Dialectics in psychotherapy

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 — even though most clients don’t know what the word means. In reality, dialectics as used in DBT is a feature of all schools of psychotherapy.

Broadly speaking, a dialectic is 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.

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 Zen Buddhism’s self-acceptance and focused on clients’ strengths. But this, in turn, downplayed their real need to change. Dr. Linehan and her colleagues eventually 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 he or she 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 (e.g., 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 by Taoists, as in the well-known Yin-Yang symbol of interdependence). 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 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, dialectic tension generates all creativity and psychological growth.

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