[APPLAUSE]

MARSHA LINEHAN: Well thank you very much.

That was an amazing introduction, I have to say.

This is going to be my first talk ever for 45 minutes.

And so that was very long and I'm not

counting it as part of my talk.

[LAUGHTER]

Just to let you know.

Well, thank you for coming.

I really appreciate it.

I always like to talk about my research,

as probably every researcher in the world does.

And I'm going to be talking about suicide.

And I'm just noticing that I'm missing-- here it is.

I'm going to talk about suicide, as you no doubt can see,

because that's been the research I've

done really my entire career.

I want to just comment to you to start with about what it's

like to be a suicidal person.

And suicidal people, it's like being

a person locked in a closet with white walls that

go all the way up to the ceiling and red hot pain on your feet

and up through your heart.

The suicidal person looks for a way out.

They try everything to get out of that room.

But they can't find the room, the door to let themselves out.

And so ultimately they find only one door,

which is the door of suicide, which they go through.

Many years ago in my own life, I decided, first of all,

I was very interested suicide.

And I decided that I was going to spend my life going

into hell, because that's where all these people were,

to get them out of hell.

And the talk tonight is really a review

of my best effort to date to do exactly that.

I can't say that I've been so successful that we

don't need so much more work.

But this is the best that I've been able to do so far.

So I'm going to share that with you.

Now, as you're looking here, you see all these names

at the bottom.

I hope that you can see them.

We've got Anita, we've got Trevor, we've got Chelsea,

we've got Kevin.

These are my graduate students at the moment.

And everyone who's had a researcher professor

knows that nobody gets anything done without students.

And these are the students who've supported me

so much over this time.

And they're doing, to be perfectly honest

with you, the most exciting research in the world.

And if I have time at the end, I will tell you.

I almost want to do it now, but then I

might not be able to finish my talk,

because they do such exciting stuff.

But I'll try to squeeze it in later.

So these are my conflicts of interest.

You can see right away.

I feel like Hillary now.

[LAUGHTER]

You can see right away that you should

take with a grain of salt everything I have to say,

given that I have a lot of conflicts.

OK I get money and funding from the National Institute

of Mental Health to do my research.

I receive training and consultation fees

from Behavioral Tech, which is a trainee companies

that I founded.

I receive compensation as an owner

of Behavioral Tech Research, which is

group that develops products.

And I receive royalties from the sale of my DBT books.

So now that you know that, we'll just go right on.

I'm going to talk about dialectical behavior

therapy, which is an evidence based therapy for high suicide

risk.

First I'm going to tell you how it got the name.

Because those of you who've ever seen

the book have seen the book and know that the name of book

is Cognitive Behavior Therapy.

And that is not what the treatment is.

The treatment is dialectical behavior therapy.

But my editors wouldn't let me put that name on

because they said no one would buy the book if it was said

to something like dialectical, which nobody knew

what it meant, including me.

And I'll talk a little bit as we go on about how

it happened to be dialectical.

So where did everything start?

My work on this particular treatment

started when I came to the University of Washington.

And I got a small grant from the National Institute

of Mental Health, who were wonderful to me,

I've got to tell you.

I mean, no one has treated me better than they have, really,

over the years.

But at that time, I was very young.

And they liked my idea.

So they gave me a little bit of money

to see if I could do anything with it.

Because I told him that I wanted to figure out

a treatment for suicidal people.

So they gave me the funding.

And I was a complete and total believer in behavior therapy.

I'd been trained in behavior therapy

by the best, a whole group of Gerry Davison and Marv

Goldfried.

And if ever there was a believer in behavior therapy, it was me.

And I figured that I wasn't really going

to find out whether it worked.

I was going to prove that it worked.

You can tell I wasn't too scientific in those days.

And so that was the basic idea.

So I figured, I don't know how long I thought it'd take.

But I didn't think it was going to take that long,

because I figured the treatment was just going to work

and I'd get all those people to stop being suicidal

and I'd go do something else with my life.

Probably stay in suicide, but my treatment was going to work,

so I wasn't really worth.

So that was a big mistake.

Because immediately the treatment blew up.

That's the best way to put it.

I was treating people to develop the treatment.

I had to treat people.

But I figured I had a treatment, it was behavior therapy.

The problem was that the people I was treating,

they experienced me as being judgmental,

as telling them what to do, et cetera.

Mainly because I was acting like a behavior therapist.

So they would come in.

I would say, what's your problem?

I figured out their problem.

I'd say, OK, no problem, I'll see you next week.

They would come in next week and then

I would say things like, OK, so I see that this is the problem.

I can help you change.

They said, what?

You're saying I'm the problem?

I said, no, no, I'm not saying that.

Absolutely I'm not saying that.

Absolutely I'm not saying that.

And they would scream and yell and cry

and the whole nine yards.

So I thought, OK, that's not a problem.

My degree's in experimental personality theory.

So I knew all kinds of other things.

And I thought, OK, I'm going to do

an acceptance based treatment.

I'm going to do one of those ones

where you're just always listening and paying attention,

validating, understanding, all that kind of stuff.

I thought, this must be what I need to do.

So then I started doing that.

That was an even worse disaster.

They said, what, you're not going to help me?

I said, of course I'm going to help you.

Yes, I am going to help you.

So I had to solve that problem, of course,

because it couldn't go forward without solving it.

So I had to do the next thing.

I figured out that I needed new therapies strategies.

So what did I need?

I needed a synthesis.

I needed a technology of change and I needed

a technology of acceptance.

I realized right away I needed a spaciousness of mind

to dance with movement, speed, and flow

and also because the client would come in

and they'd have one problem.

They'd say, my problem is my boyfriend.

And I really don't know what to do about it.

And I say, OK, well let's work on that.

And say, yeah, I know, but the problem is he moved out

and now I can't pay my rent.

And I say, oh, well, let's work on how to do the rent.

At which we start working on that and they say,

well, I'm killing myself anyway.

I don't think it makes any difference.

I say, all right, let's work on that.

So I realized that I had to be able to really move

with the client.

So I also realized at the time that I

had to get radical acceptance of the clients themselves.

Now why did I have to do that?

Let me tell you how I got these patients for my research.

I was very afraid that my treatment would not

be as good as treatment as usual in the community.

So I figured that I couldn't just do a regular study.

Because what if everybody got better on their own

and I couldn't show my treatment was better?

So I decided what I would do is try

to get the worst of the worst, the most

difficult of the difficult. This was so that I'd be able to show

that my treatment was better.

So I called all the hospitals in town

and I said, what are the worst patients you have

and the suicidal, the most difficult to treat,

and the ones you really don't want to treat?

Would you send those to me for my research?

I was this little nobody from nowhere.

They said, right.

We'll send them right to you.

And that's how I got them all.

Because they were very difficult to treat.

And the problem was I had no experience

before this of ever dealing with anybody like this.

I had dealt with people where you had sort of simple problems

and treatments worked and they all got better.

And all of a sudden I had these people

who had a very slow and episodic rate of progress

and a real high risk of suicide.

And I realized that I had to figure out how to accept that.

And then I came upon the knowledge

that I needed to also get humility.

Because it turned out that it was clear

the problems were transactional.

In other words, it wasn't that they were screwed up and I

wasn't.

I had my own part to play in the relationship.

And I started to realize that also.

And just to let you know what happened

with the treatment, that particular finding,

was that to get on a DBT program, to be a DBT therapist,

you have to sign things that you agree to, to get on a team.

Because you have to be on a team.

I'll talk about that later.

But to get on the team, you have a lot of things

that you have to agree to it.

And one of the things that all DBT therapists have

to agree to, this is the truth, you

have to agree that in reality most therapists are jerks.

And that most of the things that our clients say that we do,

we actually do.

This is true too.

So this was a good agreement.

So the solution was to apply change strategies

and acceptance strategies.

And I had learned those primarily

from many behavior therapy strategies for the change

strategies.

And then acceptance strategies I learned in many other places.

And I'll talk a little bit more about that.

But the main acceptance strategies are validation.

And the core of change strategies

are problem solving of one [? square ?] to the other.