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Dialectics of DBT

Life is full of dialectics. Some can be very difficult to accept.

In my practice, I utilize Dialectical Behavior Therapy (DBT). DBT was designed to treat Borderline Personality Disorder, a diagnosis that many clinicians view as both impossible and undesirable to treat. The key dialectic of DBT is “the need for a client to accept herself as she is in the moment and the need for her to change.” (1)  For many individuals in DBT, this idea is revolutionary. They are not accustomed to having their existence validated. With this dialectic setting the stage, the treatment’s success has been demonstrated repeatedly with Borderline P. D. and many other conditions.

In my own practice, as I honed my DBT skills, I found a significant dialectic arose with these patients. While I had a great deal of faith in the treatment, and I sincerely wanted to help my clients, I noticed that some of them really, really bothered me. In fact, there were a few who I genuinely disliked. I remember sincerely struggling with this at first. I felt like I was betraying these individuals who came to me for help. I would be listening to their troubles, and yet, felt far more empathy for the people who “deserted” them than for my actual patients. I knew how people with Borderline P. D. were discriminated against by other therapists. They were perceived as being needy, manipulative, spiteful, and selfish. Yet, I couldn’t help but see those qualities as well.

However, the truth is that they do embody those qualities at times. It is the nature of the condition. The traits of a person with BPD can be inherently aggravating. Utilizing DBT does not require that those who practice it become super-human. As therapists, we remain entitled to our thoughts, emotions, and opinions. You do not need to feel differently than the therapists who rejected treating your clients in the past. Your job is to respond differently. Avoid inflicting guilt or shame for the symptoms. Remain supportive and collaborative. Focus on your common goal of improving the person’s functioning and obtaining a “life worth living.” And even when you have accomplish that, you still don’t have to like them.  

(1) Linehan, M. M. (1993). Skills training manual for treating Borderline Personality Disorder. New York, NY: Guilford Press.


RutkowskiBy Dr. Beth Rutkowski, PsyD, LP, CAADC

Dr. Beth Rutkowski is an adjunct professor at the Michigan School of Professional Psychology, Licensed Psychologist, and Certified Advanced Alcohol and Drug Counselor (CAADC) who practices in Farmington Hills, Michigan. Dr. Rutkowski is certified in Dialectical Behavior Therapy and has her Doctoral Certificate in Child and Family Studies. Dr. Rutkowski is member of the Society for the Psychology of Women (Division 35 of APA) and the American Psychology-Law Society (Division 41 of APA). Her practice’s website is www.healthymindsmichigan.com/