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What Does Dialectical Mean?

By Charles H. Elliott, Ph.D.

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.

13 Comments to
What Does Dialectical Mean?

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  1. This is a most interesting article and I would like to hear more.

  2. Gimme more, Dr. Elliott! I love thinking about thinking! But… is a bipolar opposite the opposite of a polar opposite?

  3. This is an excellent piece. Would enjoying reading more about this.

  4. We’ll definitely have more to say about this topic in the future. Thanks for your interest! Here’s a relevant short quote from an earlier book I wrote with Dr. Maureen Lassen about 12 years ago:

    We have labeled this principle the Polarity Paradox, which refers to the nonlinear idea that:
    “The more opposite two phenomena appear,
    the more they become the same.”

    Opposites form two sides of the same reality. These sides must be integrated and balanced for optimal functioning. The two hemispheres of the brain must be coordinated in order to function effectively. The immune system also requires balanced integration. If too active, auto-immune disorders such as scleroderma or lupus develop; if too inactive, diseases such as colds, flu, or cancer may emerge. Also, the parasympathetic and sympathetic nervous systems must be kept in balance or one will suffer from either excessive fear and overarousal or fatigue, lethargy, and underarousal. When opposing mechanisms achieve coordinated integration, it’s like watching a well-edited film. When integration breaks down, it’s more like watching the scenes one frame at a time.

  5. @Bonnie: There’ll be more to come. In the meantime, questions like that make my head hurt! :-)

  6. Sorry, Dr. Elliott! Sometimes I can’t resist the opportunity to play with words. Maybe it’s some kind of disorder. Let’s call it WPA (Word-Play Addiction.) Or maybe it’s QTMYHHD (Questions That Make Your Head Hurt Disorder) Does this mean it’s time for another acronym contest? :-)

  7. @Bonnie: No, no, no….not another acronym contest! (Although I do sort of like QTMYHHD)….

  8. “When going to opposite extremes, one actually ends up with unintended, paradoxical outcomes.”

    One of my favorites:
    “There are no absolute truths.”
    Is that absolutely true? If there are no absolute truths, then a statement claiming that there are no absolute truths actually proves that there are absolute truths, because the validity of such a statement requires it to be true.

    Now MY head hurts!!

  9. Therapy is full of counterintuitive paradoxes. My therapist has firm boundaries that I fought for years because I wanted more from him than he was willing to give me. I thought he was cold and rigid, and I wanted him to change his style of relating to me because it was too uncomfortable and I didn’t like it at all. But something that was very important for me to learn was that the more I focused on what he didn’t give me, the less I could appreciate what he did give me. When I reached a point where I was willing to trust that maybe he really did know what the process of therapy needed to be in order for me to heal and not be harmed further, I began to see him as a much warmer and more caring person than I had thought he was when all I could focus on was how deprived and powerless I felt because he wouldn’t give me what I wanted.
    I used to believe that being empowered in therapy meant getting what I asked for as long as it was something I really believed I needed in order to move forward. But eventually I realized that I wasn’t empowered by that at all because feeling empowered was entirely dependent upon my therapist’s response. If he said yes, I felt empowered. If he said no, I felt powerless. The only power I had at that point was to push harder or leave, but if I left I’d repeat the same pattern with someone else — feeling empowered when they said yes, and feeling helpless when they said no. So, for the most part, I gave up trying to control the process of therapy and in doing so I learned that giving up control led to real empowerment, because now I have some of the tools I need to develop relationships with people I would have avoided in the past because I didn’t know how to relate to anyone whose style was so different from my own. But the idea of becoming empowered by giving up control seems so counterintuitive that we’re often unwilling to try it.

  10. @Bonnie (on the 12th): Now you can say you have finally found absolute truth; that there is no absolute truth.
    @Bonnie (on the 13th): Nice insights! Thanks for sharing them with our readers.

  11. Millions of Americans suffer from mental illnesses like Borderline Personality Disorder. Silver Hill Hospital has clinicians trained in evaluation, diagnosis and treatment, including dialectical behavioral therapy, and provides hope for people who may not have been getting the right care

  12. Sounds like “shadow” work….Nice article; I would definitely like to hear more….

  13. So let me see if I am understanding this concept.,, If I oversee every aspect of my daughters life and control who she sees where she goes and what she does, she will hate me…. but if I pay her no attention work 80 hours a week and let her do what ever she wants.. she will also hate me…. or how about nothing is always or never…or if Im an employee and I stay late almost everynite and they do not,,,they will resent me, or if they stay late some of the time and I hardly ever,,, same effect….

  14. Dear Chuck —
    Thank you for this eloquent explanation, which I will share with an astute client who asked me this question. You write as clearly as you teach.
    All the best,
    Elsie Uffelmann
    (former student at Fielding!)

  15. Thank you for mentioning the seeming polarity of Freud with the id vs. superego concept. We could also add that these are western concepts, and that the seed of everything contains its opposite.

  16. I am learning (just recently) to use mindfulness and exposure therapy with DBT for anxiety issues and dissociation- helping client to stay present. How would or could DBT be used for integration?

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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Overcoming Anxiety for Dummies and Child Psychology & Development for Dummies.

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  • Kat: I am really grateful to have come across this article. I don’t think anyone is going to read this but oh...
  • Whaat?: I’ve read all of these comments and there are several opinions here, which we are all entitled to;...
  • Sharon: I am learning (just recently) to use mindfulness and exposure therapy with DBT for anxiety issues and...
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  • Beverley: I think in response to Chris you need to shave this back a bit. There is a duty of care to yourself first...
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