1 Dialectical Theory Part I Dialectical Theory Part I.
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Transcript of 1 Dialectical Theory Part I Dialectical Theory Part I.
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Dialectical TheoryDialectical Theory
Part IPart I
Dialectical TheoryDialectical Theory
Part IPart I
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Structure the Structure the Philosophy of CarePhilosophy of Care
Structure the Structure the Philosophy of CarePhilosophy of Care
DBT requires DBT requires
a consistent a consistent philosophy of carephilosophy of care
DBT requires DBT requires
a consistent a consistent philosophy of carephilosophy of care
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Beh
avio
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cien
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Behav
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ence
Beh
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Behav
iora
l Sci
ence Zen Practice
Zen Practice
Zen Practice
Zen Practice
Dialectical PhilosophyDialectical Philosophy Dialectical PhilosophyDialectical Philosophy
Philosophical AssumptionsPhilosophical Assumptions
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Dialectical Philosophy Dialectical Philosophy of Treatmentof Treatment
Dialectical Philosophy Dialectical Philosophy of Treatmentof Treatment
Dialectics AsDialectics As
• PersuasionPersuasion
• World ViewWorld View
Dialectics AsDialectics As
• PersuasionPersuasion
• World ViewWorld View
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Dialectics as PersuasionDialectics as PersuasionDialectics as PersuasionDialectics as Persuasion
A method of logic or argumentation A method of logic or argumentation
by disclosing the contradictions by disclosing the contradictions
(antithesis)(antithesis) in an opponent’s in an opponent’s
argument argument (thesis)(thesis) and overcoming and overcoming
them them (synthesis)(synthesis)..
A method of logic or argumentation A method of logic or argumentation
by disclosing the contradictions by disclosing the contradictions
(antithesis)(antithesis) in an opponent’s in an opponent’s
argument argument (thesis)(thesis) and overcoming and overcoming
them them (synthesis)(synthesis)..
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The universe is so constructed that the The universe is so constructed that the opposite of a true statement is a false opposite of a true statement is a false
statement, but the opposite of a profound statement, but the opposite of a profound truth is usually another profound truth.truth is usually another profound truth.
N. Bohr, quoted in K. Wilber, 1977N. Bohr, quoted in K. Wilber, 1977
The universe is so constructed that the The universe is so constructed that the opposite of a true statement is a false opposite of a true statement is a false
statement, but the opposite of a profound statement, but the opposite of a profound truth is usually another profound truth.truth is usually another profound truth.
N. Bohr, quoted in K. Wilber, 1977N. Bohr, quoted in K. Wilber, 1977
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Appearance is the process of arising Appearance is the process of arising and being and passing away again, a and being and passing away again, a process that itself does not arise and process that itself does not arise and pass away, but is per se, and pass away, but is per se, and constitutes reality and the life-constitutes reality and the life-movement of truth…movement of truth…
[thus] the truth of the process is not to [thus] the truth of the process is not to be found in any of its single phases, be found in any of its single phases, but in its totality (which is no mere but in its totality (which is no mere plurality), the rational rhythm of the plurality), the rational rhythm of the organic whole"organic whole"
HegelHegel
Appearance is the process of arising Appearance is the process of arising and being and passing away again, a and being and passing away again, a process that itself does not arise and process that itself does not arise and pass away, but is per se, and pass away, but is per se, and constitutes reality and the life-constitutes reality and the life-movement of truth…movement of truth…
[thus] the truth of the process is not to [thus] the truth of the process is not to be found in any of its single phases, be found in any of its single phases, but in its totality (which is no mere but in its totality (which is no mere plurality), the rational rhythm of the plurality), the rational rhythm of the organic whole"organic whole"
HegelHegel
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Three Types of Adult ThinkingThree Types of Adult Thinking(Michael(Michael Basseches, 1984)Basseches, 1984)
Three Types of Adult ThinkingThree Types of Adult Thinking(Michael(Michael Basseches, 1984)Basseches, 1984)
• Universal FormalUniversal Formal
• RelativisticRelativistic
• DialecticalDialectical
• Universal FormalUniversal Formal
• RelativisticRelativistic
• DialecticalDialectical
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(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)
• Truth is fixed and unchangingTruth is fixed and unchanging
• The Universe is orderedThe Universe is ordered
• Some individuals have the Truth and Some individuals have the Truth and others do notothers do not
• It is the therapist’s job to help the It is the therapist’s job to help the client arrive at the unfixed, stable client arrive at the unfixed, stable TRUTHTRUTH
• Truth is fixed and unchangingTruth is fixed and unchanging
• The Universe is orderedThe Universe is ordered
• Some individuals have the Truth and Some individuals have the Truth and others do notothers do not
• It is the therapist’s job to help the It is the therapist’s job to help the client arrive at the unfixed, stable client arrive at the unfixed, stable TRUTHTRUTH
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(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)
• Truth is entirely relative and varies from person to Truth is entirely relative and varies from person to person, culture to culture.person, culture to culture.
• No one person’s viewpoint is superior No one person’s viewpoint is superior or or inferior to inferior to another’s.another’s.
• There is no universal order and no Truth.There is no universal order and no Truth.
• It is the therapist’s job to help the client determine It is the therapist’s job to help the client determine what values and opinions are most comfortable or what values and opinions are most comfortable or useful to her or himuseful to her or him
• Truth is entirely relative and varies from person to Truth is entirely relative and varies from person to person, culture to culture.person, culture to culture.
• No one person’s viewpoint is superior No one person’s viewpoint is superior or or inferior to inferior to another’s.another’s.
• There is no universal order and no Truth.There is no universal order and no Truth.
• It is the therapist’s job to help the client determine It is the therapist’s job to help the client determine what values and opinions are most comfortable or what values and opinions are most comfortable or useful to her or himuseful to her or him
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(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)
• Elements of Universal Formal and Relativistic Elements of Universal Formal and Relativistic ThinkingThinking
• Rejects relativistic stance of not striving to find Rejects relativistic stance of not striving to find and create more powerful truths.and create more powerful truths.
• Also rejects universalist notion that an “all Also rejects universalist notion that an “all inclusive truth” is possible.inclusive truth” is possible.
• Elements of Universal Formal and Relativistic Elements of Universal Formal and Relativistic ThinkingThinking
• Rejects relativistic stance of not striving to find Rejects relativistic stance of not striving to find and create more powerful truths.and create more powerful truths.
• Also rejects universalist notion that an “all Also rejects universalist notion that an “all inclusive truth” is possible.inclusive truth” is possible.
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(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)(Basseches, 1984)
• There is Truth There is Truth andand Truth evolves over time.Truth evolves over time.
• Process of arriving at Truth involves discovering Process of arriving at Truth involves discovering what is what is left outleft out of existing truths and creating of existing truths and creating new truths or orderings that include or embrace new truths or orderings that include or embrace what is left out.what is left out.
• It is the therapist’s job to help the client It is the therapist’s job to help the client synthesize polarities, to search for what is left synthesize polarities, to search for what is left out, to both arrive at truth and be willing to let it out, to both arrive at truth and be willing to let it go.go.
• There is Truth There is Truth andand Truth evolves over time.Truth evolves over time.
• Process of arriving at Truth involves discovering Process of arriving at Truth involves discovering what is what is left outleft out of existing truths and creating of existing truths and creating new truths or orderings that include or embrace new truths or orderings that include or embrace what is left out.what is left out.
• It is the therapist’s job to help the client It is the therapist’s job to help the client synthesize polarities, to search for what is left synthesize polarities, to search for what is left out, to both arrive at truth and be willing to let it out, to both arrive at truth and be willing to let it go.go.
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• Search for “what is left out”
• Weave a “web of logic”
• Emphasis on speed, movement, flow
• Search for “what is left out”
• Weave a “web of logic”
• Emphasis on speed, movement, flow
Dialectically-Informed Dialectically-Informed Treatment Strategies of Treatment Strategies of
PersuasionPersuasion
Dialectically-Informed Dialectically-Informed Treatment Strategies of Treatment Strategies of
PersuasionPersuasion
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Dialectical Philosophy Dialectical Philosophy of Treatmentof Treatment
Dialectical Philosophy Dialectical Philosophy of Treatmentof Treatment
Dialectics AsDialectics As
• PersuasionPersuasion
• World ViewWorld View
Dialectics AsDialectics As
• PersuasionPersuasion
• World ViewWorld View
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Dialectics as Process of ChangeDialectics as Process of ChangeDialectics as Process of ChangeDialectics as Process of Change
The process of change The process of change whereby an idea or eventwhereby an idea or event
(Thesis(Thesis)) generates and is generates and is transformed into its transformed into its oppositeopposite
(Antithesis(Antithesis)) and is preserved and and is preserved and fulfilled by it, leading fulfilled by it, leading to a reconciliation of to a reconciliation of oppositesopposites
((SynthesisSynthesis))
The process of change The process of change whereby an idea or eventwhereby an idea or event
(Thesis(Thesis)) generates and is generates and is transformed into its transformed into its oppositeopposite
(Antithesis(Antithesis)) and is preserved and and is preserved and fulfilled by it, leading fulfilled by it, leading to a reconciliation of to a reconciliation of oppositesopposites
((SynthesisSynthesis))
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Functions of Functions of Dialectical PhilosophyDialectical Philosophy
Functions of Functions of Dialectical PhilosophyDialectical Philosophy
• Guides assumptions about the Guides assumptions about the nature of realitynature of reality
• Provides foundation of biosocial Provides foundation of biosocial etiologyetiology
• Balances treatment goalsBalances treatment goals
• Balances treatment strategiesBalances treatment strategies
• Guides assumptions about the Guides assumptions about the nature of realitynature of reality
• Provides foundation of biosocial Provides foundation of biosocial etiologyetiology
• Balances treatment goalsBalances treatment goals
• Balances treatment strategiesBalances treatment strategies
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Dialectics as a World View: Dialectics as a World View: AssumptionsAssumptions
Dialectics as a World View: Dialectics as a World View: AssumptionsAssumptions
• Holistic, connected, and in relationship
• Complex, oppositional, and in polarity
• Change is continual
• Change is transactional
• Identity is relational and in continuous change
• Holistic, connected, and in relationship
• Complex, oppositional, and in polarity
• Change is continual
• Change is transactional
• Identity is relational and in continuous change
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ChangeChange
CoreCore
Problem Solving
Problem Solving
AcceptanceAcceptance
ValidationValidation
Team Consultation
Team Consultation
ReciprocalReciprocalReciprocalReciprocal
Environmental Intervention
Environmental Intervention
Consultation-to-the-PatientConsultation-to-the-Patient
IrreverentIrreverentIrreverentIrreverent
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Translating a Dialectical World View Translating a Dialectical World View into Treatmentinto Treatment
Translating a Dialectical World View Translating a Dialectical World View into Treatmentinto Treatment
Provides foundation of biosocial etiology1. Transactional development and maintenance2. Systemic disorder
Dialectically informs treatment strategies1. Balance of Acceptance vs. Change2. Search for "what is left out"3. Emphasis on speed, movement, flow
Dialectically informs treatment goals1. Emotion regulation2. Interpersonal effectiveness3. Mindfulness4. Distress tolerance
Provides foundation of biosocial etiology1. Transactional development and maintenance2. Systemic disorder
Dialectically informs treatment strategies1. Balance of Acceptance vs. Change2. Search for "what is left out"3. Emphasis on speed, movement, flow
Dialectically informs treatment goals1. Emotion regulation2. Interpersonal effectiveness3. Mindfulness4. Distress tolerance
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Dialectical View of DisorderDialectical View of DisorderDialectical View of DisorderDialectical View of Disorder
Foundation of Foundation of
biosocial etiologybiosocial etiology
–Transactional model of development Transactional model of development and maintenanceand maintenance
–Systemic disorderSystemic disorder
Foundation of Foundation of
biosocial etiologybiosocial etiology
–Transactional model of development Transactional model of development and maintenanceand maintenance
–Systemic disorderSystemic disorder
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BPD results from transaction of BPD results from transaction of biological vulnerability with biological vulnerability with
invalidation over timeinvalidation over time
BPD results from transaction of BPD results from transaction of biological vulnerability with biological vulnerability with
invalidation over timeinvalidation over time A1A1 B1B1
A2A2 B2B2 AAii BBii
A1A1 B1B1
A2A2 B2B2 AAii BBii
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Systemic Disorder DefinedSystemic Disorder DefinedSystemic Disorder DefinedSystemic Disorder Defined
• Defines disorder with respect to Defines disorder with respect to normal functioningnormal functioning
• Assumes continuity between health Assumes continuity between health and disorderand disorder
• Assumes disorder results from Assumes disorder results from multiple rather than single causesmultiple rather than single causes
• Defines disorder with respect to Defines disorder with respect to normal functioningnormal functioning
• Assumes continuity between health Assumes continuity between health and disorderand disorder
• Assumes disorder results from Assumes disorder results from multiple rather than single causesmultiple rather than single causes
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Dialectically-Informed Dialectically-Informed Treatment GoalsTreatment Goals
Dialectically-Informed Dialectically-Informed Treatment GoalsTreatment Goals
ACCEPTANCEACCEPTANCEACCEPTANCEACCEPTANCE CHANGECHANGE CHANGECHANGE
Distress ToleranceDistress ToleranceDistress ToleranceDistress Tolerance InterpersonalInterpersonal EffectivenessEffectivenessInterpersonalInterpersonal EffectivenessEffectiveness
BALANCESBALANCES BALANCESBALANCES
Emotion RegulationEmotion Regulation Emotion RegulationEmotion Regulation MindfulnessMindfulness MindfulnessMindfulness
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The The Overarching Overarching
DBT DBT TargetTarget is...is...
The The Overarching Overarching
DBT DBT TargetTarget is...is...Dialectical SynthesisDialectical Synthesis
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Dialectical SynthesisDialectical Synthesisthe “middle path”the “middle path”
Dialectical SynthesisDialectical Synthesisthe “middle path”the “middle path”
Dialectical AnalysesDialectical AnalysesTruth is sought through efforts to discover Truth is sought through efforts to discover
what is left out of current wayswhat is left out of current ways of ordering eventsof ordering events
Dialectical LifestyleDialectical Lifestylewalking the “middle path” walking the “middle path”
with balanced behavior patternswith balanced behavior patterns Balanced Actions, Emotions and CognitionBalanced Actions, Emotions and Cognition
Dialectical AnalysesDialectical AnalysesTruth is sought through efforts to discover Truth is sought through efforts to discover
what is left out of current wayswhat is left out of current ways of ordering eventsof ordering events
Dialectical LifestyleDialectical Lifestylewalking the “middle path” walking the “middle path”
with balanced behavior patternswith balanced behavior patterns Balanced Actions, Emotions and CognitionBalanced Actions, Emotions and Cognition
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Goals of Treatment by Level of DisorderGoals of Treatment by Level of Disorder Goals of Treatment by Level of DisorderGoals of Treatment by Level of DisorderDialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Dialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
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• DecreaseDecrease–Life-threatening behaviorsLife-threatening behaviors–Therapy-interfering behaviorsTherapy-interfering behaviors–Quality-of-life interfering behaviorsQuality-of-life interfering behaviors
• IncreaseIncrease behavioral skillsbehavioral skills Core MindfulnessCore MindfulnessDistress ToleranceDistress ToleranceInterpersonal EffectivenessInterpersonal EffectivenessEmotion Regulation Emotion Regulation Self-ManagementSelf-Management
• DecreaseDecrease–Life-threatening behaviorsLife-threatening behaviors–Therapy-interfering behaviorsTherapy-interfering behaviors–Quality-of-life interfering behaviorsQuality-of-life interfering behaviors
• IncreaseIncrease behavioral skillsbehavioral skills Core MindfulnessCore MindfulnessDistress ToleranceDistress ToleranceInterpersonal EffectivenessInterpersonal EffectivenessEmotion Regulation Emotion Regulation Self-ManagementSelf-Management
Stage 1 Primary TargetsStage 1 Primary Targets Dialectical SynthesisDialectical Synthesis Severe Behavioral DyscontrolSevere Behavioral Dyscontrol Behavioral ControlBehavioral Control
Stage 1 Primary TargetsStage 1 Primary Targets Dialectical SynthesisDialectical Synthesis Severe Behavioral DyscontrolSevere Behavioral Dyscontrol Behavioral ControlBehavioral Control
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Structure the Structure the Secondary TargetsSecondary Targets
of Treatment of Treatment
DBT selects secondary DBT selects secondary targets by their positions and targets by their positions and
functions on the chain functions on the chain analyses of problem analyses of problem
behaviorsbehaviors
Structure the Structure the Secondary TargetsSecondary Targets
of Treatment of Treatment
DBT selects secondary DBT selects secondary targets by their positions and targets by their positions and
functions on the chain functions on the chain analyses of problem analyses of problem
behaviorsbehaviors
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BiologicalBiologicalSocialSocial
BiologicalBiologicalSocialSocial
EmotionalVulnerability
EmotionalVulnerability
Active PassivityActive
PassivityUnrelenting
CrisesUnrelenting
Crises
Self-InvalidationSelf-Invalidation
InhibitedExperiencing
InhibitedExperiencing
Apparent CompetenceApparent
Competence
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DBT Secondary TargetsDBT Secondary TargetsDBT Secondary TargetsDBT Secondary Targets
IncreaseIncrease
11.. Emotional ModulationEmotional Modulation
2.2. Self-Validation Self-Validation
3.3. Realistic JudgmentRealistic Judgment
4.4. Emotional ExperiencingEmotional Experiencing
5.5. Active Problem-solvingActive Problem-solving
6.6. Accurate ExpressionAccurate Expression
IncreaseIncrease
11.. Emotional ModulationEmotional Modulation
2.2. Self-Validation Self-Validation
3.3. Realistic JudgmentRealistic Judgment
4.4. Emotional ExperiencingEmotional Experiencing
5.5. Active Problem-solvingActive Problem-solving
6.6. Accurate ExpressionAccurate Expression
DecreaseDecrease1.1. Emotional ReactivityEmotional Reactivity2.2. Self-InvalidationSelf-Invalidation
3.3. Crises Generating Crises Generating BehaviorsBehaviors
4.4. Grief InhibitionGrief Inhibition
5.5. Active-PassivityActive-Passivity
6.6. Apparent-onlyApparent-only CompetenceCompetence
DecreaseDecrease1.1. Emotional ReactivityEmotional Reactivity2.2. Self-InvalidationSelf-Invalidation
3.3. Crises Generating Crises Generating BehaviorsBehaviors
4.4. Grief InhibitionGrief Inhibition
5.5. Active-PassivityActive-Passivity
6.6. Apparent-onlyApparent-only CompetenceCompetence
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Goals of Treatment by Level of DisorderGoals of Treatment by Level of Disorder Goals of Treatment by Level of DisorderGoals of Treatment by Level of DisorderDialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Dialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
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STAGE 2STAGE 2
Dialectical SynthesisDialectical Synthesis Quiet DesperationQuiet Desperation Emotional ExperiencingEmotional Experiencing
STAGE 2STAGE 2
Dialectical SynthesisDialectical Synthesis Quiet DesperationQuiet Desperation Emotional ExperiencingEmotional Experiencing
Primary TargetsPrimary Targets
– Decrease Post-Traumatic Stress ResponsesDecrease Post-Traumatic Stress Responses• Distortion/denial of facts of traumaDistortion/denial of facts of trauma• Stigmatization, self-invalidationStigmatization, self-invalidation• Denial/avoidance of traumatic cuesDenial/avoidance of traumatic cues• Dichotomous response styleDichotomous response style
GoalsGoals– Non-traumatizing Emotional Experiencing Non-traumatizing Emotional Experiencing – Connection to the EnvironmentConnection to the Environment
Primary TargetsPrimary Targets
– Decrease Post-Traumatic Stress ResponsesDecrease Post-Traumatic Stress Responses• Distortion/denial of facts of traumaDistortion/denial of facts of trauma• Stigmatization, self-invalidationStigmatization, self-invalidation• Denial/avoidance of traumatic cuesDenial/avoidance of traumatic cues• Dichotomous response styleDichotomous response style
GoalsGoals– Non-traumatizing Emotional Experiencing Non-traumatizing Emotional Experiencing – Connection to the EnvironmentConnection to the Environment
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Goals of Treatment by Level of DisorderGoals of Treatment by Level of Disorder Goals of Treatment by Level of DisorderGoals of Treatment by Level of DisorderDialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & UnhappinessOrdinary Happiness & Unhappiness
Dialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & UnhappinessOrdinary Happiness & Unhappiness
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STAGE 3STAGE 3Dialectical SynthesisDialectical Synthesis
Problems in LivingProblems in Living Ordinary Happiness Ordinary Happiness & Unhappiness & Unhappiness
STAGE 3STAGE 3Dialectical SynthesisDialectical Synthesis
Problems in LivingProblems in Living Ordinary Happiness Ordinary Happiness & Unhappiness & Unhappiness
Primary TargetsPrimary Targets
– Increase Respect for SelfIncrease Respect for Self–Decrease Individual Problems in LivingDecrease Individual Problems in Living
GoalsGoals
–Self Respect Self Respect • Mastery, self-efficacyMastery, self-efficacy• Sense of moralitySense of morality
–Acceptable Quality of LifeAcceptable Quality of Life
Primary TargetsPrimary Targets
– Increase Respect for SelfIncrease Respect for Self–Decrease Individual Problems in LivingDecrease Individual Problems in Living
GoalsGoals
–Self Respect Self Respect • Mastery, self-efficacyMastery, self-efficacy• Sense of moralitySense of morality
–Acceptable Quality of LifeAcceptable Quality of Life
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Goals of Treatment by Level of DisorderGoals of Treatment by Level of Disorder Goals of Treatment by Level of DisorderGoals of Treatment by Level of DisorderDialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & UnhappinessOrdinary Happiness & Unhappiness
Level 4: IncompletenessLevel 4: Incompleteness
Capacity for Joy and FreedomCapacity for Joy and Freedom
Dialectical SynthesisDialectical Synthesis
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & UnhappinessOrdinary Happiness & Unhappiness
Level 4: IncompletenessLevel 4: Incompleteness
Capacity for Joy and FreedomCapacity for Joy and Freedom
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STAGE 4STAGE 4
Dialectical SynthesisDialectical Synthesis IncompletenessIncompleteness Capacity for Sustained Joy Capacity for Sustained Joy
STAGE 4STAGE 4
Dialectical SynthesisDialectical Synthesis IncompletenessIncompleteness Capacity for Sustained Joy Capacity for Sustained Joy
Expanded AwarenessExpanded Awareness
–SelfSelf–Past to PresentPast to Present–Self to OtherSelf to Other
Peak Experiences/FlowPeak Experiences/Flow
Spiritual FulfillmentSpiritual Fulfillment
Expanded AwarenessExpanded Awareness
–SelfSelf–Past to PresentPast to Present–Self to OtherSelf to Other
Peak Experiences/FlowPeak Experiences/Flow
Spiritual FulfillmentSpiritual Fulfillment
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Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & UnhappinessOrdinary Happiness & Unhappiness
Level 4: IncompletenessLevel 4: Incompleteness
Capacity for JoyCapacity for Joy
Level 1: Severe Behavioral DyscontrolLevel 1: Severe Behavioral Dyscontrol Behavioral ControlBehavioral Control
Level 2: Quiet DesperationLevel 2: Quiet Desperation Emotional ExperiencingEmotional Experiencing
Level 3: Problems in LivingLevel 3: Problems in Living Ordinary Happiness & UnhappinessOrdinary Happiness & Unhappiness
Level 4: IncompletenessLevel 4: Incompleteness
Capacity for JoyCapacity for Joy
Stages of TreatmentStages of TreatmentStages of TreatmentStages of TreatmentCommitment and AgreementCommitment and AgreementCommitment and AgreementCommitment and AgreementPre-Treatment Goals:Pre-Treatment Goals:Pre-Treatment Goals:Pre-Treatment Goals:
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BiologicalSocial
BiologicalSocial
Emotional VulnerabilityEmotional Vulnerability (Emotional agony, Falling into the abyss, Loss of control,
task impossibility)
Emotional VulnerabilityEmotional Vulnerability (Emotional agony, Falling into the abyss, Loss of control,
task impossibility)
Self-Invalidation(Self-directed hate & contempt; Dismissal of pain
& difficulty; Unrealistic expectations)
Self-Invalidation(Self-directed hate & contempt; Dismissal of pain
& difficulty; Unrealistic expectations)
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BiologicalBiologicalSocialSocial
BiologicalBiologicalSocialSocial
EmotionalVulnerabilityEmotional
VulnerabilityActive
PassivityActive
PassivityUnrelenting
CrisesUnrelenting
Crises
Self-InvalidationSelf-Invalidation
InhibitedExperiencing
InhibitedExperiencing
Apparent CompetenceApparent
Competence