Remembering Marsha Linehan, the Psychologist Who Gave Us DBT
Marsha Linehan died on November 10, 2026, in Seattle. She was 83. Few clinicians change how an entire field works. Linehan did, and the people who have benefited from her work number in the hundreds of thousands, most of whom never knew her name.
She created Dialectical Behavior Therapy, or DBT, the first psychotherapy shown in a controlled trial to reduce suicidal behavior in people that the mental health system had largely given up on. Her death is a good moment to look at what DBT is, why it mattered so much, and how it still shapes therapy today, including in our own work at Houston Therapy.
Who she was
Linehan trained in experimental psychology at Loyola University and joined the University of Washington in 1977, where she spent the rest of her career. In the late 1970s, suicidal clients, and especially those diagnosed with borderline personality disorder, were often seen as too difficult to treat. Many therapists declined to work with them at all.
Linehan took the opposite approach. She set out to build a treatment specifically for the people who were hardest to help.
In 2011, decades after her first writings on DBT, she told the New York Times that she had been one of those people herself. As a teenager she was hospitalized for more than two years for severe self-harm and suicidal behavior. She later described her life's work as keeping a promise she made to herself then: to find a way out of that kind of suffering and bring others out with her. Her memoir, Building a Life Worth Living, published in 2020, tells that story in full.
What DBT is
DBT began as a form of cognitive behavioral therapy. Linehan quickly found that standard CBT, with its steady focus on change, often left her clients feeling criticized and misunderstood. Many dropped out.
Her answer was the "dialectic" at the center of the therapy: holding acceptance and change together. A client is accepted fully as they are, and at the same time is helped to change. Neither alone is enough. Linehan drew part of this balance from her own study of Zen practice, which also led her to bring mindfulness into the treatment, years before mindfulness became common in Western psychotherapy.
Standard DBT has four parts:
Individual therapy, focused on the client's own goals and the behaviors that get in the way of them.
Skills training, usually in a group, that teaches practical tools.
Phone coaching between sessions, so skills can be used in real moments of crisis.
A consultation team for the therapists, who support each other in doing hard work well.
The skills are organized into four areas:
Mindfulness: noticing thoughts, feelings, and urges without being swept away by them.
Distress tolerance: getting through a crisis without making it worse.
Emotion regulation: understanding emotions and reducing how intense and how long painful ones last.
Interpersonal effectiveness: asking for what you need and saying no while keeping relationships and self-respect intact.
Why it mattered
It gave hope where there was very little. Linehan's 1991 study was the first randomized controlled trial to show that a psychotherapy could reduce suicide attempts and self-harm in chronically suicidal women. Later trials replicated the findings. Borderline personality disorder went from being seen as close to untreatable to being a condition many people recover from.
It changed how therapists think about suicidal clients. DBT treats suicidal behavior as a problem to be understood and solved, not a reason to end treatment or refer someone away. It asks therapists to stay in the room.
It made validation a clinical skill. Linehan described, in specific and teachable terms, how to communicate to someone that their reactions make sense given their history and circumstances. That idea now runs through therapy of almost every kind, as well as parenting and couples work.
It brought mindfulness into mainstream treatment. DBT was one of the first evidence-based therapies to build mindfulness directly into its structure, helping open the door for approaches such as ACT and mindfulness-based cognitive therapy.
It explained emotional pain without blame. Her biosocial theory proposed that intense emotional struggles grow from a combination of emotional sensitivity and an environment that does not validate a person's inner experience. That framing helped clients and families stop seeing the problem as a flaw of character.
It spread far beyond its origins. DBT has been adapted for adolescents and families, eating disorders, substance use, and emotional difficulties that have nothing to do with a personality disorder diagnosis. Its skills are taught in schools, hospitals, and community programs around the world. Linehan also founded Behavioral Tech to train clinicians and helped establish a certification board to keep the treatment faithful to its research.
A life worth living
Linehan often said the goal of DBT was not simply to keep people alive, but to help them build "a life worth living," one each person defines on their own terms. It is a simple phrase, and a demanding one. It asks therapists to care about more than symptom reduction, and it asks clients to believe that something better is possible.
Her own life made that case. She knew from the inside what it was like to feel hopeless, and she spent five decades proving that hopelessness was not the end of the story.
If you are struggling
If you or someone you love is dealing with intense emotions, self-harm, or thoughts of suicide, help is available. In the United States you can call or text 988 to reach the Suicide and Crisis Lifeline at any hour. If you are in immediate danger, call 911.
If you would like to talk with one of our clinicians about therapy, including skills-based approaches drawn from DBT, you can reach out to Houston Therapy to schedule a consultation.
