Most people have never heard the word ‘dialectical’ when learning of Dialectical Behavior Therapy (DBT). When I first started studying DBT in graduate school, I remember thinking, “This must be a really complicated treatment, because I don’t know what dialectical even means.”
When I start DBT therapy groups or DBT trainings, I like to start with the question, “What does dialectical mean?” I often hear, “a discussion between two people,” “a dialogue,” “the way people talk, like the word dialect,” and finally “maybe something related to two things?” The last guess is the closest. Google and Wikipedia aren’t so helpful either; each defines dialectical with other big words!
Marsha Linehan, the creator of DBT, defines dialectical as a synthesis or integration of opposites. That’s kind of confusing, right? In simpler terms, dialectical means two opposing things being true at once. But even that is still kind of confusing!
Let’s break this down.
Think about someone you care about. Now, think of a time they upset you. Here’s an example from my own life. I love my brother dearly. He’s very busy, essentially working two full time jobs right now. I’ve been trying to reach him on the phone for weeks to ask him a simple question, and either he answers and has to go within a minute or doesn’t even pick up the phone. This really irks me. I care about my brother and think he’s great, AND him being hard to reach is something I don’t like about him. This is a dialectical situation. These two, seemingly opposing facts about the way I feel about my brother, are both true at the same time.
DBT is comprised of many dialectics, two simultaneous yet opposing truths. My favorite DBT dialectic? “I’m doing the best I can AND I want to be doing better.” This can apply to many situations. On the surface, doing the best I can and I want to do better seem quite opposite. Yet, I can imagine many times both can exist right next to each other in someone’s life. Have you ever seen a parent juggling a few kids out in public, and they just won’t all listen at once, so this parent gets angry? This parent is likely doing the best they can to manage their kids, given who the parent is, who their kids are, and the situation they are in. At the same time, I can imagine that parent wishing they had more resources, or that they did not get angry as quickly. That’s the want to be doing better part of the dialectic.
Notice when describing these dialectical situations I’m using the word AND, not BUT! That’s intentional. If I wrote, “I’m doing the best I can BUT I want to be doing better,” the first part of that sentence doesn’t matter anymore. You’re left only with I want to be doing better, and that’s not a dialectical statement.
DBT as a whole is centered on one main, overarching dialectic: acceptance AND change. For the treatment to work, providers and patients need to balance the two strategies, not focusing too much on either side. There are some other key dialectics as well, that I’ll be mentioning later in this DBT 101 blog series.
Do you have a favorite dialectic or dialectical situation? Let us know!
Andrea Barrocas Gottlieb, PhD, is the DBT Program Coordinator at Sheppard Pratt. She completed her psychology internship and postdoctoral training at McLean Hospital/Harvard Medical School in Massachusetts, where she learned to implement Dialectical Behavior Therapy (DBT) with youth and adults. She has studied and published research on nonsuicidal self-injury and mood disorders in youth. Dr. Gottlieb helps Sheppard Pratt implement DBT more widely through program development and staff training.
By Dr. Jillian Glasgow
I sit down to write this blog post as it is snowing outsidein the middle of May, perhaps the perfect time to be writing about entering theparadox of the dialectic. It reminds me that winter is not quite done with usyet – one last hurrah before it’s gone for a few months – and that it isstill spring anyway, even while it is snowing. It reminds me that seasons don’tchange all at once: there is a back and forth as we gradually move through theyear.
A dialectic is when two seemingly conflicting things are trueat the same time. For example, “It’s snowing and it is spring”. You might also see dialectics when in conflictwith other people. I like to think of it as having an elephant in the room withtwo blindfolded people on opposite ends of the elephant. If one persondescribes the elephant as being like a large snake after touching its trunk andthe other describes it as being like a rope after touching its tail, both descriptionsare true and each person holds a portion of “the truth”. A core dialectic ofDBT is accepting where we are right now and changing for the better. Inother words, “I’m doing the best I can, and I need to do better and tryharder”. We use “and” in the middle of a dialectic instead of “but” to giveboth statements equal weight – they are equally true!
Some other examples of dialectical statements are: “I feelhappy and I feel sad”; “I want to be loud and you need me to be quiet”; “Thingsare very different now from a year ago and every day feels the same”; “I feeltoo tired to work and I can do my work anyway”; “I love you and I hate you”.
Being more dialectical can help to reduce the emotionalintensity that comes from unbalanced, all-or-nothing thinking or conflicts withother people. It reminds us that there is more than one way to see a problemand people are unique and have different points of view. Here are a few ways tobe more dialectical day to day:
- Change your thinking from all-or-nothing to both-and,and soften extreme language (e.g., always, never). For example, instead ofthinking/saying “I’m a failure”, change that to “sometimes I fail andsometimes I succeed”. Instead of thinking or saying “You never listen to me!”,instead say “You’re not listening to me right now”.
- Dialectics are a good way to validate yourselfwhile still pushing for change. When you have to do something difficult thatyou don’t want to do, for example, you can validate yourself by first saying“this is hard (maybe even so hard that it feels impossible) and I canget out of bed and do it anyway”.
- Enter the paradox. Sometimes when I teachdialectics, there is this feeling like “but then what do you do?” What do youdo with that dialectical tension between two seemingly opposing things? And youenter the paradox by just allowing the two to exist simultaneously. One side isnot fully correct, nor do you have to choose between them, you just notice the tug-of-warbetween the two and that they both exist. Sometimes this acceptance can giveyou the freedom to move on, or to find a different solution, and sometimes itis just an opportunity to sit in an uncomfortable moment and learn to tolerateit.
- Practice dialectics by actively looking for themin your life. Take a few moments to notice what has changed in your life or inthe room you are in. Now, what has stayed the same? You’ll notice that you cangenerally find both.
Once you start looking for dialectics around you, you start to see them everywhere. I have compiled a playlist of songs that have dialectical messages or dialectical statements. Some music might be dialectical because it is a sad sounding song with happy lyrics (or vice versa). Try it out: see if you can hear the dialectics in these songs. Another challenge for you is to explore your own music for songs that are dialectical in some way. I bet you can come up with your own examples!
Once you start looking for dialectics around you, you startto see them everywhere. I have compiled a playlist of songs that havedialectical messages or dialectical statements. Some music might be dialecticalbecause it is a sad sounding song with happy lyrics (or vice versa). Try itout: see if you can hear the dialectics in these songs. Another challenge for youis to explore your own music for songs that are dialectical in some way. I betyou can come up with your own examples!
Frank Walker, AstridS – Only when it rains
Modest Mouse – FloatOn
Mother Mother – it’salright
DashboardConfessional – Vindicated
Jr Jr – Same darkplaces
Half alive – Still feel
Marketa Irglova –Falling Slowly
Matchbox – Unwell
Katie Herzig – Lostand Found
You can access this playlist on Spotify.
Images
Putekhova, K. (2017). Pink Flowers. UnSplash. https://unsplash.com/photos/IS7czbFUvVk.
The word “dialectic” has a long history, from ancient Greek philosophers, through Hegel and Marx, and to the present day. Its meaning has changed over the centuries, and according to different thinkers. In psychotherapy, “dialectic” is almost wholly associated with dialectical behavior therapy (DBT), where the term identifies a particular type of treatment. In reality, dialectics as used in DBT is a feature of all schools of psychotherapy.
Broadly speaking, a dialectic is a tension between two contradictory viewpoints, where a greater truth emerges from their interplay. Socratic dialog, in which philosophers mutually benefit by finding defects in each other’s arguments, is a classic example. In the early 19th century, Georg Wilhelm Friedrich Hegel described a universal dialectic, commonly summarized as “thesis, antithesis, synthesis.”
His esoteric philosophy holds that every thesis, or proposition, contains elements of its own negation. Only by considering both the thesis and its contradiction (antithesis) can one synthesize a greater truth. This process never ends, as the new synthesis itself contains antithetical elements. The term veered in meaning with Marx’s dialectical materialism, and in yet other directions with more contemporary writers. But DBT uses the Hegelian sense, and that is our focus here.
Marsha Linehan faced a problem as she developed DBT in the late 1970s. Her behavioral strategies implicitly pathologized those she sought to help. Clients thought: “If I need to change, there must be something wrong with me.” To avoid re-traumatizing them, she turned to Zen Buddhism’s self-acceptance and focused on clients’ strengths. But this, in turn, downplayed their real need to change. Dr. Linehan and her colleagues realized they would have to integrate change (thesis) and acceptance (antithesis) into a larger truth that incorporates both (synthesis).
This is the fundamental dialectic of DBT, although there are others. For example, the therapist is trustworthy and reliable, but also makes mistakes. The client is doing his or her best but wants to do better. Although worded here using “but” for clarity, DBT teaches clients to use “and” instead. (The therapist is reliable and makes mistakes.) In doing so, the therapeutic task is to embrace the truth of both propositions at once, not to choose one over the other.
An uneasy tension between acceptance and the need for change exists in all psychotherapy, not just DBT. Indeed, this tension underlies a question commonly posed to new clients: “What brings you in now?” Therapy begins only when emotional discomfort and the perceived need for change outweigh the inertia (i.e., acceptance), reluctance, and other factors that precluded it before. Then, once in therapy, change versus acceptance is often an explicit struggle. File for divorce or work on one’s marriage? Learn to be bolder or accept that one is shy by nature? Change physically through exercise or plastic surgery, or become more comfortable with the body one has?
When clients grapple with such questions, therapists of any school should refrain from choosing sides or giving advice. Except in extreme cases, we simply don’t know which option is best for the individual in our office.
However, it goes further than this. As Hegel wrote, a clash of thesis and antithesis may result in a new third way, a synthesis that incorporates, yet transcends, both sides of the argument. This “union of opposites” was first described by pre-Socratic philosophers (and by Taoists, as in the well-known Yin-Yang symbol of interdependence). The concept was later adopted by alchemists, who observed that compounding two dissimilar chemicals can result in a third unlike either parent (e.g., sodium, a highly reactive metal, plus chlorine, a poisonous gas, produces table salt). Carl Jung, who studied alchemy, weaved the union of opposites into his various psychological writings. It forms the basis of his “transcendent function” that leads to psychological change; an accessible introduction to this concept can be found here.
The shuttling to and fro of arguments and affects represents the transcendent function of opposites. The confrontation of the two positions generates a tension charged with energy and creates a living, third thing … a movement out of the suspension between the opposites, a living birth that leads to a new level of being, a new situation.
Collected Works of C. G. Jung, Vol. 8. 2nd ed., Princeton University Press, 1972. p. 67-91.
One need not be a Jungian to recognize creative, “third-way” processes in therapy. Instead of being caught on the horns of a dilemma, it often helps to take a step back and appreciate the validity of both positions: It is valid to seek autonomy and relatedness. It is valid to be serious and to play. And it is certainly valid to accept oneself while also striving to change. Insight is our term in depth psychotherapy for achieving synthesis: a position that reconciles and transcends thesis and antithesis, makes sense emotionally, and works in one’s life. In this way, dialectical tension generates all creativity and psychological growth.
©2019 Steven Reidbord MD. All rights reserved.
