Dialectical Theory
Part I
1
Dialectical Philosophy
of Treatment
Dialectics As
• Persuasion
• World View
2
Dialectics as Persuasion
A method of logic or argumentation
by disclosing the contradictions
(antithesis) in an opponent’s
argument (thesis) and overcoming
them (synthesis).
3
The universe is so constructed that the
opposite of a true statement is a false
statement, but the opposite of a profound
truth is usually another profound truth.
N. Bohr, quoted in K. Wilber, 1977
4
Appearance is the process of arising
and being and passing away again, a
process that itself does not arise and
pass away, but is per se, and
constitutes reality and the lifemovement of truth…
[thus] the truth of the process is not to
be found in any of its single phases,
but in its totality (which is no mere
plurality), the rational rhythm of the
organic whole"
Hegel
5
Three Types of Adult Thinking
(Michael Basseches, 1984)
• Universal Formal - pure deductive
formal sciences, the premises of which are
"hypotheses"-
• Relativistic - accurately described only by
the theory of relativity.
• Dialectical - Dialectic definition, of,
relating to, or of the nature of logical
argumentation.
6
(Basseches, 1984)
• Truth is fixed and unchanging
• The Universe is ordered
• Some individuals have the Truth and
others do not
• It is the therapist’s job to help the
client arrive at the unfixed, stable
TRUTH
7
(Basseches, 1984)
• Truth is entirely relative and varies from
person to person, culture to culture.
• No one person’s viewpoint is superior or
inferior to another’s.
• There is no universal order and no Truth.
• It is the therapist’s job to help the client
determine what values and opinions are
most comfortable or useful to her or him
8
(Basseches, 1984)
• Elements of Universal Formal and
Relativistic Thinking
• Rejects relativistic stance of not striving
to find and create more powerful truths.
• Also rejects universalist notion that an
“all inclusive truth” is possible.
9
(Basseches, 1984)
• There is Truth and Truth evolves over time.
• Process of arriving at Truth involves
discovering what is left out of existing
truths and creating new truths or
orderings that include or embrace what is
left out.
• It is the therapist’s job to help the client
synthesize polarities, to search for what is
left out, to both arrive at truth and be
willing to let it go.
10
Dialectically-Informed
Treatment Strategies of
Persuasion
•
Search for “what is left out”
•
Weave a “web of logic”
•
Emphasis on speed, movement, flow
11
Dialectical Philosophy
of Treatment
Dialectics As
• Persuasion
• World View
12
Dialectics as Process of Change
The process of change
whereby an idea or event
(Thesis)
generates and is
transformed into its
opposite
(Antithesis)
and is preserved and
fulfilled by it, leading
to a reconciliation of
opposites
(Synthesis)
13
Functions of
Dialectical Philosophy
• Guides assumptions about the
nature of reality
• Provides foundation of biosocial
etiology
• Balances treatment goals
• Balances treatment strategies
14
Dialectics as a World View:
Assumptions
• Holistic, connected, and in relationship
•
Complex, oppositional, and in polarity
• Change is continual
• Change is transactional
• Identity is relational and in
continuous change
15
Change
Acceptance
Irreverent
Reciprocal
Problem
Solving
Validation
Core
Consultationto-the-Patient
Team
Consultation
Environmental
Intervention
16
Translating a Dialectical World View
into Treatment
Provides foundation of biosocial etiology
1. Transactional development and maintenance
2. Systemic disorder
Dialectically informs treatment strategies
1. Balance of Acceptance vs. Change
2. Search for "what is left out"
3. Emphasis on speed, movement, flow
Dialectically informs treatment goals
1.
2.
3.
4.
Emotion regulation
Interpersonal effectiveness
Mindfulness
Distress tolerance
17
Dialectical View of Disorder
Foundation of
biosocial etiology
– Transactional model of development
and maintenance
– Systemic disorder
18
BPD results from transaction of
biological vulnerability with
invalidation over time
A1
B1
A2
B2
Ai
Bi
19
Systemic Disorder Defined
• Defines disorder with respect to
normal functioning
• Assumes continuity between health
and disorder
• Assumes disorder results from
multiple rather than single causes
20
Dialectically-Informed
Treatment Goals
BALANCES
ACCEPTANCE
Mindfulness
Distress Tolerance
CHANGE
Emotion Regulation
Interpersonal
Effectiveness
21
The Overarching
DBT Target is...
Dialectical Synthesis
22
Dialectical Synthesis
the “middle path”
Dialectical Analyses
Truth is sought through efforts to discover
what is left out of current ways
of ordering events
Dialectical Lifestyle
walking the “middle path”
with balanced behavior patterns
Balanced Actions, Emotions and Cognition
23
Goals of Treatment by Level of Disorder
Dialectical Synthesis
Level 1: Severe Behavioral Dyscontrol
Behavioral Control
24
Stage 1 Primary Targets
Dialectical Synthesis
Severe Behavioral Dyscontrol
Behavioral Control
• Decrease
–Life-threatening behaviors
–Therapy-interfering behaviors
–Quality-of-life interfering behaviors
• Increase behavioral skills
Core Mindfulness
Distress Tolerance
Interpersonal Effectiveness
Emotion Regulation
Self-Management
25
Structure the
Secondary Targets
of Treatment
DBT selects secondary
targets by their positions and
functions on the chain
analyses of problem
behaviors
26
Emotional
Vulnerability
Unrelenting
Crises
Active
Passivity
Biological
Social
Inhibited
Experiencing
Apparent
Competence
Self-Invalidation
27
DBT Secondary Targets
Increase
1. Emotional Modulation
2. Self-Validation
3. Realistic Judgment
4. Emotional
Experiencing
5. Active Problemsolving
6. Accurate Expression
Decrease
1. Emotional Reactivity
2. Self-Invalidation
3. Crises Generating
Behaviors
4. Grief Inhibition
5. Active-Passivity
6. Apparent-only
Competence
28
Goals of Treatment by Level of Disorder
Dialectical Synthesis
Level 1: Severe Behavioral Dyscontrol
Behavioral Control
Level 2: Quiet Desperation
Emotional Experiencing
29
STAGE 2
Dialectical Synthesis
Quiet Desperation
Emotional Experiencing
Primary Targets
– Decrease Post-Traumatic Stress
Responses
• Distortion/denial of facts of trauma
• Stigmatization, self-invalidation
• Denial/avoidance of traumatic cues
• Dichotomous response style
Goals
– Non-traumatizing Emotional Experiencing
– Connection to the Environment
30
Goals of Treatment by Level of Disorder
Dialectical Synthesis
Level 1: Severe Behavioral Dyscontrol
Behavioral Control
Level 2: Quiet Desperation
Emotional Experiencing
Level 3: Problems in Living
Ordinary Happiness & Unhappiness
31
STAGE 3
Dialectical Synthesis
Problems in Living
Ordinary Happiness
& Unhappiness
Primary Targets
– Increase Respect for Self
– Decrease Individual Problems in Living
Goals
– Self Respect
• Mastery, self-efficacy
• Sense of morality
– Acceptable Quality of Life
32
Goals of Treatment by Level of Disorder
Dialectical Synthesis
Level 1: Severe Behavioral Dyscontrol
Behavioral Control
Level 2: Quiet Desperation
Emotional Experiencing
Level 3: Problems in Living
Ordinary Happiness & Unhappiness
Level 4: Incompleteness
Capacity for Joy and Freedom
33
STAGE 4
Dialectical Synthesis
Incompleteness
Capacity for Sustained Joy
Expanded Awareness
–Self
–Past to Present
–Self to Other
Peak Experiences/Flow
Spiritual Fulfillment
34
Stages of Treatment
Pre-Treatment Goals:
Commitment and Agreement
Level 1: Severe Behavioral Dyscontrol
Behavioral Control
Level 2: Quiet Desperation
Emotional Experiencing
Level 3: Problems in Living
Ordinary Happiness & Unhappiness
Level 4: Incompleteness
Capacity for Joy
35
Emotional Vulnerability
(Emotional agony, Falling into the abyss, Loss of control,
task impossibility)
Biological
Social
Self-Invalidation
(Self-directed hate & contempt; Dismissal of pain
& difficulty; Unrealistic expectations)
36
Emotional
Vulnerability
Active
Passivity
Unrelenting
Crises
Biological
Social
Inhibited
Experiencing
Apparent
Competence
Self-Invalidation
37