Dialectical Dilemmas

This article is by Tom Horvath, PhD, ABPP and published by Practical Recovery


Dialectical is a word with a long history (back to the Greeks), but for now let’s define it as “focusing or acting on the interaction of opposing forces or ideas.” Dialectical Behavior Therapy (DBT) identifies and addresses three common dialectical dilemmas, in order to improve emotional self-regulation, one of the primary goals of DBT. DBT can be helpful for individuals in whom large and rapid emotional swings (e.g., from love to hate) are common, painful, and harmful.

The first of the dialectical dilemmas involves being emotionally vulnerable (either at present, or over a lifetime as a result of being emotionally more sensitive than average), but then downplaying the intensity of emotions. Typical self-statements are “this won’t be that hard” or “I should be able to manage this.” As a result we can swing back and forth between intense emotions, and berate ourselves for not coping better or claiming we are not actually having the intense emotions.

The second dilemma occurs when we are in the midst of a set of crises that make each other worse (i.e., life is chaotic), and because of the need for crisis management there is little time or energy for addressing the emotions and losses involved. As a result emotional self-care and grieving do not occur sufficiently.

The third dilemma involves over-estimating how well we are going to cope with stresses and solve problems. As a result, as stress builds up we can flip-flop from “I can handle it” to sinking into passivity and doing little or nothing (and we might attempt to get others to solve our problems).

Whatever the dilemmas we may face, ideally we can find a “middle way.” We could accept the intensity of our emotions, the high level of stress we face, and our limited ability at present to cope with these situations. We could accept these facts without berating or demeaning ourselves. We could also not give up our efforts to address our emotions and cope with situations in our world, however modest our success is. If we can work in the middle way, rather than swinging back and forth between one side of the dilemma and the other, in time we will be overloaded less frequently and painfully.

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