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Dialectical Behaviour Therapy: Looking for the plaid

Dialectical Behaviour Therapy: Looking for the plaid

My oldest friend and I have always been able to talk about anything and everything. Whenever we talk about the Capital B “Big issues” of life, we always come to the same conclusion: almost everything comes down to balance. Is it better to take care of yourself, or to focus on giving to others? Balance. Should I plan my life out and focus on long-term goals, or live fully in the moment and see where I end up? Balance. Not moderation, but balance.

This idea - that most everything comes down to balance - is similar to one of the main ideas behind Dialectical Behaviour Therapy (DBT). DBT is a relatively new therapy that was developed by Marsha Linehan to treat people who have trouble knowing how to cope with extremely intense emotions, who act on impulses and urges more than they want to, who often get into unstable or chaotic relationships, and even those who are chronically suicidal. If you’re interested in the basics of DBT, there’s a ton of information available online. I recommend reading this as an introduction: What is DBT. Or watching this brief video: What is Dialectical behavior therapy for adolescents (DBT)? 

Instead of covering the ABCs again here, I’m going to write more about the conceptual backbone of DBT with the hope that it might help you see the forest amongst the trees.

Looking for the plaid instead of the grey

As a therapist who uses a lot of DBT, one of the questions I’m asked most often is this: What the eff does dialectical mean? Fair enough! I had no idea what it meant until I started practicing DBT. Even now I find it to be an incredibly complex idea and my understanding of it is changing all the time. That’s probably what makes it so interesting.

A dialectic is the tension that exists between two opposites. It’s the idea that any one position contains within it the opposite position. You can’t have good without bad, or all without none. Because all things contain within them their opposites, this also means that there are no absolute truths. Instead, things that appear to be opposites can both be true at the same time. The easiest way to explain this is through examples. In DBT, we assume that clients are always doing the very best that they can, and at the same time, we also assume that they need to try harder. These two things appear to be opposite, and yet they’re both true. In DBT we are constantly working towards helping people both accept themselves as fully as possible, and pushing them to change themselves and their lives. Being dialectical means holding all of these seemingly opposite truths and allowing them to both exist. It means that in moving forward, we aim not to find the grey areas between black and white, but rather to find the plaid that allows both black and white to exist at the same time. Finding these plaid zones is what keep us from getting stuck when we’re trying to change and grow. 

This idea of dialectics is so abstract, that even if you agree with it on an intellectual level, it can feel overwhelming to put into practice. So, I’m going to let you in on a few tips, taken from DBT of course, that could help you bring more dialectical thinking into your daily living.

  1. “Both-and” language. Do you ever notice how when you use the word “but” it kind of crosses a line through whatever you said before it? “You did a great job, BUT…” The words before the “but” simply get erased from what we hear. By using the word “and” instead of “but” you allow for multiple things to be heard. Even in your own thoughts, using the word “and” helps you hold two opposing truths. It can feel very awkward at first, AND it’s worth it.

  2. Asking what’s missing. This question can be useful in more situations than I could list. That said, one type of situation in which it’s particularly useful is when you’re having trouble understanding someone else’s behaviour or their point of view. For instance, have you ever had a friend who frequently complains about the same person in his or her life, but also continues the relationship. Without asking what’s missing, all you really hear is the complaining and it would be easy to start pushing the person to change without seeing the whole picture. Asking yourself what’s missing would remind you to truly understand why that person is hanging onto the relationship in the first place and why it would be so hard to leave.

  3. Looking for the middle path. Dialectics often come into play when we are in arguments. You know that feeling where you’re 100% convinced that you’re right, and somehow the person you’re talking to is equally convinced that they’re right? You start thinking about how you could explain your side in new and creative ways so that the person you’re talking to could finally get it… And they’re doing the exact same with you. Those times are prime examples of thinking non-dialectically. If you want to get some actual movement in the conversation, looking for the middle path is a great way to do it. You do this by trying, as best you can, to find something that you can truly believe is valid about what the other person is saying, and try to include that valid point into your own perspective. The idea here is to find a synthesis that accepts the truth in both perspectives, rather than a compromise that waters down the truth in both sides.

Final Thoughts

Although the words “balance” and “dialectic” differ, they come down to the same thing - finding the truth in perspectives that differ from your own, and practicing what you don’t do. Try bringing your attention to these things next time you’re feeling stuck; the results could surprise you.

Michelle Leybman is a clinical psychologist in Toronto, Ontario. Learn more about Michelle here.

The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogs, podcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.


Koerner, K. (2012). Doing dialectical behavior therapy: A practical guide. Guilford Press.

Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D., & Heard, H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of general psychiatry, 48(12), 1060-1064.

You can’t save the damsel if she loves her distress: Understanding self-motivation

You can’t save the damsel if she loves her distress: Understanding self-motivation

You can’t save the damsel if she loves her distress. This profound statement was made by a client of mine. Don’t worry, she said she was ok with me using her wise words in this blog post and I’ve changed personal details to protect her identity. This client of mine had an eating disorder and was truly suffering with it. When people who cared about her would come to understand just how much she was suffering, their responses typically involved trying to help. Sometimes they would offer her rewards as incentives to change; “I’ll take you to a movie if you eat lunch today”. This occasionally got her to eat a meal, but it never led to any lasting change. She’d often get tips or advice on how she could change. “Have you thought about scheduling meals?” “Just stop weighing yourself!” and so forth. But she was a smart girl and was able to think of these solutions on her own. Knowing what to do wasn’t the problem. The real problem was that she was on the fence about whether she wanted to change or not. She found that when people tried to “motivate her” to change, she actually felt less motivated to do it. What she was telling me that day with her comment was that damsels, like most people, will usually do whatever they want to do, and trying to convince them to do something that they don’t want to do, usually doesn’t work.

I’m sure that many people reading this can relate. Think about a time when you felt unsure about whether you wanted to change something in your life. It could be forming a new habit like going to Yoga more often, or stopping something you were already doing, like quitting smoking or getting out of a relationship that wasn’t working. Who were the most helpful people at that time? Was it the ones who pushed you the hardest? The ones who rewarded you somehow when you made small changes? The ones who made you feel just a bit guilty if you didn’t make the changes you originally set out to? Or was it the ones who were there to support you and talked to you about why you had wanted to make the change in the first place?

For most people, and in line with what a lot of science suggests, the last option listed - the one that meets someone where they are at and taps into their motivation from within - would feel the best and would be most conducive to long lasting change. Tying this to therapy, it’s like therapeutic skills and strategies are the car that will get you from A to B, but a person’s own motivation to change is the fuel. The car won’t drive without it. And, interestingly, the things that a lot of people do naturally to help motivate themselves or others can often end up actually undermining motivation and can lead to less change.

How am I motivated, let me count the ways

There is one theory that has shaped my thinking about motivation more than anything else. It’s called Self-Determination Theory (SDT; for a review see Ryan & Deci, 2000). SDT tells us that our motivation can either come from outside ourselves (extrinsic motivation) or can come from within (intrinsic motivation). What’s more, extrinsic motivation can take on different forms, and all this motivation can be placed on a continuum from completely external to completely internal (e.g., Deci & Ryan, 2000; 2008).

External motivation is when we do things for reasons outside ourselves. Behaviours are performed because of some kind of demand or tangible reward. This is like a kid who does chores to get candy money, or like one partner motivating the other to go to the gym by offering to cook dinner in return. Introjected motivation is a little less external, but not much. This is essentially when we do things because we will feel guilty or bad about ourselves if we don’t. This is what drives us when we do something for someone just so that we don’t get yelled at, or when we eat healthy food because we feel like we’re doing something “wrong” otherwise. Identified motivation is moving towards being more internally focused on our continuum. This is when we engage in a behaviour because it is in line with something we truly value. We might find a TV show to be painfully boring, but we watch it with a loved one if it’s important to them. We might absolutely hate a particular class, but will study hard for tests because it will help us get into a program we really want. Integrated motivation is the most internal of the extrinsic motivation family. This is when we bring some sort of external motivation or value into how we see ourselves. We do things because they are so important to us that it wouldn’t feel genuine not to do them, but not because they are fun in and of themselves. Finally, intrinsic motivation is when we engage in a behaviour because our most authentic self simply wants to. This is when we learn about something because we are curious, or when we make someone a gift because it’s fun for us to do. This is when we act for no other reason than the joy of doing something.

Why intrinsic motivation is king (or queen, or any gender neutral ruler you like)

Our society uses extrinsic motivation to get people to do things all the time, particularly the external and introjected varieties. Anyone remember ever studying for a test for no other reason than to get that A? Or just to avoid getting scolded? I know I do. But the science suggests that getting people to do things by using external motivators both leads to worse results, and actually sucks out the intrinsic motivation from people even if it was there to start. This has been shown in a variety of ways and in a variety of contexts including businesses, schools, and in therapy (see Deci & Flaste, 1995 for a review of business and education contexts, and Ryan et al., 2010 for a review in therapy contexts).

The overwhelming conclusion is that extrinsic rewards get people focused on outcomes instead of on working well along the way, and make tasks less enjoyable. They also result in less learning. For example, in studies where groups are either told that they can read a story for interest, or need to read a story because their knowledge of it will be tested, those who think they will be tested use rote memorization instead of actually processing information and forget the information soon after they write the test. Extrinsic rewards result in less creativity in art and problem solving, and less financial productivity in business. Bringing this back to the damsel in distress, prior to starting therapy with me, my client had been in an eating disorder program in which gaining weight was tangibly rewarded. I can imagine why this type of program did not foster her intrinsic motivation to change. In my experience with her, the times that she seemed the most motivated tended to be when I would ask her about why she wanted to recover and supported those reasons. People tend to offer extrinsic rewards with good intentions, thinking they’re helping to boost motivation, but it works in the opposite way.

If you’re interested to hear a bit more, here’s a nice Ted talk by Dan Pink in which he makes a case for not using external motivators in businesses: 

Final thoughts

Writing this feels like a throwback to a joke that my very first clinical supervisor told me at the start of my very first clinical placement. He asked me, “how many psychologists does it take to change a lightbulb?” The answer feels much clearer now than it did then: it takes one. But the lightbulb has to want to change.

Stay tuned for a future entry in which I’ll talk about how to foster and support more intrinsically based motivation in ourselves and others.

Michelle Leybman is a clinical psychologist in Toronto, Ontario. Learn more about Michelle here.

The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogs, podcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.


Deci, E. L., & Flaste, R. (1995). Why we do what we do. Putnam Publishing Group.

Ryan, R. M., & Deci, E. L. (2008). A self-determination theory approach to psychotherapy: The motivational basis for effective change. Canadian Psychology/Psychologie canadienne, 49(3), 186.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist, 55(1), 68.

Ryan, R. M., Lynch, M. F., Vansteenkiste, M., & Deci, E. L. (2010). Motivation and autonomy in counseling, psychotherapy, and behavior change: A look at theory and practice. The Counseling Psychologist.