Day Five: The Synthesis of Opposites

 The basic model of dialectical thinking involves the merging of two perspectives, the synthesis of opposites.

In dialectical thinking, there is value in each perspective.  One way to frame dialectics is to connect phrases with "both. . .and. . ."

Example:

"I have made a lot of progress, and there are still things I would like to change."

"I feel vulnerable when I talk about my depression with others, and I feel support when I meet my friends at our favorite coffee shop."

"You have your perspective and I have mine.  We can both be correct."

In dialectical thinking, the answer may be found in shades of gray, as opposed to the black-and-white world of absolutes and all-or-nothing views.  The existence of black-and-white thinking is often seen in individuals with borderline personality disorder and eating disorders.

In this example, there are some cheerleading statements woven into the dialectical framework of acceptance of current self and the need for change.

Example:

"I'm working really hard at accepting who I am now- the one who wants to get better.  I still have not so great days.  I am proud that I am having more good days.  My goal is to be skillful on tough days."

Another way to think about dialectics is to think about seeing the situation from the other person's point of view.  What does she see?  What do I see?  How has he responded when faced with similar circumstances?  What did I do last time I was in a situation like this?  

Day Three: Emotion Chain Analysis

Marsha Linehan has a strong background in behavior modification.  DBT has a firm foundation of creating change and documenting the process.

Individuals with borderline personality disorder often have strong emotional reactions to events, at times feeling the emotion more intensely than other individuals and for a longer time than others individuals.  

Mindfulness will be a key component of this process.  You will need the observe and describe skills to be present and ready to look at your strong emotion and the event that prompted it. 

The What skills of mindfulness are Observe, Describe and Participate.  

The How skills are one-mindfully, nonjudgmentally, and effectively.  These will be discussed in future entries.

This is Marsha Linehan's process for the chain analysis:

1. Observe and describe the event prompting the emotion.  Just the facts- no judgments, "I should have" statements, or rationale.

2. Observe and describe the interpretations of the event that prompt the emotion.  

3. Observe and describe the phenomenological experience, including the physical sensation, of the emotion.  Phenomenology is the study of the "lived experience."  What is it like to experience the emotions this event?

4. Observe and describe the behaviors expressing the emotion.

5. Observe and describe the aftereffects of the emotion on other types of functioning.

Day Two: Acceptance of Reality does not equal Approval of Reality

Acceptance of Reality does not equal Approval of Reality

There's a balance (a dialectic) between the need for change and the (radical) acceptance of self or a situation.

A quick story for you

You have purchased a beautiful brick house with a white picket fence around a garden of roses.  You sign the paperwork and pack your bags to move into your new house.  The day you drive your moving truck into the driveway, you see that the previous owner just painted over the bricks and white picket fence...and it's purple!  In fact, it's Barney the dinosaur purple, but fortunately without the green spots.

This wasn't in the agreement.  This is not what you had expected.  Where does this leave you?  Definitely frustrated...probably irate.  To get the change you want, you must first acknowledge the fact that the house is purple and not the beautiful brick that you had expected.  You see the need for change (the house must be painted) and the need for acceptance that the house is purple and can be changed.

Without accepting that the house is purple, you are stuck in your view of what the house should be, not what it is.  By accepting the situation exactly how it is, you are able to see the change you want and know that is possible to get your needs and wants met.  This takes work and time, but in the end you may be empowered to know that you have created a positive change with lasting benefits.

So think about this and ask yourself: What is your purple house?  What are you going to do about it?

Day One: Biosocial Approach to Borderline Personality Disorder

DBT maintains the biosocial approach to understanding borderline personality disorder.  Biological and environmental factors directly affect behavior.  

"According to Linehan, BPD is primarily a disorder of emotion dysregulation and emerges from transactions between individuals with biological vulnerabilities and specific environmental influences. The dysfunction proposed by Linehan is one of broad dysregulation across all aspects of emotional responding. As a consequence, individuals with BPD have (a) heightened emotional sensitivity, (b) inability to regulate intense emotional responses, and (c) slow return to emotional baseline" (Crowell, Beauchaine, & Linehan, 2009, p. 495).


Emotional dysregulation. . .?

What does this mean?  One definition of emotional dysregulation is "a maladaptive pattern of regulating emotions that may involve a failure of regulation or interference in adaptive functioning" (Hilt, Hanson, & Pollak, 2011, p. 160).  What I like about this definition is that it describes these reactions as a pattern, not just a moment of strong, heightened emotions.  

What does this look like?  Let's look at self-harm.  For some individuals, there is a pattern of dealing with strong emotions by creating physical pain.  The logic may be that the pain moves from an abstract internal event to a concrete physical event; another view is that the emotional energy is channeled and controlled.  This cycle of a need for control and emotional release progresses with increasing distress.

For individuals with borderline personality disorder, their home environments are often invalidating, resulting in emotional dysregulation and the use of coping behaviors.  These coping behaviors could include impulsive decisions that are ultimately maladaptive and destructive but temporarily effective in emotional regulation. 

Marsha Linehan's Little Red Book

The Little Red Book of DBT

This is the Little Red Book of DBT that I'm using to learn the skills presented in dialectical behavior therapy (DBT).  This is not a comprehensive manual, as new skills have been developed in subsequent publications.  Skills Training Manual for Treating Borderline Personality Disorder is available on Amazon.

Are you one of us?

The New York Times published a great article by Benedict Carey in 2011 about Marsha Linehan and the story behind dialectical behavior therapy (DBT). 

In a therapy session, a patient asked Marsha Linehan this simple question: "Are you one of us?" I can imagine a moment of silence in the room, with the patient's intrigue and Marsha's gnawing realization that the story can be told, even in the moment of uncertainty about the potential effects on her practice and career.

The patient continued, "I mean one of us. Like us. Because if you were, it would give all of us so much hope.'

"'That did it,' said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. “So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward.”

For the full article, click here and check out The New York Times website.

http://www.nytimes.com/2011/06/23/health/23lives.html?_r=0#h[]

Meeting Marsha Linehan

"Dr. Linehan, hi, my name is Sarah.  I love your work.  Would you sign my copy of your book?"  I asked as I held out The Big Red Book,Cognitive-Behavioral Treatment of Borderline Personality Disorder.

I had the honor of listening to Dr. Linehan at a talk when she accepted the 2012 Joan and Stanford Alexander Award in Psychiatry.  She talked about the history of dialectical behavior therapy (DBT), where it has been, where it is now, and where it is going.  

I want to be a part of this movement, to be a part of the DBT community.  Over the next three months, I will be learning and practicing the skills presented in the Skills Training Manual for Treating Borderline Personality Disorder (Linehan, 1993). 

Schedule:

Monday: Mindfulness, Specific Topic (ex: Biosocial Approach), and Goal Setting

Tuesday: Mindfulness, Distress Tolerance, and Radical Acceptance

Wednesday: Mindfulness, Emotional Regulation, and Validation

Thursday: Mindfulness, Interpersonal Effectiveness, and Dialectics

Friday: Mindfulness, Weekly Review, and Goal Setting