Zoe By Eli

In 2010, on a cold winter day in New England, I first stepped into a Dialectical Behavioral Therapy Partial Hospital in Jamaica Plain, Boston. This was my initial introduction to Dialectical Behavioral Therapy (DBT), and everything felt strikingly different, even intriguingly unconventional. I was filled with hope at the prospect of finding relief from the intrusive and distressing thoughts that had tormented me for months. I also yearned to leave the hospital, which had recently become my refuge. Given the opportunity to participate in a daily program during the week, complete with lodging, I chose to remain in the DBT PHP.

I was astounded by the depth of knowledge possessed by both the leaders and the members of the program. The medical director was viewed as a healer, a figure who could navigate our pain and guide us toward healing. A few months into the program, I found myself fully committed to DBT. The skills I learned proved effective; my intrusive thoughts and urges began to fade, and the suicidal thoughts diminished. I absorbed every bit of information I could, embracing DBT as my guiding philosophy, my method of mental processing, and my daily practice. I became deeply immersed in DBT, mastering each skill and its applications. Ultimately, I distinguished myself as a star patient, successfully graduating from the program within six months.

After graduating from the DBT PHP, I decided to return to college while continuing DBT PHP on an as-needed basis and collaborating with a DBT therapist in the outpatient department. Initially, my recovery journey was challenging. I moved into a young adults group home, where I lived for three years. However, life presented unexpected challenges, leading me to take another medical leave from college and return to the DBT PHP full-time.

Upon my return, I was warmly welcomed, but I sensed a shift. During my time in outpatient therapy, I had encountered severe traumatic experiences and life stressors that triggered behaviors linked to childhood trauma—an area I previously understood very little. Before and during my full-time return, I began experiencing significant dissociative episodes that jeopardized my safety and that of others. My hospital visits increased, often due to suicide attempts, and I found myself in intensive care units on several occasions. Self-harm became a coping mechanism for stress. During these dissociative states, I exhibited seizure-like behaviors, identity changes, volatility, and dissociative fugues. I frequently arrived with knives, alcohol, medications, or sharp objects in my possession, often without recollection of how they got there. In therapy sessions, I would sometimes freeze or become mute, frequently unable to recall the events that transpired.

Over time, I started to remember instances of childhood trauma, leading me to realize that these experiences could be the root cause of my struggles.

I began seeking trauma services and support, but the initial response I received was disheartening: “You're already doing the trauma work,” and “You are learning the skills.” This response frustrated me, as I possessed a deeper understanding of these skills than many of my peers, thanks to my dedication and years of experience. Over time, the feedback shifted to “You need more practice” and “You're not stable enough.” Soon, I found myself increasingly dissatisfied. Each of my efforts seemed to be met with obstacles from the team, while my trauma symptoms worsened. I experienced homelessness for the second time in my life and became even more reliant on a system in which the DBT staff held significant influence and power.

As my situation progressed, the focus shifted to my diagnosis. Initially, they suggested I had Borderline Personality Disorder, only to later reject that idea. However, two months later, they reinstated the diagnosis. Despite my repeated requests for support regarding trauma, I often encountered delays or outright refusals. The clinical staff maintained that my challenges were primarily manifestations of a personality disorder, minimizing the role of trauma in my situation. They insisted that Dialectical Behavior Therapy (DBT) was the sole viable treatment option for me, instilling the belief that without their support, I would be at risk of suicide. This constant emphasis on dependence led me to comply with their directives, albeit blindly. Ultimately, I reached a breaking point where their assistance became more harmful than beneficial, yet they were unwilling to acknowledge this reality.

On a particularly windy spring day, I entered the DBT PHP building and demanded that they evacuate the premises and call the police. My recollection of that day is hazy, as I was experiencing a significant dissociative episode and was in possession of several large bottles of medication and chef knives. The staff claimed I expressed a desire to end my life in front of a police officer. Following this incident, a tumultuous series of events unfolded. I returned to the DBT PHP but was required to apologize to the entire program. My trauma remained unaddressed, and I was treated as a problem for challenging the DBT model. Shortly thereafter, I attempted suicide again, but my case was dismissed to outpatient DBT. The shelter staff, alongside the DBT clinical team, also disregarded my situation. I found myself homeless, without psychiatric or medical care. They claimed I was refusing treatment because I was hospitalized instead of participating in DBT and deemed too unsafe for discharge.

After my hospital discharge, I returned to live with my parents, and the outpatient DBT director, who is on Marsha Linehan's board of directors, agreed to meet with me. However, he operated more like a drill sergeant than a therapist. There was no genuine patient-therapist relationship; I felt compelled to adhere to his strict rules, or risk losing my last chance for help. Each interaction left me feeling as if I were walking on thin ice, devoid of empathy or sympathy. I sensed that he anticipated my failure, which would allow him to dismiss me. A month later, overwhelmed by despair, I felt an urgent urge to attempt suicide again. I went to the emergency room and was admitted. During my stay, this therapist pressured me to mislead the attending psychiatrist to secure my return to outpatient DBT, but I ultimately refused to comply.

Dialectical Behavioral Therapy (DBT) encompasses two distinct components: skills and models. The skills offered are practical coping strategies essential for navigating life's challenges. However, my personal experience leads me to view the DBT model as cult-like. Having been raised in a religious cult, I came to realize that after leaving DBT's Partial Hospitalization Program (PHP) in Boston, I found myself in another environment that mirrored those dynamics.

The DBT model tends to attract the most vulnerable individuals, often tagging them with a diagnosis of Borderline Personality Disorder (BPD). It positions itself as the sole therapy capable of helping those who struggle with BPD. This model fosters an environment where patients are made to feel dependent on it, as therapists often break down their sense of self to ensure compliance. Those who do not align with the model or resist its demands may face harmful repercussions, a phenomenon that seems to be endorsed by its founder.

During my time in the DBT PHP, I witnessed this model being applied uniformly to other patients, and tragically, in some cases, it resulted in loss of life. Marsha Linehan originally developed DBT to treat individuals experiencing severe suicidal ideation, rather than to target a specific diagnosis. However, due to pressures for funding, she compromised the integrity of the treatment, neglecting the complex root causes of such ideation. It is dangerous to assume that a singular treatment and diagnosis can encapsulate the entirety of the human experience, particularly when it comes to trauma, which often delves deeper than personality alone and profoundly impacts identity.

Years later, through trauma therapy and with the support of my current treatment team, I have come to understand that I live with Dissociative Identity Disorder and Post-Traumatic Stress Disorder. The shame and guilt instilled in me by the DBT model continue to affect my ability to trust mental health providers. I believe there is a pressing need for a comprehensive reevaluation of the ethics and legalities surrounding Dialectical Behavioral Therapy within both the psychological and medical communities. When a therapeutic system prioritizes its own promotion and the interests of its leaders over genuine patient care, it crosses the line into unethical territory.