What does the "dialectical" in DBT mean?
Dialectical means “concerned with opposing forces.” This concept is rooted in the philosophical principle of dialectics, which suggests that everything is composed of opposites and that change occurs through the dialogue between these conflicting forces.
The term "dialectical" in Dialectical Behavior Therapy (DBT) refers to the concept of bringing together two opposites within therapy. The primary “dialectic,” or pair of opposites, is between change & acceptance: the acceptance of the client as they are & the need for them to change. This means balancing acceptance of the client's current situation with the push for positive change.
Acceptance vs. Change
Acceptance-focused therapies emphasize accepting one's thoughts, feelings, and self as they are, without judgment. The goal isn't to change these thoughts or feelings but to develop a more compassionate and accepting relationship with them. This approach is based on the understanding that struggling against or trying to eliminate difficult thoughts and emotions can exacerbate suffering. Instead, acceptance encourages individuals to acknowledge their experiences without resistance, which can lead to a decrease in psychological distress over time.
Acceptance-focused therapists are often very supportive of their clients, but there is the danger such support may serve to keep people “stuck.” Clients might feel good about the support they’re getting and keep coming back, but their symptoms and life circumstances may be less likely to improve without a balancing focus on change.
Change-focused therapies, on the other hand, have an emphasis on problem solving, progress, and growth. They are often centered on identifying and altering negative or unhelpful thoughts, behaviors, and emotional responses. By changing these, individuals can alleviate their suffering and improve their overall well-being. These therapies often involve learning new skills, practicing different behaviors, and restructuring negative thought patterns to promote positive change.
Change-focused therapists can, for some clients, lack adequate support and validation, fail to meet the client where they actually are, and risk driving them away. Many clients just won’t come to therapy if there is a relentless focus on change without a balancing focus on acceptance.
DBT: Integration of Acceptance & Change
DBT is grounded in the idea that effective treatment must address the seemingly paradoxical needs for both acceptance and change. This approach helps clients learn to accept their thoughts, feelings, and behaviors non-judgmentally while simultaneously working to change negative patterns that are causing distress or dysfunction in their lives. It also helps clients feel supported and accepted to provide a powerful framework in which to undertake the hard work change requires.
By applying dialectical strategies, therapists help clients develop skills to manage their emotions, improve relationships, and reduce self-destructive behaviors, leading to a more balanced and fulfilling life. The "dialectical" aspect of DBT emphasizes the integration of acceptance and change within therapy, fostering a therapeutic environment where clients can grow and heal by understanding and reconciling these dual needs.
