Although DBT comes in a manual, it is not actually a manually based treatment. You can buy Marsha Linehan’s groundbreaking Dialectical Behavior Therapy treatment manual, Skills Training Manual for Treating Borderline Personality Disorder, in any bookstore. This book will tell you the how’s of DBT, but the real essence of this life saving treatment comes from its philosophy of dialectics.
Dialectics is all about learning how to simultaneously hold two seemingly opposite truths- how to tolerate the middle ground of black and white thinking. The philosophical tenets of DBT, therefore, serve as a guide to our residents as they work to create a meaningful life. This holds true regardless of whether they are at Timberline Knolls for an eating disorder, mood disorder, trauma, or substance abuse.
We recognize the vital necessity of emphasizing the philosophy and goals of TK. Certainly, we teach the skills as well, but Timberline Knolls stands apart because we also impart the dialectic mandate of DBT. We challenge residents to seek the middle ground, to both tolerate and experience emotion while also remaining committed to their meaningful lives.
A recent resident summed this up quite nicely. She explained that while she knew her parents made some pretty serious mistakes she loved them fiercely. She was willing to tolerate the dialectic of feeling both emotions.
In the past, she would vacillate between the two extremes- she hated them and everything they did, or she was overwhelmed with love and gratitude for every action. But, by being willing to embrace the dialectic, she was able to both tolerate loving her parents and wanting them in her life AND accepting that there were things about them she did not like.
Living in the dialectic is hard for every person who struggles with emotion dysregulation. Black and white thinking comes easy to us all. It is comfortable and familiar to embrace one side of an argument or emotional stance.
Living in the dialectic, however, takes constant choices to embrace the tension of recognizing that life can’t be easily divided into neat and separate categories.
To help residents direct their journeys on embracing the dialectic, we balance the highly practical and very useful skills taught in Linehan’s seminal workbook blending in a focus on values, which is an important component of Acceptance and Commitment Therapy (ACT).
We work with residents to help them identify what they value in life; what is worth the difficult work of living in the tension of the dialectic. In other words, what motivates them daily to get up and work the skills of recovery. Values identification gives the residents direction and purpose behind the skill building.