Dialectics in Psychotherapy

by Steven Reidbord edited by O Society September 17, 2019

The word “dialectic” has a long history, from ancient Greek philosophers, through Hegel and Marx, and to the present day. Its meaning has changed over the centuries, and according to different thinkers. In psychotherapy, “dialectic” is almost wholly associated with dialectical behavior therapy (DBT), where the term identifies a particular type of treatment. In reality, dialectics as used in DBT is a feature of all schools of psychotherapy.

“They do not understand how that which differs with itself in is agreement: harmony consists of opposing tension, like that of the bow and the lyre.”

~ Heraclitus

Broadly speaking, a dialectic is a tension between two contradictory viewpoints, where a greater truth emerges from their interplay. Socratic dialog, in which philosophers mutually benefit by finding defects in each other’s arguments, is a classic example. In the early 19th century, Georg Wilhelm Friedrich Hegel described a universal dialectic, commonly summarized as “thesis, antithesis, synthesis.”

His esoteric philosophy holds that every thesis, or proposition, contains elements of its own negation. Only by considering both the thesis and its contradiction (antithesis) can one synthesize a greater truth. This process never ends, as the new synthesis itself contains antithetical elements. The term veered in meaning with Marx’s dialectical materialism, and in yet other directions with more contemporary writers. But DBT uses the Hegelian sense, and that is our focus here.

“Form is empty, emptiness is form, Emptiness is not other than form, form is also not other than emptiness. ”

~ Heart of Perfection of Wisdom

Marsha Linehan faced a problem as she developed DBT in the late 1970s. Her behavioral strategies implicitly pathologized those she sought to help. Clients thought: “If I need to change, there must be something wrong with me.” To avoid re-traumatizing them, she turned to Buddhism’s self-acceptance and focused on clients’ strengths. But this, in turn, downplayed their real need to change. Dr. Linehan and her colleagues realized they would have to integrate change (thesis) and acceptance (antithesis) into a larger truth that incorporates both (synthesis).

This is the fundamental dialectic of DBT, although there are others. For example, the therapist is trustworthy and reliable, but also makes mistakes. The client is doing his or her best but wants to do better. Although worded here using “but” for clarity, DBT teaches clients to use “and” instead.  (The therapist is reliable and makes mistakes.)  In doing so, the therapeutic task is to embrace the truth of both propositions at once, not to choose one over the other.

An uneasy tension between acceptance and the need for change exists in all psychotherapy, not just DBT. Indeed, this tension underlies a question commonly posed to new clients: “What brings you in now?”

Therapy begins only when emotional discomfort and the perceived need for change outweigh the inertia (i.e., acceptance), reluctance, and other factors that precluded it before. Then, once in therapy, change versus acceptance is often an explicit struggle. File for divorce or work on one’s marriage? Learn to be bolder or accept that one is shy by nature? Change physically through exercise or plastic surgery, or become more comfortable with the body one has?

When clients grapple with such questions, therapists of any school should refrain from choosing sides or giving advice. Except in extreme cases, we simply don’t know which option is best for the individual in our office.

However, it goes further than this. As Hegel wrote, a clash of thesis and antithesis may result in a new third way, a synthesis that incorporates, yet transcends, both sides of the argument. This “union of opposites” was first described by pre-Socratic philosophers and Taoists.

2

Everywhere it is obvious that if beauty makes a display of beauty, it is sheer ugliness. It is obvious that if goodness makes a display of goodness, it is sheer badness. For

To be and not to be are mutually conditioned.
The difficult, the easy, are mutually definitioned.
The long, the short, are mutually exhibitioned.
Above, below, are mutually cognitioned.
The sound, the voice, are mutually coalitioned.
Before and after are mutually positioned.

Therefore

The holy man abides by non-assertion in his affairs and conveys by silence his instruction. When the ten thousand things arise, verily, he refuses them not. He quickens but owns not. He acts but claims not. Merit he accomplishes, but he does not dwell on it.

“Since he does not dwell on it It will never leave him.”

Translation DT Suzuki & Paul Carus

The concept was later adopted by alchemists, who observed that compounding two dissimilar chemicals can result in a third unlike either parent (e.g., sodium, a highly reactive metal, plus chlorine, a poisonous gas, produces table salt).

Carl Jung, who studied alchemy, weaved the union of opposites into his various psychological writings. It forms the basis of his “transcendent function” that leads to psychological change; an accessible introduction to this concept can be found here.

“The shuttling to and fro of arguments and affects represents the transcendent function of opposites. The confrontation of the two positions generates a tension charged with energy and creates a living, third thing … a movement out of the suspension between the opposites, a living birth that leads to a new level of being, a new situation.”

Collected Works of C. G. Jung, Vol. 8. 2nd ed., Princeton University Press, 1972. p. 67-91.

One need not be a Jungian to recognize creative, “third-way” processes in therapy. Instead of being caught on the horns of a dilemma, it often helps to take a step back and appreciate the validity of both positions: It is valid to seek autonomy and relatedness. It is valid to be serious and to play. And it is certainly valid to accept oneself while also striving to change.

Insight is our term in depth psychotherapy for achieving synthesis: a position that reconciles and transcends thesis and antithesis, makes sense emotionally, and works in one’s life. In this way, dialectical tension generates all creativity and psychological growth.

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