What are Dialectics and Dialectical Behavior Therapy Skills?

What is Dialectics?

Dialectics is based on the idea that two opposing concepts can both be equally true. One truth does not trump or rule out another, which undercuts the dichotomy of a “I am right you are wrong” type of relationship. A common dialectic is that you are perfect as you are (acceptance), and that in order for things to turn out differently in your life, you need to do things differently (change). One is not more true than the other, and one truth does not rule out the other truth. Sometimes people need acceptance, and sometimes people need to be challenged. Both belonging and growth are an inherent part of being in relationship.

Dialectics challenges the idea that one person is always “right”, because when you take into account diversity of perspective, other truths often arise. Being “right” often fails to take into account effective communication and the value of the relationship. Experience and emotions get ignored. A set agenda of being “right” often gets people stuck in a very rigid, dichotomous, black and white, non-dialectical stance. Dialectics are important in that sometimes you can find the one thing you have in common with your enemy instead of focusing in ways you are different. Relationships exist in context of conflicting truths, yet relationships are the glue that carries us through life.

What are the four Dialectical Behavior Therapy Skills?

DBT is a complex treatment that has confusing origins in terms of how it was developed and who it was for, and has been tailored to a wide range of populations and settings. The DBT skills are universally applicable materials that help people with extreme and painful emotions, intolerable life situations, and relationships. The four skills sets are as follows:

Core Mindfulness: Mindfulness is a skill that helps people focus attention, regulate arousal, calm the brain, quiet the mind, and settle in. Being mindful is a way to steady and anchor oneself in order to observe quietly and not “react” to what is going on. It is inherent in all of the other skills in that it requires a steady, quiet, secure stance in the face of demanding life situations. It takes spaciousness to know what is going in with your body, your self-experience, your wants and desires, and your life. If you don’t pause the moment and check in with yourself, it is easier to get “caught up” in the banging and thrashing of what life throws in your direction. Mindfulness can be a spiritual practice of quiet contemplation, a way to press the pause button, and way to regroup. Core mindfulness skills taught from the DBT material include skills of observing and describing without judgement. Other traditions, spiritual practices, health care services, and therapies teach mindfulness, so it is not “new” nor is it confined to just DBT skills; its roots are actually in Zen Buddhism. There are multiple ways of accessing mindfulness including mindfulness based programs, meditation groups, trainings, and apps. DBT groups are known for implementing a mindful practice or exercise in every group, and like many spiritual traditions are simply considered part of a daily practice.

Emotion Regulation: This is a set of skills that helps people to observe and describe what they feel (you can see the overlap with mindfulness) in order to help regulate arousal, understand what they feel, and know the reasons why they feel the way they feel. Skills cover ways to reduce emotional suffering through mindfulness and opposite action, and ways to reduce vulnerability to emotional suffering. Skills are quite complex and take practice, feedback, and validation. Since emotions can be tricky, elusive, (and just plain unbearable at times) the emotion regulation content is not something you could “quick learn” and be done with it. Sometimes people are not always aware of how or what they feel in general, and there is nothing pathological about this. It is a process! Knowing oneself and knowing one’s emotions is a lifelong task not subjected to any particular type of disorder, and does not end just because you have had a first exposure to all of the skill content. That is why working together on ways to regulate arousal given varying life circumstances can best be done over time in small group settings that promote cohesion and intimacy.

Distress Tolerance: In order to regulate emotional arousal, finding ways to endure the “I-can’t-stand-it-itis” of painful and extreme emotions is critical. Surviving painful life circumstances well means doing so in a way where people do not lose self-respect, forget their values, give up what is important to them, or react in such a way that makes things worse. Sitting in the fire and not reacting is often harder than picking a fight, poking the fire, making others suffer in order to prove a point, exacerbating pain to let others know how bad things are, undermining a person where it hurts, forcing the university to prove its point, perseverating on being “right”, asking “why me”, or engaging in self-defeating or relationship destroying behaviors. Being willing to tolerate the unknown, be zen with the universe, stop fighting reality, and do what works is skillful practice. We all want things to do our way or to turn out for the best. In reality, a lot of people are suffering a great deal and need everything they can to survive well. Distress tolerance skills encompass not only change strategies (if you can do one thing make it better, why wouldn’t you?), but acceptance and willingness skills. Anyone who has successfully undergone any type of exposure treatment for anxiety knows that the benefit to tolerating anxiety is a decrease in overall anxiety. There is an inherent truth that reality is easier to face once you stop fighting it, thus freeing you up to do what is needed to effectively solve problems.

Interpersonal effectiveness: True to the concept of the dialectical philosophy of DBT, it is better to be effective than it is to be right. The interpersonal skill content encourages readers to identify objectives in situations (what exactly it is you want or don’t want), how the relationship may be impacted, and if self-respect is at stake. Balancing the three helps people to look at natural barriers and consequences of interacting, and enables readers to problem solve the cost/ benefit of ignoring each. For instance, you can ask for what you want at the expense of the relationship, or you can give into a relationship but sacrifice self-respect. The balancing act of relationships is an ongoing challenge for everyone, and some give and take is part of how people stick together, find intimacy, and keep people close. Interpersonal skills also include ways to get out of or decrease contact with toxic or unwanted relationships, set limits, say no, and to identify barriers to doing so. Direct rehearsal in terms of “what to say and how to say it” benefits group members in that they can try out and receive feedback in both verbal and non-verbal forms.

A book of all the DBT skills is available for purchase via this link: https://tinyurl.com/y2qad6sk

When Things Fall Apart by Pam Chordron

Here are some paragraphs from this book:

“When the bottom falls out and we can’t find anything to grasp, it hurts a lot. It’s like the Naropa Institute motto, ‘Love of the truth puts you on the spot.” We might have some romantic view of what that means, but when we are nailed with the truth, we suffer. We look in the bathroom mirror, and there we are with our pimples, our aging face, or lack of kindness, our aggression and all that timidity– all that stuff.

This is where the tenderness comes in. When things are shaky and nothing is working, we might realize that we are on the verge of something. We might realize that this is a very honorable and tender place, and tenderness could go either way. We can shut down and feel resentful or we can touch and I met throbbing quality. There is definitely something tender and throbbing about that groundlessness.

Things falling apart as a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: Room for grief, for relief, for misery, for joy.”

(pages 7-8).

10 Reasons why you need The Emotional Extremist’s Guide to Handling Cartoon Elephants book this holiday season

1. The Cartoon Elephant book, after being temporarily unavailable through Amazon, is now back on the market. The retail price is $26.95, but sometimes Amazon will let it go for a bit less.

2. Cartoon Elephants approach painful emotions with humor. If there is an elephant in the room in your family, this book is the starting point for approaching avoided conversations. You will recognize yourself and others in this book. There is no finger pointing or blaming.
 
3. Cartoon Elephants is something you can put on your coffee table. Because it is a graphic book with pictures and fun fonts, it is an easy read. The elephants will fit nicely next to big picture books about Africa and Asia.
 
4. The Cartoon Elephant book is being used to teach people in Dialectical Behavior Therapy skills groups about emotions. Loaded with psycho-educational material and teaching points, it cleverly accomplishes the task of making people think they are reading something fun yet giving them something valuable.
 
5. This book is not hard to read. There is no “plugging away” at chapters. If you want to bring something to someone’s attention in a way that is universally applicable, this book will do the trick. You don’t need to have painful emotions to appreciate elephants- you just need to have emotions.
 
6. If you are going to buy someone a self-help book for Christmas, this is safe bet.
Whether they believe it or not, everyone has cartoon elephants. The research proving this to be true is cited in the back of the book.
 
7. This book can be used and re-used, read and re-read. You can share it with family members, friends, or long lost relatives. It won’t go out of style. Emotions, as a rule, will be with you as long as you live.
 
8. You will get some food for thought about how and where you see yourself in relationship to your elephants. This is great for discussion groups, weekend retreats, and writing workshops.
 
9. This book is great for people of all ages. If you’re trying to get your kid to read something important, heavy, and deep, you can give them this book. It won’t take long to read and it is much more fun with illustrations.
 
10. The book will be the perfect introduction for my live series on emotions starting January 20, 2014. Of course you don’t need the book to sign up, but if you have the book you will have a better appreciation for cartoon elephants in general.

 

 

Third wave behavior therapies, functions of behavior, depression, and dead conversations

Have you ever had a conversation with someone that you really cared about that ended up with them saying something like: “I’m not good enough.” “I don’t deserve that.” “I’m not worth it.”

As a recipient of this conversation, you may have been tempted to argue, disagree, convince, or encourage the person to think otherwise. While this strategy may have communicated a sense of caring or encouragement, it is quite possible that this conversation quickly fell into a polarized, deadened, undesirable re-occurring conversation. The difficulty with having these conversations is that they typically don’t end in any personal problem solving and both parties leave the interaction with a sense of dissatisfaction.

The “third wave behavior therapies” are a cluster of treatments that encourage people to look at the function and the context under which behaviors occur. For instance, if we were to think about the function of this conversation, we could start to ask a bunch of questions that would help us get at something a little bit more useful than a repeated and unsatisfying conversation.

Getting people to understand function is, in my experience, kind of hard. Function has to do with what purpose is this behavior serving. Context can help us understand under what conditions this behavior occurs.

Here are some questions that I might consider useful in considering the function of this type of conversation: What is the person wanting? How is the person expecting this conversation to end? Is convincing the responder that he/she doesn’t deserve something a way to avoid something difficult, not take a risk, do something that could change the situation for the better (but doing it is too scary)? Is the person seeking reassurance or connection? If the person wanted more of a connection with the recipient, what might be a more effective way to get it? What would be a better way of spending time together that would be more meaningful? What is the benefit, value, or use in convincing another person of one’s non-deserving status?

Third wave behavior therapies (or functional and contextual treatments) include Acceptance and Commitment Therapy, Functional Analytic Psychotherapy, and Dialectical Behavior Therapy. Three really wonderful books based on the “third wave” of thinking and can help people “get” more of what I’m talking about include ACT Made Simple by Russ Harris, Overcoming Depression One Step at a Time by Michael Addis and Christopher Martell, and Things Might Go Terribly, Horribly Wrong by Kelly Wilson.

I will also add that, for my surviving depression teleseminar this coming June 3 (click here for more info), I’m going to help you take a closer look at the function of worry/ non-useful thinking/ rumination- and give you some strategies for figuring out what this behavior is all about.

Book Review: The High Conflict Couple by Alan Fruzetti

Are you looking for a book that gives the lay person’s guide to understanding the nuts and bolts of DBT? I love Alan Fruzetti’s book, The High Conflict Couple. I often encourage my clients to read parts of it because it gives a really lovely overview of problems of emotions in relationships. And I certainly don’t think you have to be part of a couple relationship to benefit from what he has to say.

I especially like the way Fruzetti puts a coherent and descriptive framework around the many frustrations of being understood. His model applies on many levels and (I believe) is extremely helpful in assisting clients to identify and talk about what actually happens to them without blaming themselves or others.

Here is a brief quote from page 71: “The central points are, first, when expression is accurate, the other person can more easily understand, and thus validation (communication of understanding) is easier to provide; and second, when the response you get from your partner is validating, this helps keep your emotional arousal in check, which in turn makes it easier to express yourself accurately.” Alternately, he suggests that heightened emotional arousal can lead to inaccurate self-expression, which in turn can lead to being misunderstood and invalidated.

Alan Fruzetti has definitely packed in a lot of good information into this inexpensive paperback book- which makes it worth returning to on multiple occasions. His materials on validation are quite valuable and are often revisited in my groups.

ACT Made Simple by Russ Harris

I have to give some attention to this book because I really, really like it. This book is practical to use for both clients and therapists, has very compelling exercises and handouts, and really gets at the heart of Acceptance and Commitment Therapy, or ACT (a relative of DBT). This book is amazingly accessible.

ACT is known for addressing values and long term goals. This is about your life- in context! The big picture includes searching for meaning and direction. Often we get so caught up in problematic and self-defeating thoughts that it takes us down a road we aren’t willing ourselves to follow. We miss what we hold dear when we get caught up in trying to get rid of discomfort. Getting in touch with what matters can guide our interactions or distress in a direction that we are willing ourselves to go- even though current experience is painful.

The other thing that I really love about this book is the plethora of creative suggestions for relating to thoughts. If people could see their thoughts and feelings, sort of speak, their number of options for what to do with them could increase. The agenda here has to do with changing our relationship to our thoughts and feelings, rather than try to suppress, change, or get rid of them.

Here is a sample of what is in the book, taken from “Attempted solutions and their long term effects” on page 87. “What have you done to avoid or get rid of problematic thoughts, feelings, memories, sensations, or emotions? Did your thoughts and feelings go away? Did they return on the long run? Has this brought you to a rich, full, and meaningful life? What has this cost you in terms of time, energy, or money; negative effects on health, well-being, work, leisure, or relationships?”

If it’s cost you quite a bit, it might be time to try something else.