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- เผยแพร่เมื่อ 5 ม.ค. 2025
- Get the latest strategies on dissolving your client’s resistance in the short course: "How to Work with a Client’s Resistance" with Marsha Linehan, PhD, Peter Levine, PhD, Pat Ogden, PhD and more: www.nicabm.com...
In this video Dr. Marsha Linehan shares her valuable insights on addressing resistance in therapy.
When clients struggle with resistance, Dr. Linehan emphasizes the importance of shifting focus and asking a fundamental question: "Is this really effective?"
Drawing from her extensive experience, Dr. Linehan highlights various strategies to navigate resistance.
She discusses the significance of exploring pros and cons, understanding underlying fears or avoidance, and conducting a clinical assessment to identify the controlling variables that hinder progress.
Dr. Linehan emphasizes the value of guiding clients to give up resistance and explains the necessity of experiencing difficult emotions to move forward.
For the latest insights and strategies on treating common client issues, subscribe to our TH-cam channel and then visit us at www.nicabm.com...
That “Climbing out of hell” analogy is excellent
As a BPD diagnosed person, Marsha did sell me the idea of "lets do this, it will hurt but when you finally get to the top of the ladder, the horrible pain finally will end." ❤
Lets focus on effectiveness and wise mind. ❤
"the fact that it's painful is true, but there is no other way out"
Thank you Marsha for showing us the way out, as painful as it is .
babysteps
Just listening to this therapist helped me get past a painful experience even though she was not talking to me directly. Thank you. I wish there were more therapists like you. You are real.
Without videos like these on TH-cam my therapy would be going nowhere, or at most at a snail's pace. Thank you so much.
I feel like you.
Resistance so tough. I like the Hell analogy. I use the analogy of cleaning out a cupboard, it gets worse before it gets better. At first you have to take all that stuff out and look at it, which you've been avoiding for years, then we have to decide what your going to keep, what's yours, and what's somebody else's crap, what to throw away what to keep. You are going to feel overwhelmed, there will be tears. Then we have to put what we want back in there, and when it's all done you'll feel heaps better you'll look in that cupboard and feel proud of yourself for doing all that hard work and then you'll want to tackle the rest of that stuff you've been avoiding but this time you'll have experience and you'll be a bit better at it until one day you won't even need me to help you do it anymore.
Uhm...you forgot the part where the monster jumps out of the cupboard and starts feasting on your entrails as you watch in helpless horror and death.
@@LoreMIpsum-vs6dx I haven't come across any monsters my clients haven't been able to defeat with a bit of help.
@@LoreMIpsum-vs6dx Exactly.
@@Krinsta1 That's a little bit trite. I'm happy for your clients, though. Maybe Lore M. Ipsum's and my monsters are more tenacious than your clients.
@@janets7291 maybe you guys haven't had the right counsellors. I'm honestly not intending to be trite. I'm sorry you perceived any of my comments this way.
Validation is the key to selling the acceptance of pain that we don't know how to manage. Loved ones could say this conceptually, but have no idea what horror they were asking me to endure. That sale, even put by a counselor, would be easily rejected out of self preservation (which, despite it all, we think we're pretty good at)...and ridiculed, because there was no way I was going to show them what that hell looked like - the mere thought of enlightening them brought satirical chuckles. Of course they don't know what they are asking! But my counselor validated the hell and the suffering that she could not see in me, showed me various tools to get through hell better, and even showed me an example of journal blackout art that she had found helpful. It was at that moment I realized others knew what this felt like, had found a way through, and knew how important it was for me to get through too. Once I realized she was a peer, I took ownership of my recovery; I knew there was a way, and I would fight through until I found it too.
If selling the idea feels like manipulation, though...not genuine and real understanding, it could backfire.
there's a lot about DBT that feels frankly manipulative
I strongly felt that way until I could understand my therapist was not against me, but I very much hated the hoops in the meantime so I split on her all the time. I finally got to where I realized she was trying more tools to get through and help me, but I hates and still hate the game. I guess I cant ask for anyone to perfectly understand or get me but she really wants to help me.
Well described Victoria.
@@patrickhanson712 same. but we have to “get” ourselves. we tried to tell our families how hurt we are. but they invalidated us so cruelly and unempathetically. we wanted ANYONE TO GET IT. we need to own it. i’m finally doing it and not trying to prove to people how sick i am.
@@Iandefor how so?
She tells her client that they "are like a person in hell.". That would be so much more helpful than 20 years of invalidation from therapists.
mallory She also says people in emotional pain are like Burn Victims where their skin is so painful. Love Marsha!
She's awesome for sure.
Yes, what a miracle Marsha is!!! It's still painful! Yes, a life of invalidation... so well said! So glad to find this therapy!
there are some really shitty mental health workers out there. i never knew what felt right to me because of my c ptsd. it was about my moms needs. i never had any. so anyone who would listen to me, i’d stay. then my phenomenal, special therapist of 7 years, mom cut me off because she hated her. i was too depressed to work. never been able to support myself financially. my mind is a burn victim.
@@debbieschmidt7794 she was in a mental institution herself. like locked up in solitary confinement for 2 years. that’s was the time. incomprehensible. i’ve done her dbt skills but then i don’t think i did them enough. ocd baby.
Having become the 6th Peer Recovery Supporter certified in my state last year, HONEST EMPATHY has been CRITICAL to my Healing. Having had both Incest & Adult Rape experiences, for instance, I've got credibility when I empathize with survivors in various stages, but felt betrayed when therapists of mine said they " imagined" how I felt. While I wouldn't want my experiences to happen to anyone else, certainly having a clinician with a willingness to own they haven't felt what I have, THEN RESPECTFULLY ASKING what could be done in the therapeutic setting to increase safety WOULD introduce an opportunity to claim a foothold of control. In my case, simply changing my seat to face the room exit and even adding or subtracting lighting made TREMENDOUS difference. Being able to redefine safety as increasingly intimate work us done lessened MY resistance; As I get my Bachelors & LISW, I expect to expand upon this.
How great is that!
3 words struck me......"I've got credibility"
these three words in any context are the game changers if you ask me.
i don’t know if my therapist has has been through trauma but damn she’s good. of course i think she’ll abandon me.
Yeah the only way I bought into DBT was after I read Marsha’s memoir. It changed my whole perspective that she had experienced a lot of the struggles that she did and then developed it slowly over time after many years with both personal and academic purpose to teach not only her clients but also herself. Another big reason I love DBT is how logical it is. Once I bought in to the concept that someone actually understood how much I was suffering I stopped some of the destructive behaviors that I had used to try to communicate how bad things were. And then I was like shit these skills can help me to get what I want that’s lit I’m in.
I learnt to let go of labelling or judging pain as bad. It's a sensation that just happens and when you let it in it doesn't hurt. You just experience the process occuring, it subsides, then you let it go. Notice it without judgement. Mindfulness in other words. Or mindemptyness as Eckhart Tolle would say.
When my Mom was dying and when she died, I turned back to Alcohol after 18 years of sobriety and then that stopped working then I went to a target behavior that literally shut off all emotions and made me loose everything. I climbed out of hell and that ladder was hot let me tell you.
Sorry for your loss. Glad you found your way back to life clean sober. God Bless
That's really inspiring. Thanks for sharing that.
I am sorry for your loss, thank you for sharing.
Hi . I’m grieving my mum ( I have stayed sober) but I cannot feel any joy anymore. I’m having bereavement counselling starting this week . I have regressed and I’m now in Hell . I’m prepared to climb . Bless you x
Apologies- I am so sorry for your loss x
Excellent. I often say, "The only way out is through." I love the Hell metaphor. Thank you.
My last two therapists only offered the acceptance (mindfulness) part and had no concept of effective change. They wanted me to just get used to being in hell. It was humiliating.
No, when you say, "humiliating" that is your defenses speaking masking the shame, the voiceless and the pain beneath. The goal of therapy is to gain access give voice and embody those feelings and NOT to masked them by putting a quick fix cognitive band-aid as is dangerously suggested here.
@@Neilgs ... another mindful part speaking ;-)
@@Neilgs Or it could be that there's bad therapists.
So then why did you decide to take part in Acceptance Commitment Therapy ?
@@hyperchord there certainly are.
"When you're going through hell, keep going!"
What's hard is when you're borderline AND you're living in an abusive situation and people don't believe you and you begin to not believe yourself.
I am sorry to hear that :( I hope it gets better for you
Pray you can leave the abusive situation!
Yes, yes and yes.
Those are the hard parts that not many people talk about.
Good for you for speaking your truth...keep going!
I hear you and I believe you.
❤️
I've tried facing my pain and it darn near totally destroyed me, so now I keep it buried deep knowing that sometimes it will rise to the surface. When it does I just stay in bed for days until it subsides.
Same. I hope today is a less bad day. ❤
I was able to help myself a lot by IFS therapy. And I disagree that resistance comes from avoiding pain. People have trouble showing their not so positive emotions to someone else, because they experienced more pain by doing so in the past. Lots of therapists wind themselves like fish when confronted with the painful or urging emotions of their clients.
The truth slipped off her lips as she said "they have a lot of shame" - yes, they learned to hide this stuff to not be ashamed and blamed any more.
What does the phrase ‘wind like a fish’ mean?
Would you mind uploading the Spanish subtitles if I would send them to you as a .srt? I’m a translator looking to translate as much material from Linehan as possible into Spanish
I have to push away the sadness, otherwise it eats me alive! There ceases to be a "me", there is only a hurricane of sadness and shame taking up the space where I used to be.
Yeah, this is a good point, and MArsha does a good point of explaining the rationale behind it. I heard a good analogy of it once, it was in relation to addiction. Addiction is like getting into very uncomfortable pair of shoes. it hurts like hell, but it's the only hell you know, so at least it's familiar and you don't want to give that up. Resistance seems similar to me. Dropping your gaurd. You've been on guard ever since the trauma happened. why the hell would give that up and trust someone? I think I would be a very difficult patient for Marsha.
I think I would be, too but I also trust that she has the skills and experience to eventually get me through. I think I might need to just touch that first hot rung of the ladder for a while, though. I have the thought that I don't have the resilience to hold on and climb, yet.....
I sincerely wish that I could find these wonderful professionals that validate because they know my pain and dissociation are real, support me to try different tools which could enable my own decision making process. Also maybe just once in the last 3 years could someone have said ' it's not a failure on your part, this dynamic just has not worked for you'...
She has another saying that I find helpful. 'We didn't cause our problems, but we still have to solve them'.
I actually like her videos and I get that some people get help from DBT but I never did. The problem I had was shrinks who would injure me as much as my parents had. You know projection narcissism, defensiveness etc...those kinds of things. I know for me until now thank you 😊 my new wonderful guy that I would be willing but to find somebody with a modicum of skill would be challenging 😢
Cheryl Graham Some are self-taught or join online Peer groups. The workbook is $25 on Amazon.
What about resistance that stems from iatrogenesis? My trauma came from people trying to "treat" me, and hurting me instead. Now I am finally trying to get help again, but the help itself is what feels unsafe. How can I as a client, or how could a therapist as a provider, bridge that gap?
Exactly. Why did she go ahead and go backwards and make a therapy that is similar to the one that didn’t work for her?
That is an amazing therapist.
Wow. I feel like I’m ready.
I like her use of a metaphor
My experience is we can more ‘easily’ break down when spending a few days in groups of safe and supportive people, where there are no ‘leaders’, just ‘trusted servants’.
I wish I could have a consultation with Dr. Linehan. So many therapists, yet so little help so far. I AM EXHAUSTED.
and for me... broke!!
I agree Lynda and for so many years I had no clue these sessions were causing me to feel worse and to lose hope......at least now we know what we need and that we deserve it.....still excruciatingly hard to find good therapy. Best! to you.
Are u looking for a DBT therapist like her? No other therapy worked for me, but I found a great DBT program and therapistvis life changing.
Thank you so much!
@NICABM I'm a client who is onboard and repeatedly returning to the "ladder in hell". However, sitting with that pain is so intense that my fight/flight response is now kicking in at the very NON-VERBAL INTENTION of grabbing the ladder. It is now taking me days or close to a week to be able to sit with and experience the hell again. I have no control over it. I totally spin off into defensive coping mechanisms and don't "wake up" for days. HELP! It feels like I'm dying!
I have been looking into somatic therapy for myself with my anxiety. It involves releasing emotions within your body. You deserve to have a calm nervous system before you can focus on healing because you can't focus on your issues while in fight/flight mode.
The only way out is through.
God bless her❤
Yep, the only way to heal, radically accept reality....
You are so brilliant!!! What a gift!
Is there any therapists who specialise in People who are resistant to healing, apparently I'm one of those people but I don't want to give up, even though most therapists pull away from me
Good point!!
So how do u experience sadness?
Or suggesting the ladder is cold instead of hot. Whatever works for letting the patient get out of the pain.
It depends on the client and what the problem is!
But what if you can’t for example react regarding anger. No matter how much the will is there?
It’s like being in a empty room but being told the tools are right there. But still I can’t see them.
I almost cry at night. Not due to what I’m supposed to feel sad about. But due to the tremendous stress that comes with not being able to do something that clearly is supposed to work.
Being stuck in therapy is painful because you know you are the issue. But no matter will and raw openness it would not come.
lostartistic
The issues are not you. They are part of your experience though. And that's bitter to accept, but important. If the anger feels out of control, there are grounding tools that you can learn and use for that. Or, if more difficult, there are medicines that can be used for therapy to be more effective, that help us tolerate what we need to. And then they aren't needed after the work is done. I'm not a pro, just sharing what others in group said helped them. I used time outs, and now it is a subtle stepping out of the room. That took me 2 years. But it's done now. Triggers can set me off, but I step out and make myself track the root it touched - compare it to the current issue, and then decide if I can tweak my perceptions of it, or if I need to ask the other person to please not discuss that issue around me (which may or may not happen). It seems more empowering and resolved if I can see the current issue as different though.
There are peer facilitated DBT Groups on Facebook. Free.
Ask gentle questions first. Let them lead where they need to go.
What if you're sad with resistance? Like you cant get over sadness??
Alicia Bowen Self -Compassion. What would you say to a friend?
Exactly!
Very well said
She is so interesting...
Thank You ☺️💟😌💓😌💓😌
"The only way out is through." Why?
yes, through hell and back :)
Come back when you're ready.
One of my family members (I'll call her Mary) was misdiagnosed for decades as having manic depression, OCD, only to find out recently that she has BPD. Despite all those years she wasted in therapy she has no problem starting all over again to deal with her BPD. I could not understand why she was not outraged by so much money and wasted time caused by her misdiagnosis. Prior to this, Mary was diligently attending therapy as a badge of honor for alcoholism and whenever I'd go see her she would often changed the subject of our talks to talk about her trauma caused by her mother. It's not one day that goes by that she does not bring her mother up in one way or another. If I'm not mistaken, I'd say this is what Caroline Myss refers to as Woundology in that Mary has unknowingly taken her trauma and made it part of her identity. I caringly informed her that having trauma is not *who* you are, it's what you *have* Unfortunately, my concern did not register in her mind. I suspect it's because perceiving herself as a victim has payoffs. I gives her validation and those disability checks. I don't blame her for this considering she was misdiagnosed for two decades. Even so, and unlike others who resist therapy, Mary is all too happy to do it for BPD because, just as it was in the past, therapy has turned into formality. She does not take it seriously and her therapist, God bless her, has not been able to address that which I believe fuels her BPD: childhood trauma. So no matter how many times she sees her therapist, the issues they deal with are at the surface and not the deeper issues that trauma requires. Sadly, she will end up with another decade or two of therapy and I can only hope that during this time her BPD is tamed- at least.
@@jmac3482 borderline personality disorder
I don’t see the point in sadness. it’s the one emotion that seems to me to be damaging and debilitating. I can see the point in anger it can be extremely helpful I can’t see the point in being sad and it is scary to me because I’ve met people that have serious depression that are debilitated by that depression. I’ll take my rage issues any day over sadness and I hate that therapist try to pull me into sadness when it seems to be such a debilitating experience Marcia talks about it in this video as if it’s a necessary evil but I don’t see the guarantee people get out of it once you’re in it either it just seems like a dangerous place to go with no guarantee of ever coming out of it
Hayley Lewis I’m just curious if “going through it” as they say, will somehow make it better...isn’t that the idea?
Whether you can see a purpose in sadness or not...it's an emotion all humans experience. And for most of us, avoiding emotion causes other problems that blow up our life....and that's where the hell comes in. Feeling emotions you have been avoiding for years, is a slow hard process. Most people who avoid emotions learned to do so in childhood, because avoiding emotions was a safer option in the environment they grew up in. I wish it was easy to find validating therapists who will take the time to help clients practice feeling emotions they have been avoiding, and yet I know it's not.
Life is dangerous. If you can't embrace the sadness within you, how can you empathise with someone else? Treat yourself as you would others.
I wish you a ton of bravery and hugs to enter the pain you carry with you. It seems very alone and hidden.
Take care of yourself 🌻💛
i hear you. but perhaps you’ve been avoiding the pain for so long it’s stuffed. my therapist told me i’m feeling “good” pain.
@@Mockduck2020 yes
That’s all my therapist told me
“The only way out of grief is to go through it”
Ok and what does that look like? Heak if I knew
She pushed too hard too soon
God I didn't expect to get so emotional. What do you do when you're in that hell and you don't even know where to look for the ladder? I know you're supposed listen to what your emotions are trying to tell you, but sometimes what they're telling you is just as depressing. Do I need to be willing to accept that life is nasty, brutish, and short in order to move on? Isn't that just trading one hell for another?
This is where skilled therapists are necessary. Through their training and experience, they have a vantage point to look into your unique hell and find the ladder that you can't see. And if necessary (keeping the analogy going) they can also find ways to cool the ladder so that it isn't too hot to climb.
i COMPLETELY hear you. i get so paralyzed it’s hard to feed myself.
The hot ladder is the liminal phase.
I looked up liminal... lol
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
You're sick of feeling numb
You're not the only one
I'll take you by the hand
And I'll show you a world that you can understand
This life is filled with hurt
When happiness doesn't work
Trust me, and take my hand
When the lights go out, you'll understand
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
Anger and agony are better than misery
Trust me, I've got a plan
When the lights go up, you'll understand
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
Pain, without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd like to feel pain than nothing
Rather feel pain
I know, I know, I know, I know, I know
That you're wounded
(You know, you know, you know, you know)
That I'm here to save you
(You know, you know, you know, you know)
I'm always here for you
(I know, I know, I know, I know)
That you'll thank me later
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
Pain without love
Pain, I can't get enough
Pain, I like it rough
'Cause I'd rather feel pain than nothing at all
Rather feel pain than nothing at all
Rather feel pain
3 DaYs GraCe
Linehan based her "methods" on an insane hallucination of a shimmering cross, Jesus, and God. As a psychiatrist, I have found that many insane people believe they are possessed by demons. God does not appear as a hallucination, it is one of such "demons" that appear. As such, the whole process of therapy involves elaborate brain-washing, which is on the side of evil and not of the good. "Pain without love...I'd rather feel pain." The pain is in her hell, as is explicitly stated, and we know who lives in hell. It is not God, it is the devil, in metapsychological terms, and the movement must be considered to a kind of devil worship, being taught to children as well as adults, now in large numbers
@@markgermine8009 We are no match for the devil…only the all powerful God can defeat the enemy.
His help us all!!!
I am not a professional psychologist but this kind of situation, changing a person's stubborn behavior, is something many non-professionals face too. One approach is to try to get the patient's attitude confused so that he/she is no longer sure that being so stubborn is necessary from his/her point of view. To achieve this one explains to the patient that I (the treatment therapist) will now tell you the opposite of what is the good way for better behavior! After a few tries during which the patient gets confused at this, the therapist then changes back to good advise, but does not explain that it is now for the better behavior. This enables the confused patient to realize that in fact the subsequent recommendations may be either good or bad, but that the choice can be taken responsibly without necessarily having to agree with all what is advised.
Using Motivational Interviewing skills is also very helpful. Puts people in the driver's seat of their own future.
This is actually a form of manipulation. A therapist shouldn't be confusing their patient/client or giving them bad advice, because by doing so they're sending a message that they can't be trusted. And therapy needs to be based on trust.
Could you please stop the sound bites. Play the whole video
LOL
MDMA helps to break thru bc it dissolves the fear, lets you go to the grief/sadness in a deep way.
what is MDMA
@@debbieschmidt7794 MDMA is known on the street as Molly, E, Ecstasy, etc. (en.wikipedia.org/wiki/MDMA)
Well, it doesn’t really help you. It’s kinda a short cut with no way out
It also depletes your brain of Serotonin the next day, so that you face a severe come down with depression.
ADHD and addictions
I was misdiagnosed with BPD because my case manager had an agenda about teaching her DBT class. Quotas. Well, after being put through psychiatric hell, due to YOUR infulence, Marsha, I now know why I was treated like I was difficult. I was "resistant" to your bs. I read that DBT isn't for psychotic disorders. So there I sat for a year and a half in a dual diagnosis program, in full blown psychosis and mania, no one noticed, and I was forever punished by my case manager for not complying to your crap and backing out of DBT. Even when I said I didn't want to do it, she still incorporated it into everything. Agendas. You tell people to do your program and not go to the hospital. Why. You tell people not to disclose their diagnosis with medical professionals instead of educating these professionals about BPD. Why. You're not always right and I fully inded to write a letter about my experience to my local CMH, as they funded it and I believe are being misled.
Sorry, my darling Marsha that is NOT siding with the patient by essentially adopting a tough love no-nonsense attitude that you are on their side and will "Help them climb out of hell because they have no other choice" (if they want to get out of hell and be healthy). That is so utterly destructive and re-traumatizing to the patient, it boggles the F mind!
She didn't say they don't have a choice. We always have a choice. We can choose to stay in hell. But there's no magic wand that's going to take pain away. We can either sit in the pain or climb out to freedom. Either is painful, but one leads to freedom.
Sorry, but with all due respect that is completely ignorant, misguided and destructive! Simply what you are saying is NOT therapy and has nada to do with therapy. However, what it resplendently does is simply raises in ALL patients the nature of guilt and concomitant defenses! Who said anything about a "magic wand?" The hocus pocus is what is presented here and any insult to injury by further ignorantly embracing it does no one ANY good! The "magic wand" ? No , magic wand! It's call real therapy, as in psychoanalysis! Please spare me your polarization, i.e. "choice/no choice" and simpleton persona!
It is about accessing defenses and underlying pain and over time with an able and empathic therapist going from states of disassociation to increased integration...
Different techniques help different people in different ways. We are not all the same. I can see Marsha's technique helping some people (clearly it has for her or she wouldn't recommend it); and I can see your methods described above as helping - otherwise you would not recommend it. The therapist needs to be very present with the client at all times and present with their own intuition and knowledge base. What works with a client one day may not work for the same client the next day. Acceptance of the present is vital, along with the acceptance that everything to do with the body, mind, emotions and surrounding circumstances is in a constant state of flux. The present is a river not a rock - life is a process, not a conclusion; a journey, not a destination. The more the client and the therapist are willing to remind themselves of this and understand it, the more it will become their actual experience and issues will really start to become resolved.
I agree with everything you are saying. However, "acceptance" as implied here is NOT to tell the patient, as she gives, for example, "You are in hell and you need to climb out of hell because you have no other choice", etc. That is anti-therapeutic, as what it brilliantly achieves, admittedly or not in virtually all patients is on a somatic or polyvagal level, perceptual or imperceptible layers of guilt overlaid and driven by panic or hypervigilance . Bottom line always, Defenses need to gradually ease within the therapeutic process/relationship with a highly attuned and empathic analyst. The latter and not the former is the cornerstone of any authentic therapeutic process.
Very well said