‘Finding the life worth living’

Sara Mayne was just six months out of Chico State with her master’s degree in social work when she encountered a patient who’d make one of the more powerful transformations she’s witnessed as a counselor.

In early 2015, Mayne, an associate social worker, was working as a therapist for a new mental health practice in Chico where she still works called Genuine DBT (the “DBT” stands for dialectical behavior therapy), which incorporates Zen concepts such as mindfulness and acceptance.

“I have always been interested in helping people with strong needs, and allowing them to see their inner beauty,” Mayne said.

This particular patient was a deeply troubled teenage girl who said she had attempted suicide more times than she could count. Dialectical behavior therapy helped make an astonishing improvement in the girl’s life.

“The patient has not tried to end her life in the two years since she started DBT training,” Mayne said. “Before the treatment, she had recurring terror, misery and darkness, but now she has a lot of joy and healthy relationships.”

DBT primarily helps patients with borderline personality disorder, a condition affecting roughly 1 in 50 Americans, with symptoms such as lack of emotional control, volatile relationships and self-harming tendencies. The National Institute of Mental Health’s website says that “a person with BPD may experience intense episodes of anger, depression, and anxiety that may last from only a few hours to days.”

Self-injuring and suicidal behaviors are particularly serious symptoms.

Genuine DBT owner and therapist Michael Courter, a licensed clinical social worker who established the clinic two years ago, says his is the only therapeutic practice north of Sacramento in California that exclusively treats borderline personality disorder.

“Other therapies are successful in their field,” Courter said, but the sliver of the general population with borderline personality disorder “really need this therapy.”

For those who do, Mayne says, DBT is a lifesaver—and often the last resort.

“Over and over, we hear patients say, ‘I’ve tried everything and nothing has worked,’” she said. “But many end up saying, ‘For the first time, I’m entertaining the idea that I’m not going to die by suicide.’”

Dialectical behavior therapy was created by Marsha Linehan, a professor of psychology and director of the Behavioral Research and Therapy Clinics at the University of Washington in Seattle. She designed DBT to treat borderline personality disorder, from which she herself had suffered. In 1993, Linehan literally wrote the book on her new therapy: Cognitive Behavioral Treatment of Borderline Personality Disorder.

Her book is the main text from which the therapists and clients at Genuine DBT work. Clients learn specific coping techniques, many of them non-Western, using a 400-page book of skills and handouts.

“Before DBT, those with BPD symptoms like chronic self-harm and suicidal behavior were very misunderstood,” said Courter. “Marsha’s book lays out clearly why people engage in that behavior.”

The short answer: Borderline personality disorder sufferers have unmet psychological needs, and the resulting voids can yield harmful consequences.

Mayne—citing the Linehan-founded DBT training site BehavioralTech.org—touts dialectical behavior therapy as “currently the No. 1 treatment for BPD, which is often misdiagnosed as bipolar disorder, PTSD, anxiety or depression. The efficacy of DBT is far higher than other treatments for chronic self-harm, suicidality and volatile relationships.”

The therapy itself is quite involved. Courter says patients learn specific techniques in alternating weekly individual and group sessions, lasting from eight months to two years.

“One of the ways Marsha makes Zen useful is by breaking the practice into small steps you can use to stop the maladaptive behavior,” said Courter, who for 20 years has practiced meditation and Falun Gong, a Chinese blend of spirituality and meditation.

Psychologist Sara Sorci Steele, another Genuine DBT therapist, says a nontraditional feature of DBT is the way it approaches a client’s most damaging actions.

“We believe in direct treatment of the harmful behavior, rather than dwelling on the past causes of it,” she said. “Most other therapies don’t have the tools to respond directly.”

This targeted focus breaks down the time frame of the harmful behavior. Counselors ask questions such as “What did you do?”; “How did you feel?”; “What happened after you took the pills?”—without shaming or blaming.

Another powerful technique taught in dialectical behavior therapy, Courter says, is finding the underlying unmet need that led to the suicidal behavior. Then, by giving the person an alternative way to get that “legitimate need met,” he said, “they don’t have to resort to the [self-destructive] way.”

A distinct aspect of Genuine DBT is the support offered from all counselors.

“[Any] one of us might be your individual therapist, but you are also backed up by all the therapists,” Mayne said. “Each client walks into a supportive village.”

Therapeutic Solutions, a general mental health facility in Chico, also offers dialectical behavior therapy, among other forms. Its program is much shorter—one month—conducted by Patricia Long, a marriage and family therapist.

“The ‘dialectical’ in DBT is a philosophical term meaning to find the truth in the synthesis of polar opposites,” Long said, sort of like the Asian yin-yang symbol, which symbolizes good in every bad, and bad in every good.

If that sounds more New Age than clinical, Courter and Sorci Steele explain otherwise. Sorci Steele stresses that the “mindfulness” taught in DBT is not simply relaxation.

“Mindfulness is intentionality and awareness,” she said. “Instead of your emotions taking off, it allows you to be aware and set the intention for your emotions.”

Added Courter: “You can’t always change what your are feeling, but if you can accept it, that changes the way you experience it.”

The mindfulness in DBT is observing without judging. As Sorci Steele explained, “Rather than being overwhelmed and controlled by the emotion, patients can observe and react in a different way, even if just for a 5-millisecond space.”

Meanwhile, Mayne says, the concept of acceptance is emphasized regularly at Genuine DBT.

“The things we can’t change we must accept,” she explained. “The alternative is misery.”

Sorci Steele sums up much of DBT by saying, “Many don’t have the vocabulary to express their emotions, but DBT helps them feel in control and understood by others.

“We’re finding the life worth living for each client.”