exact disease you have, and how much insurance will pay for your treatment. So it's difficult to straighten things out. So she gives her own definition, and she says, it's a problem of severe and pervasive emotional dysregulation. What that means is it is not across one emotion, like depression or anxiety or fear, but it tends to be across all of them. So you have a group of individuals who present with sadness, anger, jealousy, envy, depression, etc. They have extreme and volatile up and down emotions. And not only that, but they are not able to regulate themselves. There are people today who believe that if we could rename the disorder, it would be a disorder of pervasive emotional dysregulation.
She says they can't regulate their thoughts. They can't regulate their feelings, their physiology and how they feel, and they can't regulate action. So there's a degree of impulsivity in the disorder. It's very difficult to have a good relationship with a person whose emotions keep changing all the time. I hate you today. I love you tomorrow. I wanted to play golf with you today. But now I hate golf, and I want to go to a movie, etc. It's very difficult. Or if they're not that way, they see the solution to unbearable emotions. They see suicide killing themselves as the solution. There's an underlying belief that if they are dead, they will actually feel better, or at least they won't feel as bad, even though there is no shred of evidence that this is true. And there's definitely the belief that alcohol will make you better, you know that people believe that cutting makes them feel better. I think most people know what cutting is, a lot of people who are in extreme distress will actually cut their arms and other parts of their body. And it seems to bring them temporary relief. And certainly alcohol brings relief. I will attest to that.
She said there's a lot of impulse control behavior, but the behavior functions to regulate your emotions only for the time being.
So she set out as we said before, to find some way to help people in this really dire condition. And in the first article, I brought out one that was published in Psychology Today. She talks about that.
The goal of any behavior therapy is to help individuals change behaviors, in particular behavior patterns that significantly disrupt their life at home and in the workplace, and replace them with more effective alternatives. DBT is different. It's designed to help individuals who are at high risk for suicide are difficult to treat, have multiple serious mental and behavioral problems, and often are on the no admit list of hospitals. And it's also different because standard behavior therapy didn't seem to work. Early in my research at the University of Washington, a client would come in we talk and she told me about her problems and why her life did not seem worth living. We had to discover which of her problems was driving her suicidality might be her believing that no one loved her that people hated her, or that she just wanted to die. I would say no problem, I can find a treatment for that. I would then go through existing Behavior Therapy manuals to try to come up with the appropriate treatment. The next week, I would review with the client what I thought was needed to solve the problem we had focused on what changes we could make together. But a typical response to any attempt to change patient's behavior was What are you saying I'm the problem. They got upset, sometimes retreating into silence other times yelling, throwing chairs and stomping out of them. room, you're not listening to me, clients would say you're not hearing what I'm suffering, you're trying to change me. Most of the clients had experienced intense suffering. They had tragic stories. In addition, they were extremely sensitive to anything that appeared to invalidate their pain, anything that suggested that they themselves needed to change. To them. Standard Behavior Therapy, which is focused on helping people change was a red flag.
For these clients, it was as if they didn't have emotional skin, as if they had suffered from third degree burns all over their body. Even the lightest touch was excruciating ly painful. And they lived in environments where everyone kept poking at them, they perceive suggestions aimed at change, as personal attacks, or as further invalidation, it would whip them off the emotional charts. You know, it occurred to me been reading a book recently about inflammation, and the causes and the effects. And it really is like a form of inflammation. When it gets out of control, it's very hard to dampen it down.
And it's not just this population that has the problem of not liking to hear the message, you need to change. We're all like that. Nobody really wants to do that work. We all want a pat on the head. So she says, I realized that what these people obviously needed was compassion, a pat on the head, to validate them to show that the factors driving their suffering made sense to me. I had to see the world from their point of view. And these people very rarely get that kind of input. Because they're so annoying. It's one of the one of the kindest things you can do is to meet annoying people with acceptance and compassion. It's very difficult to do. But it's possible. Especially if there are relatives. She said. So I dumped the emphasis on change and went for full bore helping clients Accept where they were in their lives. My new goal was to validate my clients tragic lives. I knew about unconditional positive regard, a set of strategy strategies developed by the humanistic psychologist Carl Rogers. And I knew of supportive supportive therapy and approach that focuses on providing a strong therapeutic alliance, where the therapist is both trusting and validating. No problem I thought acceptance is it, I am switching my strategy. The response to this was as volcanic as it had been to my focus on change, what you're not going to help me, the client would say you're going to just leave me here and all this pain, more tears more sitting mute, more walking out of the room, I began dancing back and forth, back and forth, back and forth, trying to find the right balance between the duck in the dynamic between pushing for change and offering acceptance. It was like walking on a tightrope, too much weight on either side and over you go. This is exactly like practice. This is exactly like what we're doing on the mat. Too much control and you've lost it to lakhs and it's gone. It's really it's really the middle way. In Buddhism originally the middle way, I think referred to the Buddha's abandoned meant of asceticism and his adoption of the middle way of, of taking care of the needs of the body in order to be able to pursue awakening. We see it in the duality of mindfulness and concentration. Going into absorption but we have to be aware of when we go down the wrong hole. said yesterday at the at the workshop that is like two wings of a bird mindfulness on the one hand and concentration or absorption on the other. And those are the two final steps in the Eightfold Path. Number seven is mindfulness. This and number eight is Dianna means absorption or concentration. Think this duality this this tension is also captured in the a slogan, God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.
She she had someone make a comment to her that she was as she was pursuing this line of therapy, that she said Marsha, would someone or assistant of her said, Marsha, what you're doing is dialectics. And so she went and looked that up. And because it was kind of a science term, she, she used it as the name of her therapy once it was once she had developed it and was deploying it. She called it Dialectical Behavioral Therapy, Behavior Therapy.
But as she as she started working with clients, now that she'd sort of hit on a way to approach these impossible cases, she realized that the real key to it was acceptance.
This is, this is her talking about developing her therapy in the conference. Room, your interview with Dr. Burzynski. She said, I had to pull back and say what is needed there. Two things became completely clear to me over time. One was that as a therapist, I had to learn to radically accept these clients, I had to radically accept a slow rate of progress. Many of us have had to do that in our Zen practice. It's really it's really one of the issues of practice is people's impatience to see results, which is totally counterproductive. There's a story about the Zen monk who came to the master and said, You know, I'm on fire to awaken. I study with you, I'll do everything you say, how long will it take me to come to awakening? And the teacher gave him an answer, he said, could take two or three years. And the monk said, I don't have that kind of time. Is there isn't there some faster way? Any the teacher thought for a moment so well, your case it might take five years. So he exploded just like a bipolar, or a psychology patient. And the teacher said, actually, in your case, 10 years. Marsha Linehan says, in other disorders, we have very effective treatments that actually work pretty fast. You can get results in 12 weeks. But all of a sudden, I had a group of people who were taking a long time to change, they were engaged in behaviors that were very aversive to me, and they didn't do any of the cooperativity and clarity I thought clients should be doing.
So the first time, I realized that I myself, had to learn to accept these clients and not demand that clients change immediately. And then to it became clear to me particularly particularly, after listening to their lives, and the pain and suffering, they were going through that for many, not all, but many, because many, not all, but many had unbelievably tragic paths, that they also had to radically accept the present. They had to accept their life as it was and they had to be able to accept their lives in the past. I also realized that somehow I had to teach them to tolerate distress, long enough for us to solve a problem. They couldn't be constantly going to cutting or trying to kill themselves or getting drunk or taking drugs or overeating, or going to all the other impulsive, destructive behaviors. They were so common in this particular group. It became clear about what I had to do what the problem was. It was just that I didn't know how to do that myself. I thought God, I better learn how to do this
and this is where it gets interesting, because she, she actually took a year long sabbatical and she went looking for someone who could teach her acceptance to teach her the skill, and she got a couple possibilities back. And so she went to two places. The first was Shasta Abbey, which many people know about. That was a Zen Center run by Peggy Kennett. I can't remember what her Zen name is, but she was a Zen teacher. And then she went for some number of months to another Zen teacher in Germany named Villegas he agar villain is the agar is actually a teacher sanctioned by Yamuna Roshi, who, of course, is the successor to Yasutani. Roshi, which was Roshi capital's main teacher. So somehow, rather Marsha Linehan ended up learning acceptance in our particular line of Zen. She said about her, she went first to shots to Abby, she said, I could go somewhere where the person is a woman. Or I could go where the teacher to Germany where the teacher is, like me a Catholic. And she thought, Well, I'm gonna go with a woman first. So she went to Shasta Abbey, and she said, in about two weeks, she realized this was it. This is what she needed. And it was it was basically, you know, just Zen training. Many people have read the article, Roshi wrote, called the freedom of no choice about the benefits of Zen training of just doing what's in front of you, of setting aside your preferences, being okay with things as they are. And that's what she experienced when she went there, she talks about in the morning, everybody would get their assignments and learning to just take whatever assignment it was, and go with it. Not to waste time worrying about oh, I hope I get the good one. Hope I get the bad one. I don't know if any of the people here at the Center have that go on in their head.
The other thing she noticed she mentions in her description is that when the bell would ring, save for tea break or for some other for the end of the work or whatever, whatever you were doing, stopped right in the middle. You know, if you're sweeping the floor, sweep in one direction, you don't even bring it back the other set the broom down and go to the next thing. It's really a state of immediate responsiveness.
She came back
she came back and tried to work with her patients bringing what she had learned. And the first thing she did was to teach them breathing like we do on the mat. And that just totally didn't work. You know, our patient said Marsha, if I tried to do that I'll die. And so she had to, she had to look at what was it that she had really learned in her time studying Zen. And by the way, it's a study that's gone out and she's been practicing Zen now for 30 years. I believe I read somewhere that she's actually sanctioned this as M teacher.
So this is her the approach he took, which is rather than telling people to do a different behavior, say to radically accept their situation. She She framed it as practice doing that. There's just a shift from here's what's wrong with you, you need to fix it to you can practice this skill. She says radical acceptance means acceptance totally from the top to the bottom. It's not superficial acceptance, which many of us can do. But the real problem with acceptance is to remember that you can't make yourself be accepting. If someone says to you just accept it, you can't do it. You cannot make yourself do that. It is unbelievably invalidating to tell I also want to accept the difficult for the person who's on fire about the value of acceptance, they found it in their own lives, and they do want to spread the gospel. But you're really invalidating the suffering of the person you're trying to help that she found out head on. She says it's also invalidating because it implies that you have no understanding whatsoever of what they're going through. What you have to say is practice. In fact, for all our skills, and DBT is primarily a skills training treatment, we say practice your skills. Now, of course, therapists are practicing all the time. In my clinic, we are always saying what skills are you practicing? Or someone will say, practice your willingness, Marsha, practice, your willingness, when they know I'm not going to like something. We all go around saying what are you practicing? Mm. It's really important for me to communicate that telling people what to do is often experience and validating. But suggesting and telling people to practice is not. So you say, practice.
And then she gives some examples. If someone's loved one dies, telling them to accept it is really problematic. But saying, you know, you're really going to have to practice radical acceptance, I know that's going to be hard. That recognizes it can take a really long time. So that's why we have another skill called Turning the Mind. Here's what I mean by turning the mind. Have you ever noticed when you practice radical acceptance, you think you accept something, and then about 10 minutes later, you're not accepting it. A good example, mundane, but nonetheless good is when you look in your pocket for your keys, and they are not there, you start looking in other places. And about 20 minutes later, you look in your pocket again. In other words, you're not accepting that they are not there, you're back to thinking they could be. Interviewer says they shouldn't be there. Marsha says, yes, they should be there, therefore you look again, but it doesn't matter how many times you look, they're not going to be there when they are not there. For everything and acceptance, that is how it often goes, you accept, and then you're not accepting, you're accepting. And then you are not specially true with grief. So many of these emotions come with waves, we come to some sort of balance, and it seems like we're okay. And then in the next moment, we're back at square one. She says, acceptance can take a really long time. And this is one of the important things that therapists with this population have to do, they have to recognize that they to it as a therapist themselves have to radically accept not only themselves as the as the therapist, but they have to radically accept the client as they are and the pace as it is true for anybody who's trying to help other people. Everything is causes and conditions. Everybody is moving from where they are. Some sometimes change takes a long time, used to be a saying I'd hear in a slow change is good change. Of course, what we want is immediate change. And she says that doesn't mean you don't try to improve the pace and make things work better. Because of course you have to.
That term radical acceptance. Sounds really contemporary using the word radical. It's rad, man. But I remember reading I think it was Thomas Cahill reading a book about early Christianity. And that was pretty radical, wasn't it? Guys remember. Just love your neighbor as you love yourself. That's, that's, that's impossible. That's a really, really something you have to work at, isn't it? It's really similar with radical acceptance. These days. If you go to a Buddhist site, it seems like the teacher Tara brach is sort of the copyright owner of radical acceptance. And I'm glad she's teaching it. I read something that she wrote, which says it's something I call radical acceptance. And that sort of rubs me the wrong way. As far as I can make out this approach and this wording was developed by Marsha Linehan in 1993. And it isn't like it came from psychology to Zen came from Zen to psychology, she learned it straining at Zen centers, and Zen temples
it's, it's so important to be able to work from a place of acceptance. Because when we when we can be okay, with how we are, who we are, be okay with what we've done, you know, we find a regret the past, there's no need to shut the door. But it's over, it's past, now. It's this have to be okay with that. If we can, then change becomes practice. And we have a way of working, then we're not swirling with regret and self criticism, resentment. We have a we have a good shot at developing faith and confidence, which are really probably the keys to beginning a strong practice. It takes a while to develop, you have to have experience you can't just believe it because someone says so. But gradually you realize, okay, change is possible I can do this. There is a there's a really good example of acceptance in life. And that's improv, improvisation improvisational comedy. So I'm going to indulge myself and read a little something from a article it was taken from the book, Bossy Pants by Tina Fey. And it's Tina Fey is rules of improvisation that will change your life and reduce belly fat. That's an asterisk after that, and then down at the bottom, it says improv will not reduce belly fat. So she says, The first rule of improvisation is agree, always agree and say yes. When you're improvising, this means you are required to agree with whatever your partner has created. So if we're improvising and I say freeze, I have a gun. And you say, that's not a gun, that's your finger. You're pointing your finger at me are improvised scene has ground to a halt. But if I say freeze, I have a gun and you say, the gun I gave you for Christmas, you bastard. Then we have started a scene because we have agreed that my finger is in fact a Christmas gun. What better gift, though, obviously, in real life, you're not always going to agree with what everyone says. But one of the rule, but the rule of agreement reminds you to respect what your partner has created. And at least start from an open minded place. Start from a yes, and see where that takes you. As an improviser, I always find it jarring when I meet someone in real life. Let's first answer is no, no, we can't do that. No, that's not in the budget. No, I will not hold your hand for $1. What kind of way is that to live? The second rule of improvisation is not only to say yes, but yes. And yes, comma, and you're supposed to agree and then add something of your own. If I start a scene with I can't believe it's so hot in here. And you just say, Yeah, we're kind of at a standstill. But if I say I can't believe it's so hot in here, and you say, what did you expect? Or in hell? Or if I say, I can't believe it's so hot in here and you say, Yes, this can't be good for the wax figures are fine. I say I can't believe it's so hot in here. And you say, I told you we shouldn't have crawled into this dog's mouth. Now we're getting somewhere. To me, yes. And means don't be afraid to contribute. It's your responsibility to contribute. Always make sure you're adding something to the discussion. Your initiations are worthwhile. It's, yeah, it's it's kind of wonderful. To just learn to, to the extent we can and it's a practice it's practice, learn to take what you're given and just go with it. You know, the, the, the course correction doesn't have to be Holding your hand up, you know, it's not always talked to the hand. We can we can work with other people, we can find a way. And we can work with ourselves. There's so often what comes up is emotional pain is fear or anxiety. And then we have the question of how are we going to deal with that? The the unconscious thing that most people do is to try to put a lid on it, try to push it off to the side, not face it head on. But if we turn towards it and say, you know, why is it that I don't want to give this talk and just look at, you know, whatever anxiety or discomfort is coming up, and bring some curiosity about it into the equation, then then things have room to move. Marsha Linehan makes a point in some of the skills, she teaches her patients, that when you have a strong emotion resisting, say, doing something difficult, the first thing to do is to see well is that emotion valid, for instance, you may be afraid to go into a room because you think there's a snake in there. Well, if there is a snake in there, don't go in the room. But if there is no snake, then the technique she teaches is do exactly the opposite of what you want to do. Go into the room, and see what happens. And so often, that's the way through emotional difficulties, is just finding the courage to do the simple thing that you're unwilling to do. I had a friend once who said I could pay my taxes, if I had the right drugs. Well, sometimes you don't have the right drugs, or sometimes you don't really want to take those drugs. And then you just have to pay your taxes.
There's there's so much that's possible, when we're able to work at accepting things as they are. And when no longer when our focus is no longer on what's wrong, especially on what's wrong with me. And with what's wrong with you. Those are both really, really big problems. And we have to remember that I'm the way I am. You're the way you are because of causes and conditions. This is what the Buddha taught. Everything follows from one thing to another. Henry Wadsworth Longfellow wrote, if we could read The Secret History of our enemies, we would find in each man's life, a sorrow and a suffering, enough to disarm all hostility. Now Roshi used to drive around with a bumper sticker on the back of his car, which said, mean people are suffering. It's true. It's completely completely true.
Gradually, as we progress in practice, as we practice, we find we are able to take on things that used to throw us we learn those skills, we can get to a point where there's an awful lot that we can handle. The teacher Joko Beck use the term a bigger container is more and more that we can take on there's always a point at which we can't. And then we have to practice that's our point of practice. Jack Kornfield had a quote. He said, If you can sit quietly after difficult news. If in financial downturns, you remain perfectly calm. You can see your neighbors travel to fantastic places without a twinge of jealousy. You can happily eat whatever is put on your plate and fall asleep after a day of running around without a drink or a pill. If you can always find contentment just where you are. You are probably a dog
we could work towards becoming dogs. All of us. So yeah, I'll dedicate this talk to my dog, Archie. And we'll stop here and recite the four vows
