In the 1970s, an important advance was made in therapy.
Like all good therapy, it emerged through the wisdom and practise of treating clients and experiencing their ‘stuckness,’ but also through the personal lived experience of a therapist. In this case it was a psychologist, Marsha Linehan, who herself had suffered from bouts of overwhelming suicidal ideation and self-harm and received a diagnosis of schizophrenia as a young woman.
The emergence of Linehan’s Dialectical Behaviour Therapy (DBT) meant a new, more effective treatment and approach for suicidal individuals and those with self-harming behaviours. Often these clients receive the diagnosis of borderline personality disorder, or as it is described today, Emotionally Unstable Personality Disorder (EUPD). They are the clients most associated with therapist burnout due to their volatile and often impulsive behaviours, neediness and rejection in equal parts, and a seemingly stubborn refusal to engage in recovery. DBT offered hope equally to clients and the therapists desperate for a way to reach and support clients who were in such obvious distress.
Its founder, Dr Linehan, combined cognitive behavioural therapy – the emphasis on behaviour (CBT) with elements of Zen Buddhism, shaped a new therapeutic approach based on radical acceptance and change.
It states that you (the client) are not responsible for what happened to you – often, but not always, EUPD is associated with experiences of childhood trauma – but you are responsible for making the changes. DBT teaches clients to accept their feelings of intense distress but to understand they will pass. Mindfulness is the core component of the therapy.
In establishing DBT, Dr Linehan was also unwittingly helping people who were experiencing other adverse mental health issues. This new therapeutic approach would later be found to benefit other clients: those who were self-harming but also clients struggling with eating disorders and addictions.
This underlines a core belief I hold about therapy: there needs to be a choice of therapy for each individual. Each therapy is valid and effective to some. CBT, for example, is extremely effective for some people, but for others simply does not ‘work.’ It is not the case that six sessions of CBT will ‘sort everyone out’ (whatever that means). For children and young people in particular, a choice of therapies which incorporates a humanistic approach is essential.
As a mental health organisation, we ensure that all of our online and face-to-face counsellors are trained in DBT skills and are therefore able to apply this approach to help children and young people who are self-harming.
In furthering our DBT work, we previously invited children at various high schools in Knowsley to attend a 16 week “skills group” DBT course. The course involved weekly sessions involving group work and one-to-one therapy. Counsellors worked with young people to help them understand their behaviour, understand self-harm and gain a deeper understanding of themselves – and to learn the skills to manage their feelings.
By the end of the course, all of the pupils has stopped self-harming.
Self-harming is now consistently in the top ten presenting issues on Kooth, being presented well over 4,000 times last year. A recent poll by the National Education Union (NEU), found that more than half of school staff said youngsters had been self-harming or thinking of self-harming.
Ensuring our therapists are equipped to support young people who are self-harming is therefore essential.
We need to provide easily accessible and professional care as early as we can to avoid escalation: thanks to Dr Marsha Linehan, DBT is an effective way we can and will continue to support young people.
Founder and Chair, XenZone