A Dialectical View of Change

Knowing is not enough;

we must apply. 

Willing is not enough;

we must do.

(Goethe)  

With knowledge comes an understanding that there is a need for action, that we are not passive in this world. We are active agents in the course of our lives.  As humans we interact with others, therefore impacting them as well.  We influence their lives in ways that we cannot understand or appreciate in the moment.  One breathed word travels through waves to crash on the ears of another, bringing with it a message.

We cannot turn back to our previous selves because of the changing power of a message. Knowing more has set the stage for change.  With this new information comes a new perspective, an opportunity to see the dialectic. 

Let's explore dialectics.  Dialectics are the “synthesis of opposites” (Linehan, 1993a), or the merging of two opposing perspectives into a third new perspective that has elements of both perspectives.  The concept is similar to blending paints.  One splash of blue paint combines with a splash of yellow paint creates green paint.  We can see the value in all colors, just as we can see value in different perspectives.   

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.  Maintaining a dialectical stance is essential because it allows us to see truth from many perspectives, not just our view, the adolescent’s view, or her family’s view.  

Incorporating multiple perspectives gives an increased knowledge base and may help in finding Wise Mind.  Wise Mind seeks the balance in emotions and thoughts to yield balanced behavior. 

"What keeps us stuck?" Emotion Mind and Homework

In DBT, clients and skills trainers have homework assignments from week to week.  "Repetition is the mother of understanding."  The intentional practice prompts the client to develop and hone her skills.  The interpersonal effectiveness skills really require practice with others because they involve interactions with others, so it can be difficult to practice by yourself; DEAR MAN, GIVE, and FAST are the main interpersonal effectiveness skills.

In skills groups, there is a designated time for a review of the homework.  This is usually after the mindfulness activity and before the skill lesson. 
Sometimes the homework isn't completed when the clients arrive for group, so there might be clients writing quickly as the other clients talk about their homework.  If skills trainer asks about the unfinished homework, she may ask the client to complete the work and bring it next week and/or to write a chain analysis about what kept her from completing her homework.  

The chain analysis may elucidate the emotional factors and cognitive factors that influenced the outcome.  Sometimes emotional responses hinder the likelihood of completing tasks. It's a difficult process to figure out "what happened when."  

Chain analyses are not punishments and should not be punitive.  They are tools for helping the client identify the behavior(s), what led up to it (emotional vulnerabilities), the prompting event, and what happened as a result of the behavior(s).  It can be dysregulating and difficult to write the chain analysis alone, so it may be helpful to work through a chain analysis with the individual therapist.  She or he can help the client self-soothe and regulate her emotions when filling out the chain.

Looking at factors that keep us from working effectively, procrastination is an application of Emotion Mind.  Fear and anxiety can create a hostile environment for effective task completion.  Randy Pausch described procrastination as one of the hindrances to completing tasks in his lecture, "Time Management;" click here to watch the YouTube video of "Time Management." 

"If you are procrastinating, you've got to find some way to get back into your comfort zone.  Identify why you are not enthusiastic. Whenever I procrastinate on something, there's always a deep psychological reason. Usually it's, I'm afraid of being embarrassed because I don't think I'll do it well, or I'm afraid I'm going to fail at it."

Let's look at homework experiences to see the effects of the anxiety and fear that can come with being in Emotion Mind. 

I don’t want to be avoidant today.

I want to look at the theories book,

pick up it up and say,

I am not going to live in fear.

I will read this

one section at a time.

I can do this.

I may need help

along the way.

You will not define me.

I will not label myself as a

bad, ignorant, or avoidant

student.

I can do this.

In looking at the poem, there is a consistent cheerleading statement: I can do this.  It also has components of goal setting: reading the book one section at a time.  There are also elements of Wise Mind and non-judgmental stance in not wanting to add labels that could increase avoidance, diminish motivation to finish the work, increase the likelihood of living in fear, and keep us from reaching our potential.

DBT Training Wrap Up from May 2013

This week has been as much fun as summer camp!  It was intense to work with Shari Manning and Karyn Hall for a week.  I am kind of bookish, so it was a perfect fit for a graduate student who is eager to learn and apply...and run with the big dogs in the treatment world. 

When I arrived at Menninger for the training, I had barely slept and didn't need to with such anticipation and excitement.  I was one of the first to arrive, so I had a moment to look around the room and soak in the reality of the moment- here I am as a student- surrounded by some of the top practitioners and clinicians in mental health.  I had my binder and was ready to go. 

Before the introductions, Karyn smiled at the group and led the first mindfulness.  Observe is the first core mindfulness skill, so it was the perfect place to start.  When you practice mindfulness, you do so with your eyes open, so that you are fully present and aware of your environment.  The target was to track the thoughts, as one would track the clouds moving across the sky.  In Observe, there are no labels, judgments, or words assigned to what you see or think.  The goal is to just notice the thought and let it go.  

I watched my thoughts.  With each breath, I let go of the expectations that had filled my mind with wonder in the car and still lingered as I sat.  I was sitting in my chair and began to realize that this is real- the day has finally come and I am here to embrace it and to live in it. 

I let go of the comparison of being less experienced, realizing we all have different areas of specialty and understanding.  "Comparison is the thief of joy" - Theodore Roosevelt.  And he is right.  From the moment I realized and accepted that I was "enough," the tension in my shoulders left and I could be fully present. 

Remember, all we have is this moment.  Live in it.

Dialectical View of Dealing with Expectations

A sense of being a failure, one who falls short of expectations, can be seen in so many populations, not just individuals with borderline personality disorder.  There are several perspectives about expectations.  The expectations we hear can come from the words we speak to ourselves, the direct words we hear from others, and the wordless comments that we perceive from others.  

Trying to live up to expectations can take the fun out of life.  For the client, her expectations for herself could be too grandiose to accomplish.  The expectations we hear from others may create dissonance, in the pursuit of trying to meet the expectations of others and trying to be yourself.  The expectations she perceives from others may be the result of mind-reading.  

So what do we do with these expectations?  We have many options, like weighing the facts, the What Skills of Mindfulness (observe and describe), chain analysis, and finding the kernel of truth.  

Let's start with Observe and Describe.  Observe, Describe, and Participate are the three What Skills of Mindfulness.  Observing is just noticing without attaching words, judgments, or meaning.  Describing is adding words to the observations, while still maintaining a one-minded, effective, nonjudgmental stance.  We'll talk about Participate in a later post, but generally Participate means whole-heartedly diving into an activity; I have heard others say that Participate is a similar concept to Mihaly Csikszentmihalyi's Flow. 

Let's go to weighing the facts.  In this context, it's a little on the Reasonable Mind side of Wise Mind; focusing on the facts can draw us out of Emotion Mind.  Questions could include: Who was talking?  What was said?  We're looking for the actual words, not interpretations.  What is the context of the discussion?  When did the discussion start?  We're looking for this most recent, specific discussion; try not to dig in the pain of the past.

Chain analysis is a key process in DBT, as the roots of DBT are in behavioral analysis and cognitive behavioral therapy.  Essentially, chain analyses link the triggering event to the emotions, perceptions, actions, and consequences.  More will be coming about chain analyses.  

Last, finding the kernel of truth involves dialectical thinking.  There are many ways to view an event.  In looking at the stated expectations from another person, try to see her perspective.  What does she see?  What is she saying?  Take these questions into consideration, especially when trying to find the dialectic.  Find what your Wise Mind knows to be true.  Now integrate these concepts. 

DBT Core Mindfulness Skills: States of Mind

The DBT Training starts on Thursday.  I could not be more excited.  I will be meeting people who are as fascinated by the DBT skills and illness as I am.  

So the four structural posts of DBT are Core Mindfulness Skills, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance.  In the next three days, we will have an overview of these modules and questions for consideration.
 It can be hard for individuals with borderline personality disorder to trust their perceptions, in part because the emotional reactions can be so strong and pervasive invalidation can be detrimental in trusting your perspective.  In working with individuals with borderline personality disorder, remember that there is not a single "right way" to look at a situation.  There are often dialectics that can be explored. To explore these different perspectives, turn to the source.

So let's look at the States of Mind.  No one can live exclusively in one mind, so expect to see a mixture of Minds.  

Marsha Linehan defines Reasonable Mind as "your rational, thinking, logical mind.  It is the part of you that plans and evaluates things logically.  It is the cool part" (Linehan's Little Red Book, p. 65)

She also describes being in Emotion Mind as: ". . . your emotions are in control- when they influence and control your thinking and behavior" (Linehan's Little Red Book, p. 65).

So DBT emphasizes the synthesis of opposites.  Wise Mind is the synthesis of logical thinking and passion.  It takes the most effective aspects of the Emotion Mind and Reasonable Mind and integrates them into the processing of situations, moods, emotional reactions, and time for contemplative thought.

Marsha Linehan describes Wise Mind as "that part of each person that can know and experience truth" (Linehan's Little Red Book, p. 66).  

I like to call Wise Mind truths the things we know in our bones.  Like a skeleton, these thoughts help us to have structure and mobility to act on what we know to be true.

I found this poem recently.  It is true for me and the battles that we face in the realization of dwelling in the poles of Reasonable Mind and Emotion Mind, but also in Fixed Mind.

Found myself here in this place again
caught up in this moment
seeing that slavery brings security,
but in what, for what, and by what means?
It is moving from the known-
the constants and forces of what works within me-
to the uncertainty of hope and the freedom it brings.