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.