Finding the Dialectic in Dialectical Behavior Therapy (DBT)

Dialectics, in Dialectical Behavior Therapy, refers to the process of investigating and synthesizing apparently opposing or contradictory ideas. In DBT, there might be your truth and my truth, but there is no search for absolute truth. Instead, there is a dialog about our contradictory positions in which both can find a new meaning. It is not a search for resolution by establishing right and wrong, but a development of understanding, over time, that may never result in a final truth or indisputable fact.

In a dialectical world view, change is considered a continuous and essential part of life. In therapy, both the client and the therapy itself are in a state of transformation.

This is a particularly difficult and important process for people with Borderline Personality Disorder (BPD), whose behaviors and relationships reflect a pattern of extreme impulsive reactions and intensity. Their lives are frequently unstable, with unrelenting crisis and chaotic interpersonal relationships. In this state, understanding without a final truth and the idea of change can be terrifying.

The Dialectic of Acceptance and Change

The core dialectical strategies in DBT are problem solving and validation strategies. At the heart of the treatment is the balance of the opposing acceptance and change based treatment strategies. The treatment strives to validate a person’s responses as understandable and, at the same time, show them as dysfunctional and in need of change. The balance between the need for acceptance strategies and change strategies is also in constant flux, requiring flexibility from the therapist. This ever shifting balance is why dialectics is at the core of the treatment.

References:

Linehan M. Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.

8 Replies to “Finding the Dialectic in Dialectical Behavior Therapy (DBT)”

  1. I’ve found that when therapists fail to keep a good balance on the dialectic of acceptance and change, they usually error in the direction of too much emphasis on change and too little on acceptance. After all, therapists want to see things happen so it’s easy for them to be seduced into pushing for too much change before their clients are ready.

  2. Pingback: PsychCentral
  3. My understanding of DBT is that it is a core approach to achieving stability, even happiness, by teaching a fine-tuned self-awareness along with personalized adaptive strategies to deal with change.

    The difficulty with DBT, and many other tools for mental health support, is that it is associated with a “pathology” such as Borderline Personality Disorder. Granted, that for purposes of appeasing insurance companies, those labels seem to be crucial. But the label(s) can completely deter those who need help, know they need help, but cannot deal with a label.

    For instance, DBT is being used effectively by people with Aspergers. Those with AS who are high functioning are often (understandably) resistant to even being associated with an autism spectrum disorder, and thus even more resistant, to a therapy developed for BPD. With all due respect to Linehan’s work, I wish mental health professionals would work on making effective therapies more friendly to those who shy away from labels.

    It is ironic that DBT, which in many ways is a training course in resilience for those who struggle with emotional balance and perspective, seems irrevocably linked to a specific “disorder.” This makes it appear very inflexible, which it is not, when led by a therapist skilled in DBT.

    My own perspective is from trying to get a teenager with Asperger’s who can seem “normal” much of the time when stress is low, who so desperately wants to be “normal” that he sacrifices self-awareness on a daily basis, and who is in absolute terror of being discovered by his peers. Remove the labels that infer pathology, mental health problems, etc. Replace them with something more inviting and empowering and many young wounded warriors in hiding and in dire need of help might step out of the shadows.

  4. how do i join your organization and do online dbt chat group. i have some experience in a group setting and i am in therapy with a dbt therapist
    please let me know.

    thanx very much for your time
    very much

    1. I don’t currently have a DBT chat group, but you can continue to read my blogs and comment. As you comment, others are likely to respond. I’ll keep your email and let you know if I start up a DBT chat or come across one.

      Thanks for reading.
      Christy

Leave a Reply

Your email address will not be published. Required fields are marked *