The obvious question to ask about dialectical behavioral therapy is “what the hell does that ‘dialectical’ part mean anyway?”
(Tangent: This blog post uses the word ‘dialectics’ a lot. I am a bear of very little brain and do not understand Hegelian dialectics. Therefore, I have no idea if dialectics in DBT are the same thing as dialectics in Hegel, and you should not assume I am talking about the philosophical kind.)
Niels Bohr once allegedly said, “The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth.” This is the essence of dialectics in DBT.
The dialectic that comes up most often in DBT is acceptance versus change. On one hand, people ought to accept themselves as they are; on the other hand, people ought to change. It’s very easy to assume that one of these is true and the other isn’t: after all, they’re contradictory! However, if you only believe one of those things, you won’t behave well. Just wanting to change is a recipe for self-hatred, futile struggle, and “I just need to use more willpower!” Just accepting yourself is a recipe for sitting in your underwear eating ice cream and browsing Tumblr for the rest of your life.
The perspective DBT takes is that both are true. People have to accept themselves as they are; and simultaneously they have to change.
This is not the same thing as a compromise between those two points. It is not that it is half true that you have to change and half true that you have to accept yourself as you are. It is completely and 100% true that you need to accept yourself, and it is also completely and 100% true that you need to change. One must hold both truths in one’s mind simultaneously.
Yes, this is paradoxical. Fortunately, I like paradoxes.
A lot of other things work in similar ways. For instance, think about “you have to set boundaries” vs. “you have to be kind to other people”. Or “be selfish” vs. “care about doing good in the world.” Or “everyone makes mistakes” vs. “set high standards for yourself.” Or harm reduction vs. abstinence. Or… well, you can think of more yourself.
In my experience, one of the biggest signs that you’re facing a dialectical dilemma is that the two things appear to be opposites, but if you think about them you can see the seeds of one side in the other. Fully and completely accepting yourself as you are is a pretty massive change. Setting boundaries is a strategy for being kind to other people (after all, most people don’t want to violate your boundaries!). Planning for and recovering from your mistakes is a very high standard.
While normal people often tend to get fucked up by going to one side of a dialectical dilemma and ignoring the other one, this is particularly a problem for borderlines, because of a symptom of borderline personality disorder called ‘splitting’. Borderlines tend to see things (concepts, ideologies, people, themselves…) as either all-good or all-bad, to either pedestalize something or to think of it as worse than dirt. Therefore, borderlines have an especial need to learn to navigate the dialectical dilemma “this person has virtues” and “this person has flaws”.