Building a Life Worth Living: A Memoir

This is the story, the narrative, of a survivor, Marsha Linehan, an innovator in the treatment of borderline personality disorder (BPD) using a method she and her team invented called Dialectical Behavioral Treatment (DBT). Linehan has written a memoir, not a treatment manual (separately noted in the complete post). Her memoir contextualizes the diverse interventions used by DBT such as acceptance, distress tolerance, emotional regulation skills, self soothing skills, communication skills, limit setting skills, assertiveness training, and so on. She attempts and largely succeeds in connecting the dots between DBT and its skills and the key events in her life, many of which had not been publicly available. Linehan is on a tear – standard behavioral therapy doesn’t work with the most seriously distressed (suicidal) patients and cognitive behavioral therapy has serious issues, too. You have to get a person whose life and all-available-evidence “prove” that “all the good one’s are taken” or “life sucks” to be reasonable and admit that “some of the good ones are not taken” or “life does not have to suck at all times.” The thing about the iceberg [of life] is that it’s the iceberg “all the way down.” The visible part of the iceberg is not a different iceberg than the less visible part submerged beneath the water. The behavior is visible, but the biology is not visible, what the individual had to survive is not visible, how the community reacts to the individual of is not visible. But unlike – or perhaps just like – the iceberg, research treats these all as different siloes. It is true that we all – including Linehan – now speak of the bio-psycho-social individual and express authentic commitment to integration. But the effort required to integrate just shows how dis-integrated the entire phenomenon is. The tip of the iceberg does not regard itself as distinct from the iceberg. The “tip” is our abstraction. Likewise, with behavior. Linehan demonstrates this compelling as she takes the psychoanalytic distinction of “introject,” operationalizes it, and shows collects evidence that DBT improves measures of introject over against a stricter behavioral intervention. Amazing. How shall I put it delicately? Like every other individual, Linehan has a privileged access to her own first person experience – the golden light moment, the blue hydrangea moment. She also has many advantages in interpreting what that experience means, since, like every other individual, she knows a lot about her own history that others might or might not know. But as to what the experience “really means,” one individual has as good a chance of getting it right as another once the experience has been captured and reported. At first she says “The golden light means God loves me”; but then, since that experience was like [felt like] her love for Ed [a person who she actually loved deeply], she reinterprets the golden light to mean “I love God.” So she has to continue searching for God’s love for her, which brings us to the blue hydrangea by which time the meaning of God and of love have shifted. Hence, the title: Saint Linehan. But wait. Her Zen experience will eventually have taught her this is just another Zen koan – it is like the ambiguous Gestalt image the duck-rabbit where the rabbit’s ears and the duck’s bill and the figure spontaneously reverses – perhaps she got it right the first time – “God is God” and “love is love.” In short, Linehan is really slinging it here, and there is nothing wrong with that. It works. Her rhetoric is that of the beginner’s mind after long struggle. She is irreverent, assertive, disruptive within limits (and without), empathic, highly empathic, and contrary within limits (and without), innovative, all DBT skills, and we thank you, Marsha, for being Marsha.

The author's contribution to counseling by building the process of accepting where you are (so that you have solid ground to stand on) while learning to be a more capable person, is a major contribution to counseling. While Cognitive Behavioral Therapy is quite effective, some people need to go beyond that, meaning that they are so overwhelmed that their cognition is overtaken by fear and other emotions, kind of feeling like a toddler in meltdown in situations that do not overwhelm most of us. People who have these collections of psychological symptoms are said to have such personality syndromes as Obsessive-Compulsive behavior or Borderline Personality Disorder. These "syndromes," described in a manual (the DSM--you can look it up) that is used by counselors are intended to help counselors figure out the best way to counsel particular people. They are not intended to label people for life, just as a dyslexic can learn to read, but may need some extra help to do so. (lots of dyslexic people in my family) Linehan's insight was that such people first need to understand and be able to manage their emotions, using such skills as meditation, in order to be "still" enough inside to use the toolkit of habit-changing responses provided by CBT. Only later and gradually did the author realize that she herself would probably have been best diagnosed as having BPD, one of the harder syndromes to treat because such people are so fearful and defensive. The book is very well-written, and a bonus is having the story of Linehan's life, in which she made choices about how to live her life and build relationships of caring and trust.

I have been a DBT therapist for about 15 years. One of my former coworkers was sent this book by the publisher to read and review. I sent the publisher an email and asked for a copy as well, citing trainings I had done as a participant and facilitator, reviews of books pertaining to DBT which I had read, and even included a photo of me with Marsha from a training in Seattle. I read it in one sitting and immediately purchased a copy through Amazon so I could loan it out. I tried not to do my normal reading thing--make notes in pencil, annotate specific quotes in a small notebook, and make a list of other books to read--but resorted to this by page 75. I also was making apple butter with pecans so had wonderful aromas in the kitchen as well as a pot of strong coffee. Then, to make the mood absolutely perfect--had my Alexa speaker play Adele. I think Marsha would have enjoyed that. I have been fortunate to participate in trainings with Marsha and to have staffed clients with her. She used to have students from her intensive trainings over for dinner at her house. It was absolutely wonderful to walk around arm-in-arm with her and have her tell me kind thoughts and wish me well with my clients. That was really one of my life's highlights. Around 2012 I was doing a DBT group with adolescent girls. One 12 year old asked if possibly Marsha was 'one of us?' I asked her what she meant by that, why did she think so? And the child said it was because she seemed to know exactly what we had been through. I nodded and told them about the NY Times article and brought it in the following week. When I had met Marsha her arms still bore severe scarring. On page 176 Marsha talks about using occasional strategic helplessness--which had me laughing out loud. When my oldest daughter was 18, the car made a funny noise and we pulled off road. She asked how we would get some help? I knew this kid was going to be moving out and on her own and I suggested she pop the hood and look forlornly at the engine--said some man would be by in about 5 minutes to help us out. Yes. I did that even after having come up in the 70's and having been told no most of my life--I have used occasional strategic helplessness to my advantage. On page 272 there is a remarkable awareness of the misery shared by many borderline clients which Marsha identifies as being homesick. How poignant. What an apt description. There is a brilliant quote by Rainer Maria Rilke that should be on the wall of all DBT therapists, at least 4 other books I want to look up. Much of the information on skills and research was familiar to me. It was fun to go to the ISITDBT conference and see many of the DBT rock stars. Many DBT therapists are gifted trainers and have helped thousands of people over the course of their work. Marsha is a solid human being who has made the most of what was given to and made available to her. She is a remarkable human being. She loves her clients and her work. If the level of DBT experience and capability was identified by the seat number you were given at the world's largest stadium--I would probably be at home watching the event on TV. Still, Marsha makes everyone feel they belong at the head table. One last thing. I grew up in Connecticut and our mother was at the Institute of Living on several occasions--also in the 1960s into the early 1970s. A sad dialectic-- it was a renowned hospital and it was unpleasant. Shock treatments and cold packs were often the norm and no one spoke of mental illness. Marsha's development of biosocial theory and her path to wellness are earned. This book would be validating to persons with borderline personality disorder, their family members, therapists who provide DBT services, and especially those who may work with persons with borderline personality disorder who do not share the love of those suffering. Thank you, Marsha. We love you.

I enjoyed the book, although I didn't find the author to be a compelling storyteller. Her actual story is quite good, and might have been better told by someone else. She weaves some of the teachings of DBT into the book, and if you appreciate her work, it is definitely worth reading.

A beautiful look into the life and work of a beautiful person. I’m grateful I had the oppertunity to read this book.

Marsha Linehan is the developer of Dialectical Behavior Therapy (DBT) which is a highly effective theraputic treatment for borderline personality disorder as well as other disorders like eating and substance abuse. When I found out recently that Linehan herself was highly suicidal when she was a teenager and was hospitalized in a psychiatric institution, I was intrigued and knew that I wanted to know more about her life. Reading her memoir I discovered that she made a promise to herself and God that she would help others stuck in hell when she got out of that awful hospital. That is precisely what she ends up doing. She lays out her journey to achieve that in her memoir. While at times the writing was disjointed, I didn't mind to so much. I was able to understand a lot about her. Her faith journey was also fascinating to me. She was raised Roman Catholic and she had a strong relationship with God. Through Catholic mysticism she eventually discovered mindfulness and studied under a Catholic priest who was also a Zen master. She incorporated mindfulness into DBT at a time when mindfulness was seen as a new age teaching and wasn't taken seriously. As such she was well ahead of her time. It was a very interesting read for me and I am glad I purchased the book on my kindle.

This is a great book for anybody interested in learning about the background of the development of DBT. Marsha is very brave for sharing her story. The concepts of DBT can be helpful for anybody. It is based on accepting how life is in the moment and then learning tolerance skills. She built a life worth living by deciding she wanted to and that she wanted to help others do the same. She hit bottom and never wanted to go back. Bottom was her time at the Institute of Living. I admire Marsha for daring to come up with a treatment that is unconventional and doesn't rely on dispensing medication. She targeted behaviors. That is how it should be! So many people get misdiagnosed and mislabeled since mental health symptoms tend to overlap. I had been told that the average patient goes through 7 medications till the "right" one is found. I hope that someday a DBT skillset for parents to use with children is published. Many of the conventional parenting skills do not work well with kids that have trouble regulating their emotions. Marsha doesn't remember much of her life before her time at the Institute of Living. I am guessing there were things her family noticed and could have helped with had they known what skills to use.

This was the perfect book for me to be introduced to DTB. My therapist mentioned DTB as a form of treatment for my depression. She said to make sure I purchased a book written by Dr. Marsha Linehan as there were many books on the subject by various authors. I saw many text-book type books on DBT written by her, but then I saw "Building A Life Worth Living - A Memoir". First, the title drew me in right away, as I had been struggling for a happier life. Not that I didn't have a great life, I just had depression I needed to sort out. Second, it made sense that I should know something about this person if I was contemplating her brand of therapy. Reading that book was going be my starting point. It was such a pleasant surprise to learn about DTB and Marsha both at the same time! It made the introduction to DBT much more personal and not as dry as it would have been otherwise. It made me understand the "why" for every component in her treatment plan. It also allowed me to see a personal side of her that wasn't always pretty. I love how open she was to include her mistakes or blunders when she had a setback. She sure didn't have to be! I even cried I little when I finished. It was like saying good-bye to a friend after having a very loving, meaningful visit. I would recommend this book to anyone, not just those with mental health issues. These "life skills" as Dr. Linehan calls them can be used by every person in their daily life.

I have read a lot of BPD books but they are often either written solely from the perspective or partner, therapist or patient. As the person who created DBT therapy and as a BPD patient herself, this offers more of a perspective on living with the condition, how she overcame it and also the clinical side of things. And it’s just really well written.

Marsha Linehans's biographie, interesting reading to understand her innovative therapy DBT

Tengo BPD y me recomendaron el libro, si bien no es como una guía o manual para el trastorno aprendes mucho de la lucha y constante invalidacion que vivió la autora.

I knew a little about DBT and even less about Marsha when I started reading this book. I absolutely loved it. Marsha is a force to be reckoned with. It is incredibly well-written and authentic. It is ultimately a story of hope from the deepest depair.

Is to love her. A Master writes about her own raw,painful experience. Gave me hope in a very dark time in my life. Please read if you have BPD, but even otherwise a beautiful read.