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Wise Counsel Interview Transcript: An Interview with Marsha Linehan, Ph.D. on Dialectical Behavior Therapy

David Van Nuys, Ph.D.

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Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by MentalHelp.net, covering topics in Mental Health, Wellness, and Psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist, and your host.

On today's show we'll be talking about Dialectical Behavior Therapy with my guest, Dr. Marsha Linehan. Marsha Linehan, Ph.D is a professor of Psychology.

Marsha Linehan, Ph.D. is a Professor of Psychology, Adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington, and she is also Director of the Behavioral Research and Therapy Clinics there. She is also the author of four books and numerous scientific journal articles.

Her primary research is in the application of behavioral models to suicidal behaviors, drug abuse, and borderline personality disorder. She is also working to develop effective models for transferring efficacious treatments from the research academy to the clinical community.

The treatment she has developed, combines the technology of change derived from behavioral science with the radical acceptance, or "technology of acceptance, " derived from both eastern zen practices and western contemplative spirituality. The practice of mindfulness, willingness, and radical acceptance form an important part of her treatment approach.

Dr Linehan has received many awards recognizing her clinical and research contributions. She is the past-president of the Association for the Advancement of Behavior Therapy, a fellow of the American Psychological Association and the American Psycho-pathological Association, a diplomat of the American Board of Behavioral Psychology and is currently President of Division 12, Society of Clinical Psychology, American Psychological Association.

Now, here is the interview...

Dr. Marsha Linehan, welcome to the Wise Counsel Podcast!

Dr. Marsha Linehan: Well, thank you. Thank you for inviting me.

Dr. David: Yes. Now, you've developed an approach known as Dialectical Behavior Therapy or DBT for short. Maybe we can start by having you tell us just what DBT is.

Dr. Marsha: All right. DBT or Dialectical Behavior Therapy is an integration of two major approaches. The first approach is the approach of cognitive-behavioral therapy.

Dr. David: OK.

Dr. Marsha: So, it contains within that sort of standard cognitive-behavioral therapy or behavior therapy. As behavior therapy changes and improves, DBT changes right along with behavior therapy, cognitive-behavioral therapy and improve.

Dr. David: OK.

Dr. Marsha: Then it balances a technology of change with the corresponding technology of acceptance. The acceptance is a derivative primarily from contemplative spiritual practices of Zen, primarily, but also other contemplative practices. Mindfulness, mindfulness-based practices and also validation of clients.

The acceptance end of the treatment is two-part. It's a radical acceptance of a client as the client is at this moment by the therapist and teaching the client the same corresponding ability to radically accept. The reason it's called "dialectical" is because it's a synthesis of acceptance and change. Back and forth, a constant transaction interplay all the time.

Dr. David: Yes, when I first heard the term "dialectical, " of course, I immediately thought of Hegel and Karl Marx and so I wasn't quite sure of what the relationship was but they did talk about synthesis and antitheses and then the... Have I got that right?

Dr. Marsha: Yeah, it's the theses...

Dr. David: Theses and antitheses.

Dr. Marsha: The antitheses and then the synthesis. The notion is, "everything contains within it its opposite, " which really means that nothing exists really without an opposite of it. Even if you take something as mundane as a box, there couldn't be a box if there wasn't a non-box, a no-box, a not-box, because a box is very defined as it's this so there's obviously something that's not a box.

Everything that exists has its opposite and Dialectics looks at the tension between; what exists and its opposite, or the theses and the antitheses or the opposite, and looks at the transaction between them, and that tension and that transaction which always brings about change.

Dr. David: In terms then of your therapeutic work and your therapy model, what are those two poles of tension?

Dr. Marsha: Oh, there are many. There are many, many, many poles. One of the most fundamental poles is that within every unwise act, there is some inherent wisdom. Taking heroin, which is long term, a dysfunctional, destructive behavior in our culture. Within there, is the wisdom of, "You feel better immediately." So there is dysfunction and function always coexisting together.

The tension is finding the synthesis of; "Are there other ways for example?" or "How to radically accept that if one's in great pain, getting out of pain is reasonable" while at the same time accepting that if one is in great pain, getting out of great pain by doing something that will continue to pain in the future is not reasonable. You're always looking for a synthesis, where is a point that without rejecting the other side.

Dr. David: Mmm-hmm. This is part of that radical acceptance then?

Dr. Marsha: Yeah.

Dr. David: It's accepting the polarity of both ends, which as a person with Jungian leanings, that makes a lot of sense to me.

Dr. Marsha: Yeah, so the therapist is constantly saying, "Where is the synthesis?" and meanwhile, teaching the client to also say the same thing, "Where is the synthesis here?"

Dr. David: I liked your example of heroin because, I think another one of the positive dimensions potentially there for the person who takes heroin is seeking of a transcendent experience, a seeking of oneness with God even.

Dr. Marsha: I'm waiting to have a client who says that's the reason they're taking it.

Dr. David: Nobody says that...

Dr. Marsha: Not yet.

Dr. David: Yeah. Do you sense now that it could be in there somewhere? Maybe I have...

Dr. Marsha: Not in my clients, but I accept that there are people out there who are taking drugs for that reason, and of course, the synthesis is to radically accept that desire and also accept that there may be other equally effective ways to do that.

Dr. David: Yeah. As you begin to articulate this approach and make it unique, was it targeted towards certain kinds of problems?

Dr. Marsha: Well, I started out at the beginning, which was back in the 1970's, really trying to develop an effective treatment for people who wanted to be dead. My real target and focus was the person who found life so painful and the anguish so insurmountable that they truly wanted to be dead.

I went to work with this group of people and I thought that I could treat them with the existing, of-the-day cognitive behavior therapy which I had learned on post-doctoral fellowships. I was out not only to save the world but quite confident that I could do it.

Dr. David: Good for you!

Dr. Marsha: Within not too long a period of time, the first year or so, the treatment fell apart, it didn't work. I discovered that the people I was working with... Mainly because I wanted to give the worst of the worse, so I'd called all the hospitals and said "Give me the most suicidal, the person who's tried to kill themselves multiple times and all of that.

They came in, and what I discovered was that these people had so many problems. They were such an ever changing set of problems, so that one day it was one thing, and another day another. If you worked on one problem, another problem was more intolerable. You try to work on that problem and the person says, "Well, I'm going to kill myself, this is all hopeless."

What happened was, I discovered that, if you have a lot of problems, you can't work on all problems simultaneously, so you really have to radically accept some set of problems to work on something out. But I had no technology, I had no way. That was not part of behavior therapy. Acceptance, when I started, was simply not part of the treatment.

Dr. David: Right.

Dr. Marsha: The acceptance based treatments didn't have change. I was stuck with, "I could either have a change based therapy," which behavior therapy is, and it's very good at; cognitive behavior therapy. Or I could go to an acceptance based therapy and they were good because they didn't help people very much with change.

Dr. David: Was the difference between the two, that the behavioral approach specified stages along the road of change?

Dr. Marsha: Behavior therapy primarily says, "You've got a problem, let me help you solve it." It never really said, "Maybe you could tolerate that problem, maybe you cannot change everything." Behavior therapy at the beginning, I was in the kind of a little bit of the beginning of the first wave.

Behavior therapy was developed in the 60's and I was trained in the 70's. Behavior therapy is really about, "Listen, we can change things. We can do this." It really wasn't about, at that time, "There is something that either one must accept or that it is wise to accept."

Behavior therapy started with easier problems, and I was dealing with people who've had tragic, unbelievable tragic lives with childhoods that not only could not be changed, but it was unreasonable to think you would ever think of your childhood without crying and that day wasn't on the horizon. People, who led lives with such problems, that you could not intervene in and make OK in any reasonable period of time.

What I realized was that I was dealing with a group of people who later emerged, I did not know whether it's beginning but it emerged later because in 1980 a new diagnosis was added to the diagnostic field; Borderline Personality Disorder. When I read about that, which I had not previously heard of, I developed the entire treatment for highly suicidal people, then found out about Borderline Personality Disorder. Then I discovered that all the people I've been treating make criteria for that.

Dr. David Van Nuys: Interesting, interesting...

Dr. Marsha: I unwittingly had developed a treatment, then discovered that although there were psycho-dynamic treatments available at the time, none of those treatments had research data. I was operating in a research environment myself, had full plans to do a randomized clinical trial and was very unwilling to publish a book on a treatment without a randomized trial.

As it turned out, I did one of the very first randomized trials showing that a treatment was effective. The importance of that was at the time, the state, insurance companies and almost everyone said this is non-treatable disorder and therefore we won't pay for treatment. I inadvertently stumbled into a major clinical problem without any design on my part to do it.

Dr. David: Yeah, and since that time or maybe at about the same time, other people were also working on trying to validate approaches including psycho-dynamic ones. I recently interviewed Dr. John Clarken on his Transference Focused Therapy for borderline personality and he's done a bunch of research. Are you familiar with his work? Are there similarities or differences?

Dr. Marsha: Oh yeah. No, they have... There are two studies on that. One is showing it is not as effective as Schema Focus Therapy, which is a cognitive behavior therapy that's also new and just been evaluated only against Transference Based Therapy. They have another therapy which they did... They have only one other study which had very few subjects.

Dr. David: Mmm-hmm.

Dr. Marsha: I've consulted with him in the past. There's a huge study of that treatment going on right at the moment in Sweden and we're waiting for the results. That would be the first really big trial of that treatment, it's comparing it to DBT and treatment as usual...

Dr. David: OK...

Dr. Marsha: That's a major study.

Dr. David: They focus, I guess, more on Transference which is the relationship between the therapist and the client, while yours, the focus seems to be more strongly on the idea of acceptance that you were talking about?

Dr. Marsha: No, it also has a major focus on the relationship.

Dr. David: Oh, it does?

Dr. Marsha: In fact, that's the second target topic. The first topic is life threatening behavior and the reason that's such a huge focus in DBT is that, when it comes to suicide, you really can not put that off and say, "well, we'll just accept that you're killing yourself" because the person will be dead and the treatment won't work if they're dead. No treatment works with dead people.

Dr. David: [laughs] Right.

Dr. Marsha: So, we focus first on, life interfering behavior and that's the main target of the treatment. Only if we think the person is going to be alive, by the next week do we target anything else. The second thing we target is any behavior of the patient or client that interferes with treatment progress. That always will be the interaction between the client and the therapist.

We focus both on the patient's behavior with the therapist, but equally on the therapist's behavior with the patient, because... our psycho-dynamic looks at Transference as the client is transferring to the therapist.

Now, of course, behaviorists don't have the construct of Transference, we call that generalized biology [laughter]... that you're generalizing behavior from other environments to this environment which everybody of course does. But the therapist also can interact in ways that are not helpful to the client.

So there's a major focus and in fact our data is extremely good compared to psycho-dynamic therapy, on changes in the relationship and changes in the patient's self-concept.

Dr. David: Mmm-hmm.

Dr. Marsha: We had a "treatment by experts" condition where we hired expert psychotherapists who weren't behavior therapists. They couldn't be cognitive behaviorists, so they were mostly psycho-dynamic and some systems and other source of therapists, then we compared the relationship of the client with the therapist and showed major changes in an instrument that was... I called up the psycho-dynamic people and said "Give me an instrument that if I can show I changed it you'll believe the treatment's effective."

Dr. David: [laughs] What did they come up with?

Dr. Marsha: They came up with Lorna Benjamin's Structural Analysis of Social Behavior.

Dr. David: Now I should let listeners know because our listeners, by the way I'm not sure I informed you that our listeners are mostly going to be laypeople, not professionals. So, when you say "instrument" you're probably talking about some kind of paper and pencil test, is that right?

Dr. Marsha: I'm talking an assessment, yes, where, in the therapy, we had people do two things. They rated their therapist and a lot of things about how they felt about their therapist and they also rated themselves. What we found over time, was that their self-concept went from very, very, very negative to positive in DBT. Their rating of their therapist's warmth and their therapist's helpfulness and willingness to go out of their way to help also went way up during therapy.

Dr. David: That's great. There's been such a movement now towards validating these therapeutic approaches through this kind of research that...

Dr. Marsha: Oh, yes. Now there's another very good therapy. There are two others, but Transference based therapy probably has the least amount of research although they're actively researching it now and I'm thrilled that they're doing that.

Dr. David Van Nuys: Mmm-hmm.

Dr. Marsha: There's a scheme of focused therapy by Jeffrey Young in New York City.

Dr. David: I interviewed him as well.

Dr. Marsha: He has... they have one study compared to Transference based psychotherapy, which at the end of three years of treatment, found better outcomes. Then a very good therapy also by Bateman and Fonagy, England, called "mentalization" and they have very good data from a partial... a five-day-a-week partial hospitalization, compared to no treatment. They're doing a study now about patients and I hear they're going to have very good results too.

Dr. David: OK.Well there's another person I interviewed, and it seems to me that his approach might have some similarities to what you're doing and that's Dr Steven C Hayes. Are you familiar with his acceptance commitment therapy or ACT?

Dr. Marsha: Yes. Mmm-hmm.

Dr. David: And he emphasizes acceptance and mindfulness, so how does your approach differ from his?

Dr. Marsha: Well, the big difference is, his treatment is largely trying to get you to stop reacting to your own thoughts, and... so it's like an exposure based treatment where you're in the same way, trying to get you, so that when thoughts and images come up that are painful, you are not so reactive to them; you can radically accept them. But... so it's an acceptance based treatment and it focuses on changing your level of acceptance, literally.

If you worked out with people, with the unbelievably excruciating lives, they're the people I work with, you simply have to have change. You cannot say, "accept". It would be like having a person with third degree burns and no skin after a fire in a hospital; you do have to tell them to accept because they have to be debrided and things so they have to accept this pain, but that's certainly true...

But you can't say, "OK accept, and we will just take you out of the hospital now.", or "We'll teach you how to accept the pain, but we won't do anything to change the pain". The people I deal with are like that; they are psychologically in chronic pain and accepting it is one thing but you must change it. You must focus on change. So DBT is a treatment that combines, that brings both to bear without a statement anywhere that acceptance is more important than change.

Dr. David: One of the things that I'm struck by is how a concept like mindfulness which as you indicate maybe comes out of eastern spiritual practices, is finding its way into experimentally validated kinds of treatments. I think you and I are pretty much to the same generation... My own doctoral dissertation touched on the study of meditation and I'm aware that other researchers of our generation have helped to make this mainstream. How did you come to draw upon eastern approaches?

Dr. Marsha: Well what happened with me, when I started, mindfulness was nowhere in... it wasn't in psychotherapy and it wasn't in behavior therapy. So... it just wasn't there at the time, and particularly coming to behavior therapy, which Steve Hayes is and all the new mindfulness based treatments are... really, it wasn't there at that time and what really happened to me was, I have a background in Christian contemplative prayer and in fact was trained as a spiritual director in contemporary prayer and that was sort of where I was at...

Dr. David: Uh-huh...

Dr. Marsha: And I went into these extremely... these people in just such excruciating pain, who could not tolerate the pain long enough for me to help them. I realized that I had to help them accept, and I simultaneously realized that I did not know how to do that myself. I didn't know how to teach it.

So because of my contemporary prayer connections, I called on my friends and said, "Who is the best teacher in the world?" I thought if I was going to learn I was going to learn from the best. I didn't go to Christian contemporary prayer even though in the mystical tradition, it is surrender, it is acceptance, the will of God. But I didn't go that direction because there are so many concepts there and words, that I thought I might have trouble generalizing it to the non-Christian client, many of them I was treating.

So, two teachers names came out more than once and all these people recommended. One was a woman Zen Master and one was a Benedict monk Catholic Zen Master. So I had no idea what Zen was, not even the slightest, but I decided to go work with them. I couldn't decide whether I was a Catholic or a woman. I decided to go three months with the woman and one month with the Catholic and ended up taking a leave of absence and going three months to a Buddhist Zen monastery, it was a woman teacher, and then three months to a Catholic monastery with the Benedictian monk.

Dr. David: How fascinating, now did you encounter any resistance to bringing in these ideas for meditation?

Dr. Marsha: Well first of all, I wasn't doing that. It was meditation. Well, the first thing I did was, I knew that I could not use the word "Chant." At the same time, at the University of Washington, I was extremely fortunate that Allen Marlap was here. He had learned meditation himself personally for various reasons and was also integrating meditation into treatment. He was Buddhist and I was trying to integrate Zen but without the Buddhism. Both of us were in the closet. Neither one of us were telling anyone really what we were doing outside of the University of Washington.

Dr. David: Understandably.

Dr. Marsha: We are working. But as I brought it in, I did what could be elusively considered to be a behavioral translation of Zen. I used the word "mindfulness" because in psychology. They have a lot of research on mindfulness, which is mindfulness versus mindless or automatic behavior versus behavior with awareness. So I thought mindfulness sounded like a psychological word and actually did not know that it was such a major spiritual word. I thought I was picking psychologist, because I am sitting here looking at Langer's book of mindfulness right on my bookshelf which is a research, a psychological research.

Dr. David: Interesting.

Dr. Marsha: So when I put mindfulness into the skill, so I developed. Because my patients said they didn't do breathing, they didn't do walking and they won't take off their shoes. So I just thought "OK. Fine, " I'll just translate it. What happened was, after I wrote my treatment manual, many people told me if that if they knew Zen, they said, "you know if you know Zen, you read your book, you see it and if you don't know it, you don't."

But I just had literally two nights ago, a former student of mine, came over for dinner and we were talking. She is Christian and she told me that she came to work with me because when she read the book, she thought, she said "I saw the bible". So, it just goes to show the contemplated Christian acceptance and surrender will of thought and the Zen mindful acceptance letting go or of the same... the same spiritual experiences generated both.

Then they came in to treatment. When I started, no one was looking at mindfulness research other than Allen Marlap and others or may be a couple of other people who weren't really writing, and now of course, the other person who had looked at mindfulness was John Kabat-Zinn...

Dr. David: Yes.

Dr. Marsha: He came out before me. But he was doing his stress reduction and everybody knew that meditation worked for stress reduction but I wasn't. I had no desire to use mindfulness for stress reduction. I was looking for stress tolerant. So I have figured, I had plenty of clinical behavior therapy for stress reduction. I was really interested in mindfulness, in effect how to desperately want something and not be desperately miserable for it, when you don't get it.

Dr. David: Mmm-hmm.

Dr. Marsha: I went in about how to want that last or how to reduce stress because I figure behavior therapy, I could have been wrong but I figured, I figured I knew how to do change, my problem was how to not do change.

Dr. David: It's with the foot in both worlds. It's been fascinating to me to see how these ideas from Eastern thought and Western psychology have been converging around the notion of, "Look at your thoughts." Look at what's going on in your mind and if you monitor that, that can be an important...

Dr. Marsha: Now that's not my approach, just to be clear. That is meditation, but my treatment is not meditation. I am the only one where it is not meditation. What I did, was deconstruct meditation for people who can't meditate, so watching thoughts is one thing to watch, but watching a leaf or tree is another thing is not to watch, or watching a sensation or a feeling and learning how to describe which you have to do if you go see your Zen teacher. You've got to describe without adding a whole bunch of stuff to it.

But also how to participate, how to become one with your environment, not how to become, and not how to lose your mind, you go deep into some body while you're meditating. But how do you become one in a relationship or one with a tree. How do you stop being judgmental? and not think good/bad about everything in the universe. How do you be in the present? and then how do you be effective?

In Zen it's called useful for me where being effective, becomes more important than being right or having your opinion be proved the correct one.

So the transformation of it, meditation, I have to tell people all the time, "meditation is one practice of mindfulness but only one of many..."

Dr. David: Right, right.

Dr. Marsha: Mindfulness and DBT is all of them.

Dr. David: I understand you have developed four skill modules which lead to a state that you call "wise mind." What is "wise mind", and then, what are the skills that lead to it?

Dr. Marsha: It's in "wise mind" I made up. It's based on the idea which turned out, I think, to be correct that every person has within them the capacity for wisdom. It's very similar to the Zen idea that everyone is enlightened already or in Christianity that you have God within or Jesus within.

Dr. David: OK.

Dr. Marsha: So, it was his first idea that everyone has that capacity and in, when, in the deepest parts of oneself - Why?

Your "Why" is without conflict. In other words, that you do the right thing, the wise thing, without so much conflict. And, the question is, how to get there? So, there are four sets of skills; there are two change and two acceptance. The change are interpersonal skills and emotion regulation. So, how do you become more effective inter-personally and how to be effective at regulating your own emotions? Both of which are change-based. The other was mindfulness, which is acceptance-based.

Then the fourth is distress tolerance. That really has two sets of skills. One set is crisis survival. Which is how to get through a crisis without making things worse. The other is reality acceptance which is, how to very fundamentally at a very fundamental level, radical level, accept reality as it is and willingly participate in it. So, it's got willingness, turning the mind, radical acceptance.

So, those are the... distress tolerance really has two sets, but those are the skills.

Then, colleagues of mine who've really improved DBT enormously and honestly, I do have to say, have also really developed a whole set of skills, which are called dialectical skills - which actually turns out to be very important for parents and adolescents when they're working together, learning to give up having absolute truth on your side.

Dr. David Right.

Dr. Marsha: Which is what a lot of what dialectical skills are about.

Dr. David Well, I'm wondering how people would find someone who could work with them in the way that you've described. How many practitioners have you trained at this point?

Dr. Marsha: Oh, thousands.

Dr. David Thousands.

Dr. Marsha: They're all over the world. They're in almost every state here and all, Canada, South America, China, Europe, Australia, New Zealand; they're practically everywhere. The problem is there are not enough people trained. Your best ways to find them would be to come into... is to look up Dialectical Behavior Therapy or DBT... Dialectical Behavior Therapy on Google and there are a number of places, of websites that have lists of therapists, including ours, at the University of Washington.

Dr. David OK, good. So, where do you see... just to wrap things up here... let me ask you one last question; where do you see dialectical behavior therapy going in the future?

Dr. Marsha: Well, we've done nine randomized trials showing it's effective. It is effective and no one doubts it anymore, so there's no point in continuing to ask that question. So, now, we're trying to figure out, what can we get rid of in the therapy? What is unimportant? What is that critical component? How can we trim the treatment down? That's on the one end, and...

Dr. David I forgot to ask... is there sort of a standard length of treatment? Or, more or less...

Dr. Marsha: Generally, it depends on how severe the person is. There's versions of this treatment. There's sixteen weeks for suicidal adolescents, all the way up to one year in a research I've done and two years when you're taking you are chronic mentally ill person who hasn't worked in 10 years and has been in the mental health system for say, 10 years, and been in the mental health system for say, 10 or 15 years. You are trying to get them totally out of the system; working, functioning, and out of the public system. Those are two-year programs.

Dr. David: OK, OK.

Dr. Marsha: It all depends on how serious the problems are.

Dr. David: I see. I interrupted you midstream. You were talking about where you see it all going in the future?

Dr. Marsha: Oh, so we have to make it better. Once you develop a treatment, you always find that there are people, who don't do so well, don't do well in it, you don't have the correct treatment. All of us are, a lot of us... we have an entire international group of researchers and we have to do much more research to improve the treatment and we have to do research to improve dissemination and get it to the public.

Dr. David: Yes.

Dr. Marsha: Both dissemination research, we're hoping to do that here, and component research to find out what's critical, what can we get rid of, what do we have to keep in the treatment, what's important and then research to improve the whole thing.

So, it's just a whole research program, I and many people around the world now are all on doing. It will emerge into another treatment and we'll lose the name, I hope and it'll have a much better treatment at some point in the game than we've gotten now.

Dr. David: OK. Well, Dr. Marsha Linehan, I want to thank you so much for being my guest today on the Wise Counsel.

Dr. Marsha: Well, thank you very much for having me. I enjoyed talking with you. I hope that you get a lot of comments and questions about this, and I look forward to hearing those comments.

[music - pan-pipes, tubular bells, gong, and tam-tam drum]

Dr. David: I hope you enjoyed this interview with my guest, Dr. Marsha Linehan. As you heard me mention, I continue to be impressed by the synthesis of eastern spiritual ideas with western psychological practice. This is a trend we've heard in several of our podcast interviews now.

In fact, both Dr. Linehan and my earlier guest, Dr. Steven Hayes, collaborated on a 2004 book which you might find of interest. The title is "Mindfulness and Acceptance - Expanding the Cognitive Behavioral Tradition."

You've been listening to Wise Counsel, a podcast interview series sponsored by mentalhelp.net. If you found today's show interesting, we encourage you to visit mentalhelp.net where you can add a comment or question to this show's web page, view other shows from this series, or simply page though the site which is full of interesting mental health and wellness content.

Access this show's page and show archive information via the podcast box on the mentalhelp.net home page. If you like Wise Counsel, you might also like Shrinkrap Radio, my other interview podcast series which is available online at www.shrinkrapradio.com and "rap" is spelled R-A-P. Until next time, this is Dr. David Van Nuys and you've been listening to Wise Counsel.