What Is Dialectical Behavioral Therapy?
Dialectical Behavioral Therapy(DBT) has transformed the impact of the diagnosis of borderline personality disorder (BPD). Developed in the late 1970’s specifically for suicidal women, it has become an evidence based practice found to be highly effective in reducing psychopathology in BPD. Prior to DBT, Borderline Personality Disorders were considered by many in the mental health profession to be untreatable which may have led to a profound under diagnosis that continues to this day. DBT is essentially a modified form of cognitive behavioral therapy that includes mindfulness strategies and techniques that directly address distress tolerance, interpersonal relationships, and emotional regulation.
What Are Dialectics?
At the core of DBT are Dialectics. Dialectics are metaphysical contradictions or conflicts, and DBT helps people identify them and better resolve them. As people suffer emotional pain or insecurity, they develop a reaction formation that includes what is often termed “black and white thinking” partnered with “black and white feeling”: a condition of being rigidly stuck in one emotional modus operandi. People get stuck on one side of a dialectic conflict, and their stances and behavior stay stubbornly fixated, usually destructive, and create much added suffering to the person's experience. This suffering and the subsequent behaviors bewilders and confounds people in the grip of powerful emotions and rigid thoughts. By repeatedly hurting others and themselves, their hopelessness and despair grows.
How Can I Learn to Recognize Dialectics in My Life?
The first step is recognition or awareness of the Dialectic concepts, and this can be directly taught. The awareness of these opposing forces may be responsible for some very uncomfortable insecurity, which black and white thinking/feeling attempts to avoid.
Some common dialectical conflicts are: structure vs freedom, fear of needing people vs fear of being independent, caring for others vs maintaining boundaries, being too passive vs being too aggressive (Lane Pederson, 2017). They can also be described as paradoxes. Awareness of these conflicts within a situation is the first step towards the subtleties of skillfully navigating one’s response. Recognition of the twin poles in others and in oneself as a universal human condition helps create empathy and understanding for oneself and others. Mindfulness teaches individuals to be aware of the sensations, body based and emotional, that may be a precursor to a dialectical conflict. If recognized at this stage, the formation of a fixed idea of just one bearable solution, the emotions which evoke extreme behavior to support that idea can be avoided. Recognition of Dialectics disrupt the debilitating notion of a simple right or wrong in many situations. Simply naming the dialectic involved in a conflict is the beginning.
Non awareness of dialectics can be seen in a young child who swings easily to rage when not getting what they want. A child doesn’t question or consider the sometimes contradictory nature of what they want, they just want it. They are willing to throw powerful, destructive , and exhausting emotions and behavior towards acquiring it. Young children have relationships (parents, caretakers) who perform the function that emotionally skillful adults have to do for themselves. The child’s parent may grant or block the child’s wish, calm the excess emotions, and educate that child on the reasons behind that decision with a developmentally appropriate explanation. If such an intervention is steady and consistent, it will mitigate tantrums, emotional excess, and destructive behaviors. The child will rely on that intervention and parents and caretakers eventually and in increments will hand those tasks over to the developing person. People’s desires become more complex especially in the realm of human relationships than simply wanting a toy or to be picked up and held. Identifying Dialects is a step in the slowly evolving ability to recognize when something you want in the moment may not be possible, may not be what you need, may not be what is best for you , or may not be best for the relationships involved.
How Do I work with the Dialectics I Recognize in My Life?
Once recognition of dialectics begins it can be maintained in the form of a practice of looking for dialectical conflicts that threaten to create excessive emotions and their accompanying destructive behaviors. Most people tend toward certain themes and therefore certain dialectical conflicts. A person whose fear of abandonment is paired with frequent, difficult, and devastating breakups is possibly unaware of the inner dialectical conflict of fear of needing someone vs. fear of being independent. Which dialectics predominate depend on the personality and the history of that individual. Although the understanding of where that predominant dialectic came from may be of interest and enhance understanding, it is more important to recognize that dialectics are part of being human. Suffering is more expeditiously alleviated by identifying where dialectical conflicts are causing suffering in the here and now of an individual’s life. Developing a practice in the present to be aware of when dialectics are at play affords people the chance to choose a more compassionate, far reaching, and beneficial reaction to these conflicts. This ability to choose mindfully in difficult situations allows people to override the destructive, entrenched personality habits of people with Borderline Personality Disorders, but is also helpful for all people seeking a more balanced and fulfilling relationships with themselves and others.
References
Pederson, L., & Pederson, C. S. (2012). The expanded dialectical behavior therapy skills training manual: Practical DBT for self-help, and individual and group treatment settings. PESI Publishing & Media.