Two Truths and a Third Way: How DBT Was Born

By Yaakov Wahl

I must be kind to myself. I must accept myself. I am perfect. I look in the mirror and study my reflection. I embrace the person I am, here and now. My quirks and foibles give me character. 

I must learn to be more effective, to set goals, prioritize, manage my time, I must improve each day. I must not stagnate, remain this flawed and floundering human.  

A Psychologists Dilemma

Which perspective is correct? Which perspective is helpful? This was Dr. Marsha Linehan’s dilemma. Dr. Linehan began her career, projecting confidence, assured she had the know-how to cure whatever ails people. And why not? Dr. Linehan had studied the complexities of the human mind and the nature of life’s journey. She had books and libraries of cures. Cures for people who believed nobody loved them and cures for people who felt life was no longer worth living. After carefully evaluating her clients she would present the treatment plan to her client, reassuring them that she had found the way up and out of their suffering. 

But her clients’ responses were unexpected. Some would yell at her, others would retreat into silence, and some just up and left. “What?! I’m the problem?” they would ask incredulously, “You’re not listening to me! You are just trying to change me!” they would complain.

Dr. Linehan went back to the drawing board. She decided that if changing her clients created so much anger, she would take the opposite approach. She would accept them exactly as they were. She would show them that they were wonderful humans today, right here, right now. She would take the time to understand their life’s journey and see the insurmountable obstacles they have overcome, she would come to understand that their suffering was understandable and even expected. 

But nothing changed. Clients responded with angry silence, stormy outbursts, and storming out of the room. “You're abandoning me!” they would cry in protest, “You're not even going to help me?!”

Dr. Linehan’s Tango

Finally, Dr. Linehan discovered that healing is not a solo act, but a dance choreographed to the symphony of acceptance and growth. One that accepts people here and now, and makes plans for growth; that sees the challenges people face, and whispers, we will do better. She found it to be like walking a tightrope, to traverse the void she needed perfect balance. Dialectical Behavioral Therapy was born. 

A Life Worth Living

Dialectical Behavioral Therapy is a skills based therapy that carefully asks the key question: What thinking, feeling, and acting skills are essentials to create a life worth living. A core tenet of DBT is Dialectical thinking (it's right there in the name). Too often we fall into the trap of absolutes. 

• The world is a wonderful, kind place 

• The world is an evil hell hole full of suffering

• They love me and only think of my best interests

• They hate me and only think of how to destroy me

• They are wise and understanding and have all the right answers

• They are foolish and misguided and have nothing worthwhile to offer

It’s black or white, with no shades of grey. 

Seeing the Grey for a Colorful Life

But a life worth living is a life with nuance, with seeing the good and the bad, the grey complexities that bring joyous color into our day. 

• The world is full of wonderful experiences that warm our hearts and are joyful to experience, the world is full of suffering and pain

• They love me and have made my life richer, they have overlooked me, forgotten me and hurt me

• They are wise and understanding and I have learned so much from them, they are blinded by their wants and needs and preconceived ideas and biases and have led me astray

Dialectical thinking lets us enjoy a special moment with a friend in the midst of an excruciating loss, it allows us to feel the pain from a friend's rejection while experiencing the most glorious honeymoon with the love of our life. 

• We can love our partner while we are hurt from their callous disregard 

• We can appreciate the good times we have had with a friend who we need to keep at a distance because they have hurt us

• We can learn from a wise mentor how to navigate a job search but disregard their terrible relationship advice

• We can bend our home rules and be good parents

​​Change Comes Through Acceptance

There’s another kind of surprising dialectic that Dr. Linehan discovered: Change doesn’t always begin with a plan. Sometimes it begins with acceptance. We often think transformation is about being inspired, planning a new way, and committing to better routines. But Dr. Linehan learned that the journey to true radical self acceptance radically changes us.

The Takeaway

Dialectical thinking means holding two opposing ideas at the same time, and allowing a third, deeper truth to emerge. It says: the world is not either/or it is both/and.

Dialectical thinking shows us how to live in complexity without falling apart. It teaches us how to hold truth and contradiction in the same hand. It’s the art of saying:

• “I’m doing the best I can.And I can do better.”

• “I accept myself.And I want to grow.”

• “This is hard. And I can handle it.”