I'm a licensed clinical psychologist with clinical experience working with children, adolescents, adults, and families. I specialize in the treatment of anxiety in people of all ages. This includes Generalized Anxiety, Obsessive Compulsive Disorder (OCD), Social Phobia, Specific Phobias, Separation Anxiety, and Panic Disorder. I have expertise in a number of evidence-based treatment approaches (link):
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Cognitive Behavioral Therapy (CBT)
Exposure and Response Prevention
SPACE Program (Supportive Parenting for Anxious Childhood Emotions)
Dialectical Behavior Therapy (DBT) informed treatment
Interpersonal Psychotherapy for Depressed Adolescents (IPT-A)
Mindfulness Based Treatments
Building on the success of Don’t Let Your Emotions Run Your Life and Don’t Let Your Emotions Run Your Life for Teens, this is the first dialectical behavior therapy (DBT) activity skills workbook designed especially for kids. Designed for children ages 7 to 12, this essential guide will help kids manage difficult emotions and get along better with others. “Don’t Let Your Emotions Run Your Life for Kids is a simple yet comprehensive tool facilitating meaningful dialogue between parents, caregivers, family members, and children for explaining and exploring emotions. The workbook discusses a variety of emotions using language geared towards children, and provides concrete examples of what emotions ‘look’ like while giving children the.
I have worked extensively with college students, teens, and children. My work with teenagers focuses on helping them learn new skills and activate preexisting strengths to better navigate the unique academic and social challenges of adolescence (bullying, peer difficulties, adjustment to separations, academic difficulties, family conflict). Additionally I provide treatment and coaching to parents of children and adolescents.
I have co-authored research publications and presentations related to anxiety and have served as clinical supervisor to externs at Mt. Sinai St. Luke’s Hospital Center.
Mt. Sinai St. Luke’s Hospital Center (DBT track), postdoctoral fellowship
Columbia University Medical Center, New York Presbyterian Hospital, clinical internship
Extensive training with the developers of DBT for Adolescents
Montefiore Medical Center, clinical externship with Alec Miller, Psy.D.
Cognitive Behavioral Associates, LLP, training with Jill Rathus, Ph.D.
Mount Sinai Hospital, clinical externship
Long Island University-Post, Doctorate in Clinical Psychology
Fordham University, Bachelor of Science, Cum Laude with Departmental Honors
MARSHA M. LINEHAN, Ph.D. is the originator of Dialectical Behavior Therapy and is a professor in the Department of Psychology at the University of Washington.
NOTE: Writing of this manuscript was partially supported by grants MH34486 and DA08674 from the National Institutes on Mental Health and Drug Abuse, respectively, Bethesda, Maryland.
Borderline personality disorder (BPD) represents a major health problem for the 1990s and beyond. It is a prevalent disorder that is severe, chronic, and persistent. The number of individuals meeting criteria for the disorder is high, approximately 11% of all psychiatric outpatients and 20% of psychiatric inpatients. In addition to being prevalent, follow up studies consistently indicate that the diagnosis of BPD is chronic. Between 57 and 67% continue to meet criteria four to seven years after the first diagnosis and up to 44% continue to meet criteria fifteen years later.
The severity of BPD is perhaps best seen in the high mortality rate of the disorder. Approximately 10% of BPD patients eventually die by suicide. The suicide rate is much higher among the 36 to 65% of BPD individuals who have attempted suicide or otherwise injured themselves intentionally at least once in the past. Looking at suicide rates from the reverse angle, 12 to 33% of all individuals who die by suicide meet criteria for BPD. The emotional costs of BPD are enormous. BPD individuals describe chronic feelings of anger, emptiness, depressions and anxiety. They experience extreme frustration and anger, and occasionally experience brief psychotic episodes. They describe chaotic relationships and 'confused identities.' Even among those who have not attempted suicide, suicide ideation is common. The quality of life ratings for some of the problems frequently experience by BPD individuals suggest that their quality of life is amongst the lowest.
At present there are very few treatments with proven efficacy in treating BPD individuals. In summarizing the findings of pharmacological treatment studies, Paul Soloff, MD., concludes that pharmacotherapy effects, while clinically significant, are nonetheless modest in magnitude. The empirical evidence supporting psychosocial treatments for BPD is similarly meager. This poses a special problem because even when effective pharmacotherapy is given, the complexity and severity of BPD dictates concurrent psychotherapy. To date cognitive-behavioral therapy (specifically, Dialectical Behavior Therapy or DBT) is the only treatment that has been shown in controlled clinical trials to be effective treating BPD.
Dialectical Behavior Therapy: Foundations
DBT is based on a model suggesting that both the cause and the maintenance of BPD is rooted in biological disorder combined with environmental disorder. The fundamental biological disorder is in the emotion regulation system and may be due to genetics, intrauterine factors before birth, traumatic events in early development that permanently affect the brain, or some combination of these factors. The environmental disorder is any set of circumstances that pervasively punish, traumatize, or neglect this emotional vulnerability specifically, or the individual's emotional self generally, termed the invalidating environment. The model hypothesizes that BPD results from a transaction over time that can follow several different pathways, with the initial degree of disorder more on the biological side in some cases and more on the environmental side in others. The main point is that the final result, BPD, is due to a transaction where both the individual and the environment co-create each other over time with the individual becoming progressively more emotionally unregulated and the environment becoming progressively more invalidating.
Emotional difficulties in BPD individuals consists of two factors, emotional vulnerability plus deficits in skills needed to regulate emotions. The components of emotion vulnerability are sensitivity to emotional stimuli, emotional intensity, and slow return to emotional baseline. 'High sensitivity' refers to the tendency to pick up emotional cues, especially negative cues, react quickly, and have a low threshold for emotional reaction. In other words, it does not take much to provoke an emotional reaction. 'Emotional intensity' refers to extreme reactions to emotional stimuli, which frequently disrupt cognitive processing and the ability to self soothe. 'Slow return to baseline' refers to reactions being long lasting, which in turn leads to narrowing of attention towards mood congruent aspects of the environment, biased memory, and biased interpretations, all of which contribute to maintaining the original mood state and a heightened state of arousal.
An important feature of DBT is the assumption that it is the emotional regulation system itself that is disordered, not only specific emotions of fear, anger, or shame. Thus, BPD individuals may also experience intense and unregulated positive emotions such as love and interest. All problematic behaviors of BPD individuals are seen as related to re-regulating out of control emotions or as natural outcomes of unregulated emotions.
Dialectical Behavior Therapy: The Treatment Model
DBT assumes the problems of BPD individuals are twofold.
First, they do not have many very important capabilities, including sufficient interpersonal skills, emotional and self regulation capacities (including the ability to self regulate biological systems) and the ability to tolerate distress.
Second, personal and environmental factors block coping skills and interfere with self regulation abilities the individual does have, often reinforce maladaptive behavioral patterns, and punish improved adaptive behaviors.
Helping the BPD individual make therapeutic changes is extraordinarily difficult, however, for at least two reasons. First, focusing on patient change, either of motivation or by teaching new behavioral skills, is often experienced as invalidating by traumatized individuals and can precipitate withdrawal, noncompliance, and early drop out from treatment, on the one hand, or anger, aggression, and attack, on the other. Second, ignoring the need for the patient to change (and thereby, not promoting needed change) is also experienced as invalidating. Such a stance does not take the very real problems and negative consequences of patient behavior seriously and can, in turn, precipitate panic, hopelessness and suicidality.
It was the tension and ultimate resolution of this essential conflict between acceptance of the patient as he or she is in the moment versus demanding that the patient change this very moment that led to the use of dialectics in the title of the treatment. In DBT, treatment requires confrontation, commitment and patient responsibility, on the one hand, and on the other, focuses considerable therapeutic energy on accepting and validating the patient's current condition while simultaneously teaching a broad range of behavioral skills. Confrontation is balanced by support. The therapeutic task, over time, is to balance this focus on acceptance with a corresponding focus on change. As a world view, furthermore, dialectics anchors the treatment within other perspectives that emphasize:
DBT is designed to address the following five functions of successful treatments:
|enhancement of generalizations of gains,|
|enhancement of capabilities and motivation of therapists,|
|structuring of the environment to support clinical progress.|