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Dialectical Strategies

Most of us accept the notion that that virtually everything in life exists on a continuum, neither good or bad, nor white or black, but rather varying shades of grey. But at one time or another, we all find ourselves perceiving the moment as offering nothing more than a choice between two contradictory opposites. Seeing the world this way can cause us to become stuck and for those in recovery, slow their progress. It is not uncommon to find clients who appear to have opposites coexisting within them at the same exact time, though they choose to believe and act on only one side. Not only is this frustrating for them but for others in their life including the mental health and substance abuse workers who are trying to help them change. However, as an alternative to continuing to choose a side, dialectical reasoning allows us to join these opposites in a way that can facilitate change, freeing clients from the polarized position that may have anchored them in place. In doing this kind of work, the worker assists clients in seeing that opposites can both be true instead of having to pick a side and defend it. The worker guides the client in moving from “either-or” to “both-and.”

Entering the Paradox

One Dialectical Behavior Therapy technique for doing this is called “Entering the Paradox”. This technique enables the worker to get the client’s attentions by going IN to their thinking and experiencing it with them. Often, clients expect these ideas to be disagreed with and are surprised by the worker’s joining in. As is the case with the use of humor in our work, it often catches clients off guard and thus gains their attention. For example a client may complain when the worker is going on vacation. The worker responds, “Yes it would be better for you if I were not going on vacation AND I’m still okay for going.” For those working with clients with substance abuse disorders who are experiencing difficulties quitting, entering the paradox will assist them in making some exploratory movement. The worker may sound like, “I understand you don’t want to quit and it‘s just too hard AND you also want to be able to test clean for your probation officer.” Validation of the client’s honesty, desires and needs are all extremely important at this time. “Non-judgmental Stance” is one of the most valuable assets you have as a worker. By refusing to oppose the client’s position, the client no longer has to position him or herself deeper into the polar opposite and defend because there is no one to fighting against…You have entered IN. The client is now free to explore options to the clear dialectic she or he is experiencing, that she or he does not want to quit using and may also need to stop using at the same exact time. And THAT is okay. The client is encouraged to accept him or herself as is and still continue to make effort to make positive change. Those of us, who don’t already, can begin to use this approach in a very similar way - avoiding judgments about any past or current therapeutic decisions we’ve made and continue to attend trainings, consult meetings and seek support from co-workers to become more skillful. The entering of the paradox also allows the therapist to let go of any rigid “therapy rules” we have placed on ourselves and use what works.

Taken from Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha M. Linehan

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