Dialectical Behavioral Therapy

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Dialectical Behavioral Therapy

• Common Dialectical Dilemmas and Biosocial Theory

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Dialectical Dilemmas

• Melissa Hammer, M.S.Ed., LPCC
• Overview of Presentation
• Dialectical Dilemmas
• Biosocial Theory

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Dialectical Dilemmas

• Definition of Dialectics
• Black or White
• Not Gray Area

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Dialectical Dilemmas

• The Three Most Common Dialectical Dilemmas of
  Borderline Personality Disorder (BPD) are
• Emotional Vulnerability Versus Self-Invalidation
• Active Passivity Versus Apparent Competence
• Unrelenting Crises Versus Inhibited Grieving

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Dialectical Dilemmas
Active Passivity
Unrelenting Crises
Emotional Vulnerability
Biological
Social
Inhibited Grieving
Self-Invalidation
Apparent Competence
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Dialectical Dilemmas

• Emotional Vulnerability 4 Characteristics
• 1 Emotions are full system responses
• 2 Intense emotional arousal typically
  interferes with other on-going behavioral
  responses
• 3 High arousal and inability to regulate
  emotions leads to a sense of being out of control
  and unpredictability about self

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Dialectical Dilemmas

• Emotional Vulnerability 4 Characteristics
  Cont.
• 4 Lack of control leads to some specific fears
  that increase emotional vulnerability further
  still

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Dialectical Dilemmas

• Self-Invalidation
• Invalidates his or her own affective experiences
• Looks to others for accurate reflections of
  external reality
• Oversimplifies the ease of solving lifes
  problems
• Describe validation (more in Biosocial Theory
  section)

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Dialectical Dilemmas

• Emotional Vulnerability Versus Self-Invalidation
  The Dialectical Dilemma
• Who is to blame?
• Synthesis is found through patience, acceptance,
  self-compassion, gradual attempts at change
  (shaping), self-management, and self-soothing

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Dialectical Dilemmas

• Active Passivity
• Tendency to approach problems passively and
  helplessly
• Corresponding tendency under extreme distress to
  demand from the environment solutions to lifes
  problems
• Person is active in trying to get others to solve
  problems or regulate his or her behavior, but is
  passive about solving problems on own

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Dialectical Dilemmas

• Active Passivity Cont.
• Frantic attempts to avoid abandonment are
  consistent with this constellation

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Dialectical Dilemmas

• Apparent Competence
• Appears competent and able to cope with everyday
  life, at times
• At other times, the person may behave
  unexpectedly and as if observed competencies did
  not exist

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Dialectical Dilemmas

• Apparent Competence Cont.
• Three factors related to this
• 1 Persons competence is extremely variable and
  conditional
• 2 Person has difficulty communicating
  vulnerability clearly to others
• 3 Person acts as if in the presence of
  supportive, nurturing people even if he or she is
  not

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Dialectical Dilemmas

• Active Passivity Versus Apparent Competence The
  Dialectical Dilemma
• Person needs a great deal of assistance
• Afraid of being left alone in a world that has
  failed him or her over and over again
• Experiences intense shame at being dependent

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Dialectical Dilemmas

• Active Passivity Versus Apparent Competence The
  Dialectical Dilemma
• Inability to synthesize helplessness and
  competence, non-control and control, needing and
  not needing - also, this causes more dysfunction
• Synthesis is found by learning to balance
  capabilities and deficiencies, supportive
  acceptance and confrontational/change approaches
  

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Dialectical Dilemmas

• Unrelenting Crises
• Repetitive stressful events
• Inability to recover fully from any one stressful
  event
• Leads to a weakening of the spirit and subsequent
  suicidal or other emergency or impulsive
  behaviors
• Discuss slow return to emotional baseline

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Dialectical Dilemmas

• Inhibited Grieving
• Repetitive, significant trauma and loss
• Coupled with an inability to fully experience and
  personally integrate or resolve these events
• A crisis of any type involves loss whether it is
  concrete, psychological or perceptual

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Dialectical Dilemmas

• Inhibited Grieving Cont.
• Accumulation of loss has 2 effects
• 1 Significant early or unexpected loss may
  result in a sensitization to later loss
• 2 a pattern of many losses leads to bereavement
  overload or the inhibition of grieving itself

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Dialectical Dilemmas

• Unrelenting Crises Versus Inhibited Grieving
• Inhibition of affective responses associated with
  grief may be effective for short-term resolution
  of pain, it is not very effective in bringing
  about social support
• Goal is to see the grief process can be survived
• Grief deeply and end grieving

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Dialectical Dilemmas

• Unrelenting Crises Versus Inhibited Grieving
  Cont.
• Goal is for the person to build and rebuild his
  or her life in light of current realities

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Biosocial Theory

• BPD is often thought as a primary problem of
  emotion dysregulation either positive or
  negative
• This dysregulation can be from both emotional
  vulnerability and an inability to regulate
  emotions

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Biosocial Theory

• Emotional Vulnerability includes
• High sensitivity to emotional stimuli
• Emotional intensity
• Slow return to emotional baseline

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Biosocial Theory

• Invalidating Environments
• Contribute to the development of emotional
  dysregulation
• Fails to teach a child how to label and regulate
  arousal
• Do not show how to tolerate emotional distress
• Do not show when to trust his or her own
  emotional responses as reflections of valid
  interpretations of events

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Biosocial Theory

• Invalidating Environments Cont.
• Can be provided on purpose or because of deep
  caring
• Is defined as one in which communication of
  private experiences is met by erratic,
  inappropriate, and extreme responses

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Biosocial Theory

• Invalidation has two primary characteristics
• 1 Tells the person that he or she is wrong in
  both the description and analyses of the
  experience
• 2 It attributes the persons experiences to
  socially unacceptable characteristics or
  personality traits

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Biosocial Theory

• Goodness of fit or poorness of fit of the child
  with the environment is crucial for understanding
  later behavioral functioning
• Consequences of invalidating environment
• 1 Dont learn to label emotions
• 2 Oversimplify the ease of solving lifes
  problems

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Biosocial Theory

• Consequences of Invalidating Environment Cont.
• 3 Extreme displays and/or extreme problems are
  necessary to provoke a helpful environment
  response
• 4 Fails to teach a child when to trust his or
  her own emotional and cognitive responses
• 5 It is not detrimental for everyone

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Biosocial Theory

• Types of Invalidating Families
• 1 Chaotic Families
• 2 Perfect Families
• 3 Typical Families

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Dialectical Behavioral Therapy

• Summary
• Questions
• Information taken from Cognitive-Behavioral
  Treatment of Borderline Personality Disorder by
  Marsha M. Linehan, Ph.D.