More than a couple of decades ago, Marsha Linehan, Ph.D. developed a unique approach to the treatment of Borderline Personality Disorder (BPD) which she chose to call Dialectical Behavior Therapy or DBT. Research has established that DBT appears to help reduce some of the worst problems associated with BPD (such as repeated suicidal behaviors, therapy interfering behaviors, etc.).

If you want more information about DBT, consider starting with Wikipedia. In addition, Marsha Linehan, Ph.D. among others have since written a number of great books for professionals and laypersons alike which you can look up on Amazon. We included many elements of DBT in our book Borderline Personality Disorder For Dummies although we mostly tried to integrate the best techniques we could find from everywhere.

As weve spoken to various groups of professionals, therapists, and the public, weve noticed that many folks simply dont understand what the term dialectical means or why it could be important. Interestingly, Dr. Linehan herself has said at a few recent workshops that DBT can now be thought of as Cognitive Behavior Therapy (CBT) since the more general field of CBT has so thoroughly accepted and integrated the idea of dialectics in its latest iterations. And we think shes probably right. But that still begs the question: What the heck does dialectical mean anyway? In brief, dialectics represent the minds way of understanding concepts by understanding and appreciating their polar opposites.

Dialectics are one of the important unifying concepts that reflect how the mind fundamentally understands and perceives most core concepts and ideas. And the field of psychology contains an abundance of such concepts, including self esteem, trust, courage, honesty, rage, passivity, withdrawal, impulsivity, inhibition, blameworthiness, guilt, risk taking, and on and on. Dialectics are based in part on the fact that we cannot fully understand any of these abstract concepts without appreciating that they consist of bipolar opposites with a higher level of integration somewhere in between them.

For example, what would light mean without understanding darkness, what would wetness mean to a fish who had never experienced anything else, what would blue mean in an all blue world, what would inhibition mean without appreciating what complete disinhibition looks like? Dialectics breaks down our concepts into their seemingly opposite parts–viewed another way, as thesis, antithesis, and synthesis (or white, black, and gray). Heres a few more examples of bipolar constructs (from an earlier book written by Charles Elliott, Ph.D. and Maureen Lassen, Ph.D.):

Love and Hate

Yin and Yang

Introvert and Extrovert

Constriction and Expansion

Matter and Anti-Matter

In fact, the only way to understand most concepts, and possibly existence itself, relies on the fact that the world is constructed and perceived around seemingly polar opposites. Theres just one problem here–the term opposite often seems to imply completely different, antagonistic, and utterly irreconcilable. But from ancient Eastern mysticism to modern day physics, we now know that simply isnt the case. What look like totally opposite ideas usually contain at least some element of truth representing the other side of an argument or idea. Knowing that fact can be woven into therapy to help people understand where others are coming from and make attempts at finding an integrated, middle ground when conflict arises. Here are just a few real world examples of when going to opposite extremes, one actually ends up with unintended, paradoxical outcomes (again, modified from our earlier book):

Usually, the best time to invest is when almost everyone is so afraid that they advise against doing so.

The more you focus on the needs of other people, the less youll have available to meet their needs.

Freedom actually increases from having rules and limits.

The more you rebel against others (parents, loved ones, etc.), the more you will allow them to control you.

The more you argue for your position, the less you will be heard.

The more you absolutely must have someone, the less likely theyll end up wanting you.

As we make new medical advances, many of these are creating even harder to treat diseases (see information about antibiotics resistant to most known drugs).

The same idea holds true for most of our self views (what many therapists often call schemas). What look like completely opposite perspectives often end up with strikingly similar, yet unsatisfying outcomes. Here are just a few seemingly opposite perspectives people could hold about themselves or the world which easily could lead to the similar, poor outcomes:

People who feel unworthy of having their needs met vs. those who feel overly entitled both often cause people to avoid meeting their needs.

People who are fearful and anxious of attaching to others (due to their sense of inferiority) versus those who avoid attachments (out of a belief in their own superiority and disdain for others) generally end up estranged with unfulfilling relationships.

People who feel overly dependent on others vs. those who feel driven to be independent at all times often fail to obtain useful help when it would come in handy.

People tend to throw blame at folks who either feel blameworthy at all times as well as those who fail to accept appropriate blame.

The list is endless. Extreme, opposite views of the self, others, and the world are usually rigid, produce tumultuous feelings, damage relationships, harm health, and create unrealistic expectations of oneself and others. Fortunately, there is an answer in finding moderate, integrated, middle ground perspectives. But much of thats for another blog on another day.

Right now, though we cant resist noting that one of Freuds greatest contributions to the conceptualization of psychopathology may have been in his apparent understanding of the way dialectics work in the human psyche.

Though were unaware of whether he actually used the term, much of his core concept of the term id, ego, and superego involves a dialectical tension between over control of impulses, under control of impulses, and an attempt to find a moderate, integrated control (in the form of ego). We see strong elements of dialectics in many, if not most, psychotherapeutic strategies today. Let us know if you want to hear more about this topic in the future (or if youve had more than enough!).