Dialectical Dilemmas

Dialectical Dilemmas

What is a dialectical dilemma?

Dialectical dilemmas are a core concept in dialectical behavior therapy (DBT) that involve seemingly opposing or contradictory thoughts, emotions, or behaviors. These dilemmas can cause significant distress and hinder individuals' progress in therap Sometimes, in our own positions, we go from one extreme response to another. This can happen because of strong emotions. A parent might say, “I let the little things go and don’t react, but then they build up until I explode.” Emotion mind puts us in all or nothing thinking. Reacting in extreme ways diminishes trust and increases rebellion from feeling controlled We can flip to the other extreme when one position has failed. For example: “I stayed on top of her homework each night, but all we would do is get into screaming battles, so I gave up and I now leave her alone.” Sometimes, we take one extreme position and our family member takes another.

Biosocial Theory

Emotionally vulnerbality is biological: it's simply how people are born

Surprised

Angry

Happy

Sad

Embarrassed

Scared

Biosocial Theory

1. Low threshold for tolerating emotions 2. Reactions are immediate & intense 3. Slow to return to baseline

Invalidating Environment!

Communicates that what you are feeling, thinking, doing doesn’t make sense • Poor fit between person & environment • May not be intentional • Everyone invalidates sometimes • Can be understandable in context of high emotions

Examplesof nondialectical statements include these:• “It’s all my parent’s fault [kid’s fault/spouse’s fault]!” • “I’m either going to ignore my kid’s messy room or go throw everything out.” • “In our house, it’s either yelling and fighting or avoiding conflict and retreating.” • “It’s either bingeing on candy or starving myself.”

Who is right to be upset? Should the daughter receive a consequence?

A mother agreed to let her daughter stay out past curfew to go to a 9:00 P.M. movie with a friend, if she called when the movie got out and told her when she’d be on her way home. She did indeed call when the movie got out, but found her mother really anxious and upset with her. This was because the movie ran 3 hours and 15 minutes, and neither the mother nor the daughter knew this ahead of time. The mother had been expecting a call at 11:00 P.M. The daughter was outraged that the mom was upset when she called, considering she had done exactly as promised. [The daughter did what she promised, and the mom was still really mad and frightened.]

Dialectical Dilemmas

Emotional Vulnerability

Active Passivity

Unrelenting Crises

Inhibited Experiencing

Self‐Invalidation

Apparent Competence

Emotional Vulnerability vs Self‐Invalidation

Emotional Vulnerability refers to the tendency to become highly distressed or emotionallyaroused, highly sensitive and reactive, crying, yelling, leaving the room

Self-Invalidation refers to the dismissal of one’s own emotions, perceptions, and problem-solving approaches. For example, when reporting on homework, a teen might say, “I shouldn’t have felt that way,” or in the midst of answering a question, the teen might retract the answer, saying, “Never mind—this is stupid.”

Active Passivity vs Apparent Competence

Active passivity refers to being passive in addressing one’s own problems while actively eliciting the help of others to solve those problems. Teen may say “I dunno—what am I supposed to say?” The teen may be overly reliant on a parent

Apparent competence refers to the tendency of clients with chronic emotional dysregulation to seem, at times, to be more competent, in control, and effective, and less in need of help, than they actually are.Apparent competence can also result when the client’s facial expression and body language do not accurately reflect the level of experienced distress. In these cases, the client has likely learned to suppress emotion expression

Unrelenting Crises vs Inhibited Experiencing

Unrelenting crises refers to repeatedly engaging in risky or impulsive behaviors to avert pain. “crisis-of-the-week” syndrome

Inhibited experiencing refers to the pervasive avoidance of emotional pain. In response to subtle cues that evoke past losses or trauma, individuals in this pattern shut down the normal progression of emotions and never become habituated to their intense sadness, shame, grief, or anger. This pattern may present as numbness, a shut-down demeanor, or nonacknowledgment of emotions

Adolescent–Family Dialectical Dilemmas

Forcing independence

Too Loose

Making Light

Making too Much

Fostering Dependece

Too Strict

Too Loose versus Too Strict

Being too loose refers to being overly permissive with your teen or with yourself (teens, that is) with too few demands, limits, or consequences. This can also refer to too little monitoring—you don’t know where your teen is, whom he or she is with, or what he or she is doing much of the time.

The other extreme, being too strict with your teen or with yourself, refers to imposing too many demands and limits, or too much monitoring, while being inflexible.

Too Loose versus Too Strict

What could the problem be of being too loose? Of too strict? What are the potential consequences of holding one of these extreme positions in the long run?

Making Light of Problem Behaviors versus Making Too Much of Typical Adolescent Behaviors

Making light of problem behaviors refers to minimizing the seriousness of behaviors that could be maladaptive or harmful.

Making too much of typical adolescent behaviors refers to overreacting to behaviors that are developmentally normative.

Making Light of Problem Behaviors versus Making Too Much of Typical Adolescent Behaviors

What could the problem be of making too light? Of making too much? What are the potential consequences of holding one of these extreme positions in the long run?

Forcing Independence vs Fostering Dependence

Forcing independence refers to cutting the strings prematurely.

Fostering dependence refers to restricting moves toward independence. Some refer to those who hold too tightly to their children as “helicopter parents.” These parents hover nearby, actively solving problems for their teens before the teens have a chance to do it themselves. This kind of parenting fosters overdependence on the caregiver.

Forcing Independence vs Fostering Dependence

What is the problem with pushing away too soon?

What is the problem with fostering dependence?

Walking the middle path

Forcing Independence

Forcing independence refers to cutting the strings prematurely.

Expecting a teen to solve a problem they have never encountered before without any support or guidance. Withholding compassion and encouragement.

Active Passivity

Active passivity refers to being passive in addressing one’s own problems while actively eliciting the help of others to solve those problems. Teen may say “I dunno—what am I supposed to say?” The teen may be overly reliant on a parent

Fostering Dependence

Fostering dependence refers to restricting moves toward independence. Some refer to those who hold too tightly to their children as “helicopter parents.” These parents hover nearby, actively solving problems for their teens before the teens have a chance to do it themselves. This kind of parenting fosters overdependence on the caregiver.

A high school senior wants to apply to college across the country. One parent says “No way,” out of concern she’ll be too far away, won’t be able to return home frequently, and won’t be able to get their help when problems arise.

Apparent Competence

Apparent competence refers to the tendency of clients with chronic emotional dysregulation to seem, at times, to be more competent, in control, and effective, and less in need of help, than they actually are.Apparent competence can also result when the client’s facial expression and body language do not accurately reflect the level of experienced distress. In these cases, the client has likely learned to suppress emotion expression

Unrelenting Crisis

Unrelenting crises refers to repeatedly engaging in risky or impulsive behaviors to avert pain. “crisis-of-the-week” syndrome

Too Strict

The other extreme, being too strict with your teen or with yourself, refers to imposing too many demands and limits, or too much monitoring, while being inflexible.

“Too strict” parenting examples. Often or permanently removing TV, Internet, phone, or socializing (i.e., overuse of punishment); perfectionist standards regarding the teen’s performance in school, sports, or other activities; no privacy; spying on teen’s texts and e-mails and going through teen’s drawers and schoolbag.

Making Too Much of Typical Adolescent Behaviors

Making too much of typical adolescent behaviors refers to overreacting to behaviors that are developmentally normative.

A teen is texting three or four friends every day, wants to sleep over at friends’ houses every couple of weeks, and likes to spend an hour or 2 alone in her room each night. The parent tries to put a stop to these behaviors, saying, “You are too focused on your friends and you should spend more time with the family.”

Self-Invalidation

Self-Invalidation refers to the dismissal of one’s own emotions, perceptions, and problem-solving approaches. For example, when reporting on homework, a teen might say, “I shouldn’t have felt that way,” or in the midst of answering a question, the teen might retract the answer, saying, “Never mind—this is stupid.”

Emotional Vulnerability

Emotional Vulnerability refers to the tendency to become highly distressed or emotionallyaroused, highly sensitive and reactive, crying, yelling, leaving the room

Making Light of Problem Behaviors

Making light of problem behaviors refers to minimizing the seriousness of behaviors that could be maladaptive or harmful.

Example: For a long period of time, let’s say, a well-meaning caregiver ignores an adolescent’s failing grades, time spent with a drug-using peer group, and greater irritability at home. The parent gives the teen the benefit of the doubt, believing this stage will pass. After the teen gets suspended from school for a fight and makes a suicide attempt, the parent flips to the other extreme, and watches the teen like a hawk, and interprets even minor mood changes or requests for privacy as signs of impending danger.

Too Loose

Being too loose refers to being overly permissive with your teen or with yourself (teens, that is) with too few demands, limits, or consequences. This can also refer to too little monitoring—you don’t know where your teen is, whom he or she is with, or what he or she is doing much of the time.

“Too loose” parenting examples. No standard mealtime; no requirements regarding school or general behavior; kids’ stuff piled all over house; the kids have no responsibilities; kids go out with no curfew and parents don’t know where they are; little or no supervision.

Inhibited Experiencing

Inhibited experiencing refers to the pervasive avoidance of emotional pain. In response to subtle cues that evoke past losses or trauma, individuals in this pattern shut down the normal progression of emotions and never become habituated to their intense sadness, shame, grief, or anger. This pattern may present as numbness, a shut-down demeanor, or nonacknowledgment of emotions