From Hell and Back:
The Experience of Being a Dialectical Behavior Therapy Clinician with a Personal History of Self-Harm and Suicidal Ideation
For the full study, please click here.
DBT saved my life. I became a DBT therapist because I wanted others to find their way out of hell, too.
Overview
This study explores the experiences of Dialectical Behavior Therapy (DBT) clinicians who have personal histories of self-harm and suicidal ideation. While research has long recognized “wounded healers," clinicians whose own experiences of suffering draw them to help others, there has been little exploration of how this plays out within DBT, a treatment built on compassion, nonjudgment, and validation.
Why This Matters
Up to 85% of DBT clinicians report having lived experience with mental illness or behaviors DBT targets (Essletzbichler et al., 2024).
Discussions of these experiences within professional spaces are rare.
Acknowledging lived experience can reduce stigma, foster empathy, and strengthen ethical and compassionate clinical practice.
This project asked: How do DBT clinicians’ personal histories influence their decision to specialize in DBT, and how do these histories shape their experiences within consultation teams and the broader DBT community?
Theoretical Background
Wounded Healer Framework
Personal wounds can become a source of healing wisdom, allowing clinicians to connect with clients from a place of authentic empathy.
In this study, the framework highlights how DBT therapists’ personal histories may not be a liability but a bridge to deeper therapeutic understanding.
Social Categorization Theory
Professionals often separate “therapist” and “client” identities because of the societal “us versus them” divide surrounding mental illness.
This theory helps explain the internal conflicts and stigma that lead DBT clinicians to question when or whether to disclose their lived experiences.
Dialectical Behavior Therapy
DBT balances acceptance and change, emphasizing empathy, skill use, and consultation as “therapy for the therapist.”
This perspective situates DBT as uniquely capable of integrating the wounded healer experience because its principles already mirror the dialectic of suffering and recovery.
Methods
Study Overview
Detailed Procedures
Design
Participants
Recruitment
Ethical Approval
Data Collection
Data Analysis
Rigor and Credibility
Qualitative study using reflexive thematic analysis (Braun & Clarke, 2021).
15 DBT clinicians in the United States with personal histories of self-harm and/or suicidal ideation. All had at least 40 hours of DBT training and consultation team experience.
Purposive sampling through a DBT therapist listserv. Participants were 13 female, one non-binary, and one male.
Approved by the Rutgers Institutional Review Board on October 14, 2024.
Semi-structured Zoom interviews lasting about 45 minutes each. Participants described their training, DBT practice, and lived experiences. All provided informed consent and received $20 gift cards.
Data were analyzed using six phases of reflexive thematic analysis. Codes were developed inductively, capturing both explicit and implicit meanings. Themes were refined through mentor and peer debriefing.
Trustworthiness was enhanced through reflexivity, debriefing, and recognition of the researcher's positionality. Participants’ comfort and choice guided depth of disclosure.
Researcher Reflexivity
I am a person who feels things deeply. I am often acutely aware of others' words and body language; sometimes, this is a strength, allowing me to pick up on details that may be missed, and at other times, it is a weakness, such as misinterpreting a slight change in tone or word choice. I now refer to this sensitivity as a superpower, but it did not always feel like that. I used to let it consume me, and it felt uncontrollable, like my own personal hell. It was not until I found DBT that I discovered how to control it. DBT saved my life. I became a DBT therapist as I want to ensure that as many people as possible have the access they need to get out of their hell. Those with experiential knowledge have an important place in the DBT community. I also acknowledge that as I have grown in my practice and career, I have disclosed my personal history less and less. Recognizing my hesitation fueled my interest in this topic and led to this study.
Findings
Theme 1:
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“There’s some personal connection to it, you know.”
There’s an unspoken understanding within the DBT community that many therapists are drawn to this work for personal reasons.
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Many therapists normalize emotion sensitivity or fleeting suicidal thoughts.
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This implicit culture of the DBT community fosters empathy but avoids direct acknowledgment.
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“I think all of us sort of know, in an unspoken way, that a lot of people are drawn to DBT because there’s some personal connection to it.”
Clinicians weigh whether to reveal their personal histories to colleagues or consultation teams.
Sub-themes include:​​
Theme 2:
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To Disclose or Not to Disclose
Before/After Identity: Feeling distant from “past selves” who struggled; internalized shame or fear of being “defined” by that history.
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“I think I have my own kind of tension around my identity. It mostly happened in my teens and early twenties, and now I’m in a very different place in my life.” — Mason
Fear of Judgment: Concerns about being seen as unstable or less competent.
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“I fear that if I ever struggle or take a day off, people will think I can’t handle it. It’s hard not to wonder how others see you once they know.” — Caroline
Need for Safety and Connection: Disclosure feels safer in one-on-one or supportive environments; leadership modeling vulnerability increases trust.
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“We have leadership that sets the example. When people show up authentically, it creates a culture where it’s okay to be human.” — Olivia
Theme 3:
“Bringing it out of the darkness”
Participants wanted more open, structured spaces within DBT to discuss clinicians’ lived experiences.
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Calls for workshops, training dialogues, and acknowledgment at conferences.
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Desire to “name the elephant in the room” and integrate lived experience into supervision and training.
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Hope that DBT, rooted in nonjudgment, can lead the way.
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​“We talk about calling out the elephant in the room—except when it’s us.”
Discussion
1. The Wounded Healer Dialectic
This study reinforces the idea that clinicians’ personal histories can deepen their empathy and insight in clinical work. Participants frequently described how their own experiences of suffering allowed them to connect more fully with clients and to understand the pain that DBT was designed to address. The wounded healer framework (Farber, 2016) helps reframe these experiences not as liabilities but as sources of wisdom.
“Our wounds are not what make us unfit to help. They are often what make us effective.”
2. The Paradox of Disclosure
DBT’s nonjudgmental stance and validation principles encourage openness and authenticity. Yet, clinicians with lived experience often face stigma when considering whether to disclose their histories. This creates a dialectical tension between two truths: the desire to be authentic and the fear of being perceived as unstable or less professional. Some clinicians resolve this by separating their “therapist” and “client” identities, while others find safety in disclosing selectively.
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“DBT teaches us to hold both acceptance and change. The same dialectic applies to how we hold our own stories.”
3. Building Safe and Authentic Teams
Relationships within consultation teams play a crucial role in determining whether disclosure feels possible. When team leaders model vulnerability and openness, clinicians feel safer to share parts of their experience. This echoes DBT’s core belief that therapists must practice what they teach—empathy, validation, and willingness to be human. Teams that intentionally create space for authenticity can strengthen both clinician well-being and client care.
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“The guiding principle needs to be that the relationship always comes first. If it isn’t a safe place for everyone, we won’t realize our full potential.” — Jessica
Implications
For Trainers and Supervisors
For DBT Teams
For the Broader Field
Normalize conversations about clinician lived experience during training and supervision.
Model the same nonjudgment and validation within consultation teams that DBT teaches clients.
Recognize lived experience as a form of expertise that enhances ethical and compassionate care.
Include discussions about self-disclosure ethics and boundaries in DBT training and continuing education.
Create consultation team norms that explicitly prioritize emotional safety and mutual support.
Include clinicians with lived experience in research design, treatment development, and conference programming.
Limitations and Future Directions
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Small, qualitative sample of 15 U.S. clinicians.
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Gender imbalance (majority female).
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Self-selection bias—those willing to participate may already feel safer disclosing.Future research could explore quantitative data or cross-cultural perspectives on stigma and disclosure in DBT communities.
Conclusion
DBT clinicians with histories of self-harm and suicidal ideation embody the paradox of DBT itself: holding pain and healing at once.
As one participant noted, “We’ve all been to hell—and DBT helped us find the way back.”
Acknowledging, rather than hiding, this truth can strengthen both the DBT community and the treatment itself.
References