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Dialectics

As a worldview, dialectical philosophy provides a foundation for DBT. Dialectics is a complex concept that has its roots in philosophy and science. Dialectical philosophy involves several assumptions about the nature of reality. It suggests that reality is made of interrelated parts that cannot be defined without reference to the system as a whole and that the whole must also recognize its parts. The system and its parts are in a constant state of change, and any change affects the system. It implies that reality, rather than being static and fixed, is constantly changing. It is always in flux and abounding with obvious contradictions. This approach suggests that on the one hand, one must be tolerant of inconsistencies, and on the other hand, one must be diligent in one's attempt to search for useful means for dealing with contradictions. Thus, clients learn there is benefit to acceptance and to change. When a counselor addresses client dysfunction, this principle of interrelatedness and wholeness leads to a systemic conceptualization of behavior. A DBT counselor treats the whole individual rather than a diagnosed pathology. Similarly, the whole emotional system is addressed in counseling with the recognition that elements of the system are interconnected, influencing both the client's behavior and the environmental context external to the client.

Dialectical behavior therapy also involves specific dialectical strategies to help clients get unstuck from inflexible ways of thinking or viewing the world. For example, in response

to a client's commitment to participate in the therapeutic process, the counselor might ask whether the client is sure he or she wants to do it because it is likely to be very hard work. This approach, called devil's advocate, causes the client to argue in favor of why and how he or she will complete the counseling and not drop out. The counselor guides the client to make strong and convincing arguments about participating in the counseling as opposed to the counselor being a cheerleader for the client to participate. This type of approach is intended to facilitate therapeutic movement so the focus does not become a battle of wills between the counselor and the client. The spotlight is on "teaching and modeling dialectical thinking as a replacement for dichotomous, either-or, black-and-white thinking" (Line- han, 1993b, p. 39). The group setting offers an environment to observe and participate in the process of change for both the group as a whole and each individual. The DBT model uses many techniques to assist in self-awareness, growth, and behavior modification (Line- han, 1993b). Figure 10.2 displays some examples of dialectical strategies.

To deal with these demanding, narcissistic clients, counselors are required to be in either group or individual supervision. Supervision facilitates each counselor setting rules and limits that are appropriate for that counselor, without interpreting personal limits as representing a fear of intimacy or a need to be nurturing. Counselors are expected to make mistakes and to be accepting of their own mistakes. They are vulnerable to the pattern of comforting these demanding patients, then becoming angry and punitive, then guilty and appeasing again. They must individualize the treatment to suit each client without undermining the ideology of DBT. Counselors must maintain a balance between nurturing and demanding change, giving clients needed help and guidance, without doing for clients

Dialectical Strategies

Figure 10.2. Dialectical Strategies

what clients can do for themselves. Counselors must maintain and communicate optimism that the counseling will help each client.

 
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