"Understanding Dialectical Behavior Therapy (DBT): How to Navigate Opposites and Shift Your Thinking"

Sep 27

4 min read

In modern therapeutic practices, particularly within the framework of Dialectical Behavior Therapy (DBT), value alignment plays a crucial role in helping individuals navigate complex emotional landscapes and life choices. This approach becomes especially pertinent in cases like Sarah’s, where clients struggle with dissatisfaction rooted in external pressures. Sarah, a woman in her mid-30s, presented in therapy with chronic feelings of dissatisfaction in her career. In the early sessions, it became clear that her emotional disconnect stemmed largely from her family’s expectations, which prioritized financial stability and social prestige over her personal fulfillment. Her initial awareness of this conflict was limited; she felt an internal discontentment but couldn’t fully articulate why.

The Role of DBT and Value Alignment

Drawing from DBT, I facilitated Sarah’s exploration of her values and encouraged her to examine how they aligned—or failed to align—with her career choices. DBT, a cognitive-behavioral therapy developed by Marsha Linehan (1993), focuses on balancing acceptance with change. A key aspect of DBT is dialectical thinking, which encourages clients to hold two seemingly opposing truths simultaneously. For Sarah, the dialectic revolved around her internal conflict between fulfilling her family’s expectations and pursuing a career that aligned with her deeper values of creativity and meaningful contribution.

As Sarah explored questions like, “What does success mean to you?” and “How do you feel when you think about your current job?” she began to uncover the internal misalignment between her personal values and her professional life. This reflective process led to the realization that her career, which offered financial security but lacked creative fulfillment, was contributing to her chronic dissatisfaction. In this context, DBT’s emphasis on value alignment became pivotal in helping Sarah navigate her career choices. Linehan’s theory (1993) suggests that clients benefit from aligning their actions and decisions with their core values, thus reducing emotional distress and fostering psychological well-being.

Once Sarah became more aware of these internal conflicts, we discussed how these insights could guide her future decisions. With this new understanding, Sarah began to consider career paths that were more aligned with her values of creativity and contribution. This process eventually led her to pursue a role in a non-profit organization where she felt more fulfilled and true to herself.

The Philosophy of Balance in DBT

One of the central tenets of DBT is the concept of balance, often referred to as finding the "middle path." This idea resonates with various philosophical traditions, such as Aristotle’s Doctrine of the Mean, which advocates for a balanced, moderate approach to life (Aristotle, trans. 2004). Similarly, in DBT, clients are encouraged to avoid extremes—either total acceptance or relentless striving for change—and instead seek a harmonious balance between the two. Sarah’s journey involved this dialectical process: she needed to accept her family’s values while also recognizing and acting on her own needs for personal fulfillment.

Philosophically, this mirrors the existential tension between self-authenticity and social conformity as discussed by thinkers like Jean-Paul Sartre (1943). Sartre argued that individuals must confront the "bad faith" of living inauthentically due to external pressures, and instead, choose to live authentically by aligning actions with personal values. Sarah’s therapy reflected this struggle as she learned to identify the societal and familial pressures shaping her choices and began to act in alignment with her authentic self.

The Synthesis of Opposites

A crucial component of DBT is dialectical thinking, the synthesis of opposites. Clients are taught that two contradictory ideas can coexist. For Sarah, the dialectic was: "I am doing my best in my current career, and yet, I want to change." This synthesis allowed her to acknowledge her hard work while also permitting herself the freedom to seek a new path. This idea is echoed in Hegelian philosophy, where the resolution of contradictions—thesis and antithesis—leads to a higher understanding, or synthesis (Hegel, trans. 1977).

Through DBT, clients like Sarah learn to hold the tension between acceptance and change, thereby reducing emotional dysregulation. In therapy, Sarah also explored the dialectic of self-compassion and ambition: "I can accept that I’m not perfectly aligned with my family’s expectations, but I can also strive for a career that feels more authentic to me." This synthesis empowers clients to move beyond rigid, black-and-white thinking and embrace the complexity of their emotional and practical realities.

Non-Judgmental Awareness

Finally, non-judgmental awareness is a cornerstone of DBT practice. Clients are encouraged to observe their thoughts, feelings, and behaviors without assigning them a moral value of "good" or "bad." This mindful, non-judgmental stance helps clients like Sarah to recognize their emotional experiences in a more nuanced way, rather than getting caught in self-critical narratives. As Linehan (1993) suggests, when clients can observe their emotional states without judgment, they can respond to life’s challenges with greater clarity and effectiveness. In Sarah’s case, she began to see her dissatisfaction not as a personal failure, but as an indicator of deeper value misalignment.

Conclusion

Sarah’s journey in therapy underscores the importance of value alignment and dialectical thinking in DBT. By facilitating her exploration of her core values and helping her synthesize seemingly contradictory desires, Sarah was able to make career choices that were both emotionally and practically satisfying. This process of aligning behavior with values, as well as embracing the synthesis of opposites, reflects both DBT’s therapeutic model and broader philosophical principles of balance and authenticity.