Thanks in large part to the efforts of psychologist Meggan Moorhead, psychotherapists in this area run dozens of groups that teach patients skills in tolerating distress, improving interpersonal relationships and managing emotions. The goal is simple: to have a life worth living.

The treatment is called Dialectical Behavior Therapy, or DBT. Through group and individual therapy, patients learn to direct their attention away from their destructive thoughts and to focus on aspects of their lives that they can control. DBT was originally developed to help self-destructive patients in psychiatric hospitals, but Moorhead has helped bring it to a much wider group in the community.

Now local therapists teach DBT skills to suicidal adolescents, people with eating disorders, the depressed elderly and substance abusers, in addition to people with borderline personality disorder, for whom the treatment was developed. Moorhead has also created a modified version of DBT for university students. Therapists run student groups in Chapel Hill, Durham and Raleigh.

"The impact has been huge," said Mareah Steketee, a neuropsychologist who co-leads DBT groups with Moorhead. "She was initially and solely responsible for bringing DBT to this area."


Rejected by Duke

Although Moorhead is a leader in the therapeutic community today, she almost didn't get a chance to learn how to teach DBT. In 1993, as a staff psychologist at John Umstead Hospital, she applied to a training program at Duke University and was rejected. Moorhead couldn't sleep. It bothered her that four men -- and no women -- had been admitted. Moorhead wrote to Marsha Linehan, the Seattle-based founder of DBT and the program's leader, pointing out the absence of women and asking to be reconsidered. This time, Linehan let her in.

Moorhead said she sought the training because the staff at Umstead had little therapy that helped the patients with the most difficult psychiatric problems -- the people who cut themselves, made suicide attempts, and repeatedly destroyed relationships through making extreme demands on their partners.

These people have borderline personality disorder, which is characterized by extreme instability of emotions, impulsivity and self-destructive behaviors. Because of their volatility, people with borderline personality disorder have trouble holding jobs or staying in relationships. Many therapists fear to treat them because the patients are at high risk for suicide and tend to be demanding and provoke anger. But the patients themselves suffer greatly.

When Moorhead began teaching the DBT skills to hospitalized patients, her colleague Sara Romweber was nervous.

"The patients were pretty sick. I felt that many of them would not be able to grasp the skills," Romweber said.

But Moorhead got through to the patients, and many of them did learn to cope better with their chaotic feelings, she said.

"Meggan's an excellent teacher," Romweber said. "She knew just how to reach them."


'A life saver'

Gale Hounshell, 47, said, "DBT was a life saver for me." Since childhood, Hounshell had struggled with out-of-control emotions, which she dealt with by cutting and trying to control her food intake. She was hospitalized multiple times, mainly for suicide attempts and depression, but also for anorexia.

Hounshell was introduced to DBT skills during a hospital stay and has continued to participate in DBT groups in the two years since she left the hospital. "DBT helps you deal, to live a life worth living," Hounshell said. "The skills teach you to live with what you have, not fight it."

By 1995, Moorhead had a new idea -- to bring teaching of DBT skills out of hospitals and into private practice, where the vast majority of clients with mental health problems are seen. Along with psychiatrist Norma Safransky, she founded Triangle Area DBT, a loosely affiliated group of therapists that today has 75 members.

Moorhead is animated and fluent when talking about DBT, but is more reticent and chooses her words carefully when talking about herself. Moorhead was born and raised in Japan, where her mother was a Southern Baptist missionary.

She said she decided to become a therapist when she went into psychotherapy herself, depressed after graduating from college and missing her family who were thousands of miles away. She enrolled in the counseling psychology program at Boston University and practiced in Boston until moving to North Carolina in 1986 and taking a position at John Umstead Hospital.

Moorhead was struck by the severity of the self-destructiveness of some of the patients. She described one patient who was so suicidal that staff checked on her every 15 minutes and allowed her to eat only with a plastic spoon because she would cut herself with plastic knives or forks. DBT skills helped these kinds of patients, and that was enough to sell Moorhead on the program. "When we found out we had a way to help them, we were overjoyed," she said.


Acceptance

Moorhead said she also was attracted to the underlying philosophy of DBT, which emphasizes the tension between acceptance and change. The paradox is that to get better, you have to accept there are things about yourself and the world that you cannot change.

DBT also emphasizes mindfulness, or the practice of directing attention to what you are doing in the moment, whether it's ironing or washing dishes or simply breathing. "In order to regulate emotions, you have to have choices about what to do when you feel certain feelings," Moorhead said. "When you're in distress, bringing your mind to something simple is more useful than lying down on the bed and ruminating."

DBT teaches many forms of meditation. "It's a beautiful antidote to 21st century living," she said.

Therapists like DBT both because it offers "powerful" skills to clients but also because it helps the therapists themselves cope with the difficult emotions that come with practicing therapy, Romweber said. "All of us practice mindfulness daily," said Romweber.

Away from work, Moorhead practices meditation, writes poetry and songs, exercises, and spends time with friends. Her latest hobby? "Grooming my Lhasa Apso," she said. "It's very meditative."