Dialectical Behaviour Therapy: Looking For The Plaid

March 14, 2016
By Michelle Leybman, PhD, Psychologist 

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.

references

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.