Licensed Marriage and Family Therapist. Manager of Adult Psychiatry at Kaiser Permanente Fresno. Dialectical behavioral therapy team leader/therapist.
Any path in the mental health field and Leah Whitworth, 51, has more than likely worked it, a while mastering her craft into making effective change for patients to build a life worth living.
At 4 years old, Whitworth’s father decided to move her family from Mitchell, South Dakota, to Fresno for her oldest sister to continue her education at Fresno State. Whitworth decided to continue that family path and received her Bachelor’s Degree in Psychology in 1990. She then furthered her education through Fresno State’s counseling program, earning her Master’s Degree in 1993 in Marriage, Family and Child Counseling.
During the transition to graduate school, Whitworth held a full-tme job at Gottschalks and took night classes to pay her way through college. Yet to be officially licensed, her degree required an additional 3,000 hours for her internship, prior to taking California’s State Licensing exams.
Whitworth had originally enrolled in college as a music major because of her love for flute and choir, which had manifested as a creative outlet at a young age.
That was until her oldest brother, Donn, had his first psychotic break in 1980, was put on an involuntary psychiatric hold and diagnosed with schizophrenia right before her 12th birthday.
“Nothing was the same after he was diagnosed. Back in 1980, mental health professionals did not do very much to help educate, validate, support, nurture family members,” said Whitworth. “I distinctly remember that night of my brother’s hospitalization, my mom and I and my brothers being basically shoved out of the office by the attending Psychiatrist, as he said, ‘This isn’t about you guys,’ and that is a memory that will stay forever. That and my brother’s face on the other side of that locked door when it slammed shut.”
Whitworth pulled out a photo of her and her brother that sits at the edge of her office desk. She reminisces and cherishes the photo being one of her favorite memories of him bringing her a new pair of shoes. She jokingly blames her brother for her shoe addiction ever since!
“Losing my brother was hideously painful. The loss started that night in 1980. It was as if he had died, he was right there, yet I could not reach him. The lights were on but no one was home,” Whitworth said. “He was no longer the brother I knew. He was responding to internalized stimuli, laughing out of the blue, sitting and staring off into space. He was literally out in the flower bed at 4 a.m. digging, trying to hunt up ‘worms for the early bird.’” he said when our mother asked.
Whitworth explained that people with schizophrenia do not understand idioms, which is a great diagnostic tool in a mental status exam. She explained a patient with schizophrenia may take things very literally and have a hard time with what idioms mean figuratively.
“My brother’s experiences will live in my mind forever. As well as what it was like to be the family members who were not only not educated about the mental illness my brother now had, but actually treated very negatively by psychiatric professionals back in the day,” Whitworth said. “I have always held that in my mind, so it is one of my missions to nurture, provide education, comfort, support and validation to family members.”
Whitworth’s brother being diagnosed with schizophrenia took a toll on her own mental health.
“By the time I was 16, I was so depressed… I was suicidal. ” Luckily for Whitworth there was a very intuitive, understanding and compassionate priest in her Catholic parrish.
“At confession one day, “My priest said, ‘Gosh, Leah, you are really angry’ and I replied, ‘And what’s your point?’”
The priest referred Whitworth to a therapist by the name of Barbara Fey, (LCSW) “I called her, I made the appointment, I paid for it myself. And my mother said, ‘Therapy? You don’t need therapy, there’s nothing wrong with you.’ “Yet she had no idea.” said Whitworth.
By the time Whitworth was 17, she was starting to feel alive and herself again because of therapy. She decided to take the California high school Proficiency Exam to get out of high school early.
As I continued in therapy, by the time I started college, I changed my major. “I thought, ‘Oh my gosh!’ I want to do for somebody else what Fey has done for me,” said Whitworth.
“My therapist taught me about self-empowerment, personal control, making my own choices, and setting my own limits. That changed everything. It was like suddenly someone had just opened a window on the world,” Whitworth said.
Whitworth’s brother passed away on March 1, 2015, at 59 years old after 35 years of fighting schizophrenia.
“People with schizophrenia tend to have shortened life spans. The thing that people do not know about schizophrenia, it can be a terminal illness, said Whitworth. “Typically this is an illness that can take 15 to 20 years off someone’s life span.”
In the start of Whitworth’s career as a post-grad at Tulare County Mental Health, she had her first opportunity to work with a patient in the midst of his first psychotic break. She had the opportunity to sit with the patient’s family and give back the nurturance, support validation and education she and her family never received with her brother.
Many years later, Whitworth was offered a job at Kaiser Permanente Fresno, Mental Health Department as a Behavioral Health Manager in 2017. During her interview process, she had one simple question that would later bloom into a prodigy of effective change, “Do you have a full DBT program, and if you don’t, can I build one?”
Whitworth’s personal experience on both sides of being the patient herself and treating her patients made it her mission to strive toward impressive outcomes through DialecticalBehavioral Therapy (DBT), which was created by Marsha Linehan, Ph.D in 1993.
According to Whitworth, DBT is a “coping skills program on steroids”. DBT is broken up into four very distinct modules — Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness.
Distress tolerance: Learning how to tolerate intense over-the-top emotions that are bigger than usual without making things worse, such as engaging in self-harming behaviors, suicidal behaviors, tearing relationships, being destructive because your emotions are super hot. While also learning how to accept realities that you may not be really happy about.
Emotion regulation: Learning how to regulate emotion in a healthy way vs self-destructive behaviors to avoid or to suppress thoughts.
Interpersonal effectiveness: Learning how to have a relationship with yourself, because you can not learn how to have a relationship with anybody else till you learn how to have one with yourself. Learning how to set limits and say no when needed without fear of rejection or abandonment.
Four months after starting work at Kaiser, Whitworth held an in-house DBT for Staff in July 2017, with the goal of getting five therapists interested and willing to commit to make a DBT team. By the end of that day, she had a full staff of 10 therapists on board.
The program went live in October of 2017, with a full DBT program that combines weekly skills training class, individual therapy and skills coaching. Skills coaching offers patients the opportunity to turn to DBT staff for quick problem solving using DBT skills.
Every Wednesday morning the Kaiser DBT team of therapists come together to work on themselves. This helps the therapists nurture, validate and hold each other accountable to the DBT protocols, theories and framework in their practice and in their lives.
The DBT program started with two skills classes and 20 patients. Now in 2020 the program’s census is seven skills classes approximately 150 patients. The program does a Pre-Post test measure through a 36-item questionnaire that measures a person’s experience through their emotions and behavioral dyscontrol.
“Just last week we had a patient who graduated after a year with 67 percent decreased emotion. We are getting amazing results,” said Whitworth.
She then explained that every year, Kaiser takes on three doctoral students to conduct a research project. The 2018-2019 students did their research on DBT, following the treatment patients pre and post scores. With any clinical study you hope for a confidence level of .05 or better, the confidence level came back at a .000 for Kaiser Fresno DBT.
“I know anecdotally that what we are doing here is working, I know what patients are receiving. I know what is going on. And It is beautiful to actually see it in hard data, ” Whitworth said.
“It is so beautiful to get to witness not only the reduction of self-harming behaviors and suicidal ideation or attempts, but along with that comes the less obvious, which is the sense of peace and calm that you start to see in a person’s face,” said Whitworth. “That when life throws curves, they then roll with it. They gain confidence, self-love and acceptance of tolerating things that a year ago they would not.”
Throughout the DBT program at Kaiser Fresno over the last two years, Whitworth has witnessed patients return to the workforce, watched people who have been “cutters” for 15 years replacing destructive behaviors with validation and breathe through their feelings, coming out on the other side. She has also watched people find positives in their lives and watched people repair marriages. She states that change is because “they are now skillful, not willful.”
Whitworth is a firm believer that DBT skills have wholly contributed to the success of her marriage the past 28 years.
“The first seven years were brutal because I didn’t have DBT skills, we got married in 1992, and I did not meet DBT till 1999 and DBT has changed everything from the way I relate to myself, my thoughts, my feelings, my body, my actions. It also has been instrumental in helping my husband and our two kids. We are all pretty darn skillful,” Whitworth said.
Whitworth jokes about how her children grew up fighting her “therapist mom style” like crazy. But knowing DBT skills has allowed her kids to notice when to call up the skill they need to use to keep themselves grounded.
Overall, Whitworth is most proud of the changes in herself because of what she knows, and most importantly, because she lives her practice. Every Single Day.
Whitworth said that DBT has helped her with her own addiction with impulsive spending, which she has been clean from for over 21 years, A unhealthy coping mechanism she developed to suppress and avoid her feelings through marital problems. “
It does not get more Emotion Mind than that. It was just a way to solve for painful feelings, which is really just a glass of ice water in hell,” Whitworth said.
“I had a serious spending addiction from 16 to 31 years old. A little over 15 years, and people would joke, ‘Oh she’s a shopaholic.’ However it’s serious,” Whitworth said. “The No. 1 cause of divorce in America’s money problems.”
“I never thought I would ever be someone who would not worry about money. It’s not that I make a ton of money. I am someone who grew up poor, where I watched my parents struggle their whole married life,” said Whitworth. “Then I was the one struggling, I worked myself into a terrible financial hole.”
Using DBT skills, Whitworth was able to tackle the spending problem and conquer it.
As an alumna of Fresno State’s Counseling program, Whitworth encourages students to stay in the moment each semester when catastrophizing the heavy workload. “One day, one task, one assignment, and one moment at a time,” Whitworth said.
After graduation and searching for internships, Whitworth said students should look toward a county mental health department, as these are often the best training ground.
“Students should be prepared to be true to the discipline of starting session on time and ending session on time to write notes right after each and every patient when it is fresh in your mind,” said Whitworth.”
In September 2019, Whitworth was given the chance of a lifetime to travel to Florence, Italy, after a colleague referred to a patient who had been struggling with depression since his teens and is now in his early 70s. No amount of talk therapy, medication, electroconvulsive therapy or transcranial magnetic stimulation had helped him to overcome and move forward.
The colleague had asked Whitworth to accept this patient into her class, and Whitworth was thrilled for the challenge.
“That patient took to DBT like a starving person takes to food, he could not get enough. Within six months, suicidal ideation was gone with a 46 percent decrease in his symptoms,” Said Whitworth.
Her colleague came to her to partner with her on an abstract for a case study.
Several months later, Whitworth and her colleague were chosen to be presenters at the 25th World Congress of the International College of PsychoSomatic Medicine. Their case study was one of six case studies chosen for presentation at the conference.
“It was the most surreal experience of my life to stand in front of clinicians and physicians from all over the world talking about DBT, which to me, is just simply my way of life,” Whitworth said.
While looking in Whitworth’s office, there were seven ampersands of every size. Withworth said that the ampersand symbol represents the dialectic, looking at two sides, two things that are seemingly opposed, where the “and” helps us find a middle group or a synthesis between those two sides. The AND opens up the possibilities where BUT negates everything we said before it. The AND allows for both sides of the dialectic.