What is “Dialectical” about Dialectical Behaviour Therapy (DBT)?

Written by: Callista Forchuk, MA, MSc

What is the “dialectical” in Dialectical Behaviour Therapy (DBT)? Dialectics refers to the process of creating a synthesis from opposing forces, such as change and acceptance. Rather than becoming polarized and pushing for change or acceptance alone, a dialectical perspective simultaneously moves toward change while accepting things exactly as they are now. In DBT, a therapy that targets emotion dysregulation and associated problems (see here for more on DBT), being dialectical refers to holding a dialectical worldview and applying dialectical strategies and approaches.

Acceptance and Change

The central dialectic in DBT is that of change and acceptance. While change is needed to achieve a life worth living and improve problems, acceptance is needed to realistically face problems and pain in any given moment. DBT emerged as a response to the failures of other therapies in treating suicidality and emotional difficulties amongst those with borderline personality disorder (BPD; Linehan & Wilks, 2015; Linehan, 1993). Cognitive-behavioural therapies were heavily change focused. Yet, for clients facing complex psychological struggles and high-risk behaviours, major changes were needed. An exclusive focus on problem-solving was invalidating and often prompted clients to avoid treatment. And attempts to validate and be unconditionally accepting were also unhelpful for clients needing significant change. DBT seeks to achieve a synthesis between acceptance and change by simultaneously accepting clients where they are while also working with them to achieve progress. Thus, with change strategies to solve problems, and acceptance strategies to validate and support tolerance of challenging experiences, DBT’s embrace of dialectics is central to its clinical approach.

Dialectical Worldview and Strategies 

Broadly speaking, DBT is founded on a dialectical worldview that employs dialectical strategies. A dialectical worldview has three parts (Linehan, 1993):

1. It emphasizes interconnectedness and wholeness such that understanding any part of reality requires consideration of its wider contextual influences and consequences. For example, an individual’s tendency to lash out at others relates to how society condones that behaviour, as well as how that individual’s biology predisposes them to anger and how their social surroundings reinforce or punish it.
2. It suggests reality is made of internal opposing forces through which syntheses occur that produce new sets of opposing forces. That is, within any part of the complex whole, there is a polarity in tension. This idea relates to the central importance of validation in DBT: while change-focused therapies highlight the pathology among individuals in therapy, DBT recognizes that individuals’ problematic behaviours are simultaneously solutions. For example, problematic drinking may temporarily solve emotional pain.
3. Reality is continually changing. Through tensions between polarities and interaction between parts of an interconnected reality, individuals and their environments are in a constant process of transition. One implication of this is that there are no absolute or even relative “truths”; rather, what is true constantly evolves and each new position implies a contradictory position from which synthesis could be achieved again.

Dialectical strategies are based in the same dialectical logic but reflect practical therapeutic approaches, such as balancing warm relational styles with those that are more confrontational.

Conclusion

Through dialectics, DBT supports stability by moving between polarities. Whether balancing change and acceptance or shifting between seemingly opposing strategies or positions, DBT embraces complexity while helping clients  develop a life worth living.

If you feel overwhelmed with emotion dysregulation and behaviours that are harmful, reach out to our team of mental health professionals today to see if DBT or another therapy is right for you. Book a free Discovery Call and be matched with me or another of our Clinical Associates without delay.

References

Linehan, M. (1993). Cognitive behavioral therapy for borderline personality disorder.

Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American journal of psychotherapy, 69(2), 97-110.