DBT: What Does it Mean to Be "Dialectical"?

Dialectical behavior therapy (or DBT) is an evidence-based treatment developed by psychologist Marsha M. Linehan and was designed to help people who sometimes experience overwhelming emotions.

One of the first questions people often ask is: What does it mean to be dialectical? Most say it’s a discussion, dialogue, or manner of speaking between two people or groups. While all are partly true, none capture the core essence of this very important idea. So, let’s explore its meaning, how it applies to DBT, and what the DBT skills can offer you if you or someone you love.

Defining Dialectical

The concept of dialectical thinking was first established by German philosopher Georg Hegel in the 1800s and he was the originator of the thesis —> antithesis —> synthesis model of logic described below.

The developer of DBT, Marsha M. Linehan, describes dialectical thinking or the dialectical process as synthesizing or integrating opposites. In essence, she believes that opposites can be simultaneously true or—in her words—there’s a “kernel of truth” in opposing ideas. When we recognize (and honor) that kernel of truth, we help ourselves and, subsequently, start creating healthier relationships. It’s a way to bring people together.

This can be a very important skill to learn if you are someone who has a lot of all-or-nothing or black-or-white thinking. Sometimes it’s okay to let go of the absolutes (the “musts” and the “shoulds”) and embrace the nuances of life.

We can identify dialectical thinking with a fairly simple formula:

• thesis
• antithesis
• synthesis (<— This is the dialectic.)

Here’s a very easy way to think about the synthesis of opposites:

• Red
• White
• Pink (<— This is the dialectic.)

Or we can use a different color:

• Black
• White
• Gray (<— This is the dialectic.)

One of my favorite examples of dialectical thinking comes from author Glennon Doyle Melton in her 2013 TedX talk, Lessons from the Mental Hospital. She says:

• Life is beautiful.
• Life is brutal.
• Life is brutaful. (<— This is the dialectic.)

Another favorite way to think dialectically comes from Kiera Van Gelder. Kiera is the author of the memoir, The Buddha and the Borderline. (You can buy her book on Amazon.com by clicking here.) She has used this example of dialectical thinking:

• I have borderline personality disorder.
• I don’t have borderline personality disorder.
• Either way, there’s more to me than just a diagnosis. (<— This is the dialectic.)

Marsha M. Linehan suggests that our states of mind can even be dialectical.

• Emotion mind
• Reasonable mind
• Wise mind (<— This is the dialectic.)

In my article titled How to Recover from Borderline Personality Disorder, I discuss a “dialectic of recovery,” or a way to understand recovery from BPD in a way that is balanced. I’d love you for to take a moment and share it with others.

We all have examples of dialectical thinking. As an intensively-trained DBT therapist, I often encourage my clients to come up with their own examples of dialectics in their lives. Marsha M. Linehan has many more examples in her book DBT Skills Training Handouts and Worksheets. (You can buy her book on Amazon.com by clicking here.)

“And” Not “But” in DBT

Another way to think about dialectical thinking is to notice how we talk about ourselves or others.

Are you a “Yes, but…” person? Do you reject ideas by pointing out the potential flaws or by suggesting that the idea isn’t “good enough”?

It’s interesting to think about the language we use each day and how it can make a difference when it comes to our emotional health.

For example, perhaps someone has suggested to you, “Go for a walk. You’ll feel better.” If you’re like most people, you may have responded with something like, “No, that won’t work. I might feel better but it will only last for a few minutes.” Those little buts can keep us stuck in patterns that are not a part of a life worth living.

A commitment to dialectical thinking may help us by learning to respond with something like, “Yes, I’ll go for a walk and if I feel sad again, I’ll go for another walk.” Or maybe we’ll say, “I’m willing to take a walk and see if it helps.”

It’s a small difference in the language that we use and it can be pretty powerful.

This is a dialectical couple—separate and, yet, working together.

The Ultimate Goal of DBT

The ultimate goal of DBT is pretty simple: create a life that is worth living. You are the one who gets to decide what that life worth living looks like. If there’s a particular goal you want to reach, there’s probably a DBT skill to help you.

Thanks to the ideas inspired by Georg Hegel 200 years ago and developed in the 1980s by Marsha M. Linehan, we have a very effective evidence-based treatment for individuals suffering from emotional dysregulation, depression, anxiety, addictions, suicidal thinking, and self-sabotaging behaviors. DBT can help give you the emotional and cognitive freedom you’ve been looking for in your life.

Perhaps today’s the day for you to embrace dialectical thinking.

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Interested in learning more about DBT? I’d love for you to check out My Dialectical Life or my course for family members and friends by clicking here.

Is Exercise a Treatment for Depression in BPD?

For people who are looking for alternatives to medications or for those who are looking to integrate physical and emotional health therapies, exercise may be something to seriously consider.

It’s often encouraging for people with BPD and their families to know that there’s lots of evidence to suggest that exercise can make a positive difference in their moods. In fact, there’s research to show that those suffering from attention-deficit disorder (ADD or ADHD), impulsive behaviors, sleep problems, memory issues, depression, post-traumatic stress disorder (PTSD), and anxiety can all potentially benefit from regular exercise.

The Benefits of Exercise in Treating BPD

As a DBT therapist, I’m always interested in finding different ways to help my clients feel better faster.

Recently I came across an article about exercise as a treatment for attention deficit hyperactivity disorder (ADHD) and the authors concluded that exercise may also be beneficial for individuals with a diagnosis of borderline personality disorder—a research area that received very little attention.

But there are many reasons why exercise might be helpful for people who have been diagnosed with BPD.

We know from research published in 2019 that excessive screen time may put people at a “significantly higher risk of depression.” Another article from 2018 showed that sedentary teens may be vulnerable to an increased risk of depression. If too many hours of gaming, watching Netflix, or using apps like Instagram or Facebook may be contributing to depression we can imagine that getting outside and engaging in exercise might help reduce depressive symptoms—without the side-effects or potential long-term consequences of antidepressant medications.

It’s important to note that teens who are more sedentary are also at a greater risk for feeling lonely. Unfortunately, we know that feelings of loneliness may increase suicide risk. This evidence is another excellent reason to think about the positive benefits of group sports or exercise classes where people have an opportunity to connect socially with others and potentially create friendships.

An evidence-based approach to the treatment depression called behavioral activation can be very helpful when combined with exercise. The authors of this particular research concluded that, “Participants who engaged in more exercise also evidenced greater and faster declines in depression.” You can read more about behavioral activation by checking out this book on the science of behavioral activation by Christopher R. Martell, Sona Dimidjian, and Ruth Herman-Dunn.

We also know that exercise may help reduce the symptoms of depression very quickly. One study published in 2016 concluded that, “Exercise reduced depressed mood 10 and 30 minutes following exercise.” For people who want to manage daily depressive symptoms, we can think about the benefits of a few minutes of exercise twice daily. A quick walk in the morning and then again around noon may help people to manage their energy and remain productive during a major depressive episode.

Finally, we know that regular exercise can help to prevent future depressive episodes. The authors of this 2018 study wrote that, “Relatively modest changes in population levels of exercise may have important public mental health benefits and prevent a substantial number of new cases of depression.”

The Cons of Exercise in Treating BPD

There are also potential obstacles in using exercise to help treat borderline personality disorder.

It’s important to acknowledge that asking someone to exercise during a major depressive episode is like asking them to ride a unicycle uphill in the rain. It’s much easier to stay in bed, binge watch The Office (again), or ruminate about how this feeling may last forever. Even when the pros outweigh the cons, exercise may be emotionally and physically exhausting—especially in the beginning.

It may be also true that sedentary individuals should be cautious in starting any exercise program. When in doubt, I encourage my clients to make an appointment with their doctor or nurse practitioner before undertaking any intense training goals. No one needs to go from zero to CrossFit in one week or even one month. Because stress fractures are not a part of a life worth living, incremental and moderate progress is a reason to celebrate.

Recovery from BPD

The people I work with who have the best prognosis are individuals who prioritize their emotional and physical health. They exercise, pay attention to diet, put themselves to bed at a reasonable time each night, avoid drugs and alcohol, and think about preventative care. Moreover, they recognize the deep connection of body and mind. How we care for our physical health really does affect our emotional well-being.

If you are someone looking for treatment options for BPD or alternatives to traditional treatment, regular exercise may be something to seriously consider.

Today you can ask yourself:

• Is there a small change I can make today to help myself feel better?

and

• Do I need to ask for help in making this change?

Asking for help is one of the bravest things you can do. If you are looking for a DBT therapist, this directory may be a smart place to start.

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Want more? Check out these resources about BPD and DBT:

• My Dialectical Life

• How to Recover from BPD

• Seven Self-Help Ideas for BPD

• Treating BPD Without Medications

Can Dating and BPD Mix? Creating Healthier Relationships When Someone Has Been Diagnosed with Borderline Disorder

As a DBT therapist, sometimes I have clients who wonder:

• Should I be dating while I’m in treatment?
• Will I ever be in a healthy relationship?
• How can I find someone who is validating and supportive?
• Will my partner judge me if I tell them about borderline personality disorder?

These are all great questions.

I encourage my clients to think about their goals when it comes to dating and even marriage—even early in treatment. Because a life worth living means creating or cultivating healthier relationships, I want for my clients to have the tools they need to accomplish this important goal.

Creating healthier and lasting relationships always starts with us—not the other person.

Sometimes we have unrealistic expectations in relationships. If you are looking for the perfect person to make everything all better, you may be in for a very long wait. In my experience, being in love or being loved does not make everything all better. Love certainly doesn’t “cure” BPD, addiction, domestic violence, or any other problems. Other people cannot do the hard work that it takes to recover from borderline personality disorder, depression, anxiety, or another mental health diagnosis.

I believe that it’s impossible to have a healthy relationship unless we define what a healthy relationship looks like.

Here’s a check list of the qualities of someone who has the capacity to be in a healthy relationship.

How many of these are true for you?

☐ I can validate others.

☐ I am comfortable saying no.

☐ I am mindful of others when we are having a conversation.

☐ I don’t expect perfection from others.

☐ I respect myself.

☐ I work hard at not judging others.

☐ I give as well as take.

☐ I don’t try to “rescue” or change others.

☐ I take care of myself (physically, emotionally, financially, and spiritually) so that I can be there for others.

☐ I am compassionate toward others.

☐ I recognize when I am judging others.

☐ I am confident in asking for what I want or need.

☐ I don’t have to be “right” or always get my way.

☐ I don’t apologize for my values or beliefs.

☐ I don’t threaten others—even when I have a right to be angry.

☐ I can be kind toward myself.

☐ I keep my word.

☐ I am responsible and don’t expect others to take care of me.

☐ I am thankful for others in my life.

☐ I don’t give advice unless I ask for permission first.

☐ I work to resolve conflict quickly.

☐ I don’t use others for my sexual gratification.

☐ I check the facts before I make assumptions about what others are thinking or feeling.

☐ I refrain from yelling.

☐ I don’t expect others to anticipate my physical or emotional needs.

☐ I am open to receiving help with problems I cannot solve on my own.

☐ I am accepting of others when they have different values.

☐ I am self-validating.

☐ I don’t have to change to make someone like me.

☐ I don’t make excuses for abusive, mean, or controlling behaviors.

☐ I am truthful with others.

☐ I assume that others are doing their best.

☐ I am proactive about reaching out to others who are important to me.

☐ I am forgiving.

☐ I don’t rely on one person to meet all of my emotional needs.

These ideas don’t apply to only romantic relationships. Many of these attributes can also be important indicators of healthy relationships with friends and even work colleagues.

Of course, there are no perfect relationships. I believe that we are all doing our best and—at the same time—we all have room to grow and change. You have the freedom to make decisions about any changes that may help you to be the partner or spouse you want to become. Don’t allow someone else to tell you what you should or shouldn’t do in relationships. You don’t have to let others decide how your relationship should look.

Using the above check list requires a lot of honesty and self-awareness about areas where we may need additional help. I encourage you to share your answers with the people you care about the most.

Above all else, guard your heart, for everything you do flows from it. —Proverbs 4:23

Finally, please be careful about being in a relationship where violence or the threat of violence occurs. If you are in an abusive or dangerous relationship, please contact the experts at The National Domestic Violence Hotline. They can help you take the first steps toward safety in your relationship. Taking a break from hurtful relationships or remaining single for a predetermined period of time can be a way for you to take care of your emotional health and increase your self-respect.

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Interested in reading more about creating healthier relationships? Please check out some of my favorite books to recommend to my clients and their families.

How to Be Single and Happy: Science-Based Strategies for Keeping Your Sanity While Looking for a Soul Mate
This book is by Jennifer Taitz, PsyD—a super-smart DBT therapist. I love her optimistic and encouraging approach to future relationship success.

The Science of Trust: Emotional Attunement for Couples
John Gottman and his wife are experts at helping couples save their relationships. This is a must-read for anyone who is looking to better understand themselves and others in romantic relationships. Also check out Dr. Gottman’s book The Relationship Cure.

The Highly Sensitive Person in Love: Understanding and Managing Relationships When the World Overwhelms You
Elaine Aron, PhD is the foremost expert in the field of emotional sensitivity. She has several books that may also be beneficial for someone who is in a relationship with an emotionally sensitive person.

Are We Doing the Best That We Can? An Idea from Dialectical Behavior Therapy

Within dialectical behavior therapy (or DBT), there exists many assumptions that therapists and clients are asked to make. The first one is that all people are doing the best that they can.

But is this true? Are others doing the best that they can? We can also ask ourselves, “Are we doing the best that we can?”

It’s an interesting question to explore but, first, there are other assumptions we are encouraged to make in DBT. These include:

• People want to improve.

and

• People need to do better, try harder, and be more motivated to change. (It’s a nice reminder that we all have room to grow and change but we may need a little extra help.)

Most people will say that they are doing the best that they can—at least most of the time. I think that people can also identify with the desire to improve their lives while also realizing that it takes a lot of hard work to change the parts of ourselves we do not like.

If this is true for us, it may also be true for others in our lives.

And there may be some exceptions. For instance, sometimes people really do have the intention to cause harm to us or others. Understanding that most people are doing the best that they can does not mean, however, that we excuse or are quick to forgive others. You already know that it wouldn’t be the wisest choice for us to stay friends with someone who has stolen money from us or taken advantage of us in some other way. The same is true for people who may have physically harmed, abused, or neglected us. We can understand why people may hurt others but that doesn’t mean that we want to continue to remain on the receiving end of someone else’s pain, trauma, or addiction.

If you are in a relationship with someone who intentionally physically or emotionally hurts you, please think about reaching out to an expert who can help you make a smart decision about weighing the pros and cons of staying in that relationship. The compassionate and nonjudgmental people at The National Domestic Violence Hotline can help get you started or you can look for a therapist who specializes in helping couples create healthier relationships. Locating therapists who have been trained by The Gottman Institute can be a great place to start.

If we’re honest with ourselves, we may also think of a time in our past when we intentionally hurt others. This is especially true if we’ve been hurt ourselves. We might think, “I’m going to get back at them,” or “I want him to suffer as much as I have.”

Sometimes we inadvertently harm others when we are in emotional pain. We don’t mean to blow up relationships, invalidate others, yell, threaten, or cause people to worry about us but it does happen. All of us are guilty of this at one time or another. It’s actually a pretty normal part of been alive. If you have hurt someone else (either intentionally or unintentionally) you could apologize and work hard to change any future behaviors that may be harmful toward others.

Of course, it’s a choice to harm others. We don’t have to act on these urges. In fact, refusing to engage in these kinds of urges is a sign of being an emotionally-healthy individual. As a DBT therapist, becoming healthier is an important goal for the people I work with each day.

When I think about the idea that people are doing the best that they can, I often think about the wisdom of writer Maya Angelou:

Do the best you can until you know better. Then when you know better, do better.

I know that this has certainly been true for me as a therapist, wife, sister, and friend. Perhaps you find that it’s true for you or for someone you care about.

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If you’re interested in learning more about DBT, I’d love for you to check out My Dialectical Life—an affordable DBT self-help tool.

I love recommending Marsha Linehan’s book DBT Skills Training Handouts and Worksheets (Second edition), for additional information about assumptions in DBT.

Emotionally Sensitive or Borderline Personality Disorder?

Are you someone who is emotionally sensitive? Have you also been diagnosed with BPD but wonder if it’s an accurate diagnosis?

A diagnosis of borderline personality disorder can be hurtful to many people. When I’ve talked about the diagnosis with many of my clients, they will often ask, “Do you mean that there’s something wrong with my personality?” People may also ask, “Will I have this for the rest of my life?”

In short, no, there is nothing wrong with your personality (really!) and again, no, with good treatment, hard work, and patience most people will find freedom from the symptoms of BPD.

Borderline personality disorder is an imperfect name for a cluster of symptoms that may include:

• mood swings
• suicidal thinking or planning
• depression and/or anxiety
• self-injury
• intense anger
• black and white thinking patterns
• self-hatred
• excessive shame or guilt
• self-sabotaging or self-destructive behaviors
• paranoia or dissociation
• emptiness, boredom, and loneliness

Please note that this is not a complete list of diagnostic criteria and I urge people to be cautious in self-diagnosing. It’s also important to recognize that not all individuals with BPD are alike. Unfortunately, stereotypes of people with BPD exist and these myths make getting treatment more challenging.

Another important characteristic of BPD, however, is often emotional sensitivity.

Emotional Sensitivity in BPD

People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement. —Marsha Linehan, PhD

Most people with BPD are emotionally sensitive but that doesn’t mean that all people who are emotionally sensitive have BPD.

So what’s the difference? And does it really matter?

First of all, it’s okay to be emotionally sensitive in a world where people aren’t always open to emotional sensitivity. There is nothing wrong with being a sensitive person. The goal isn’t to become a less sensitive person. You don’t even have to medicate emotional sensitivity!

The truth is that the world needs people who feel deeply and are in touch with their emotions. Emotionally sensitive people make contributions to the world through design, art, writing, and dance. Many professional healthcare workers are also emotionally sensitive. And what would we do without the therapists, doctors, and nurses who deeply care about others and work so hard to help?

Emotional sensitivity, however, may become a challenge when:

• emotions get in the way of important academic or vocational goals—again and again
• people are hurt and then end positive, healthy friendships or romantic relationships prematurely
• individuals reject or push away their emotional sensitivity (self-acceptance is very healthy)
• people expect to be hurt by others
• emotions keep people from making new friends
• people have a hard time trusting others

If your experience in being emotional sensitive is often hurtful, it’s okay to think about getting a little extra help from a mental health professional. We know that therapeutic approaches such as self-compassion, mindfulness, and self-validation may be very beneficial in helping people care for themselves. Even dialectical behavior therapy may be helpful for people without a diagnosis of BPD.

In the end, it may not make a big difference if someone has BPD or is emotionally sensitive. We can understand that feeling better and creating healthier relationships is what really counts.

Understanding yourself—or someone you love—can lead to more happiness.

Interested in reading more about emotional sensitivity? Please check out some of my favorite books to recommend to my clients and their families.

The Emotionally Sensitive Person: Finding Peace When Your Emotions Overwhelm You
This book is by Karyn Hall, PhD. She’s a terrific DBT therapist in Houston, Texas and specializes in an approach called Radically Open DBT.

The Highly Sensitive Person
Elaine Aron, PhD is the foremost expert in the field of emotional sensitivity. She has several books that are also beneficial for parents and partners of individuals who are emotionally sensitive. Please check out her workbook for highly sensitive people.

The Empath’s Survival Guide
Judith Orloff, MD writes from the perspective of an empath. This is a smart book with lots of practical ideas for navigating emotional sensitivity.

Please note: I participate in Amazon's affiliate program. That means that I may receive a small commission from items purchased through many of the links contained in this article.

Grounding Exercises for Individuals with BPD (Who Sometimes Dissociate)

(Please bookmark this page now. You, or someone you love, may need it in the future.)

Are you someone who feels detached or separated from your surroundings? Do you often have moments where things don’t seem real—especially when life is stressful? Perhaps people tell you that you’re not paying attention or daydreaming when you’re really trying hard to stay connected?

These may be symptoms of dissociation. (Ask your therapist, doctor, or nurse practitioner for more information if you have questions.)

Some people with a diagnosis of borderline personality disorder dissociate often, but for others, it’s rare or something they don’t experience at all. Dissociation may be voluntary (you might “shut down” to protect yourself if someone is yelling or if you have a disturbing memory), or it can be involuntary. A lot of people can tell when they are vulnerable to dissociation and then can take steps to help themselves stay mindfully present. This may be a way to help prevent dissociation or shorten the duration of dissociative episodes.

“Grounding” refers to a set of strategies that can help us to cope more effectively with whatever is happening inside or outside of us. If you are someone who is familiar with the skills from dialectical behavior therapy, you may already know about some of these ideas.

Here are some ideas to help you ground yourself with your five senses:

Taste
• Tasting something warm like an herbal tea may be soothing.
• Or you could use something cold like a popsicle, ice, or a frozen drink (like a Slurpee or an Icee).
• You might also decide to ground with something that tastes sour or bitter (a lemon wedge or a piece of sour candy could help).

Touch
• Holding or petting your dog or cat may help you to feel “real” and in control.
• You could also touch something that is soothing (a favorite river rock or a photograph of someone you love).
• Massage your scalp.
• Go barefoot outside.
• Sometimes heat helps people. If you have a heating pad or a hot water bottle, you could try that as a way of grounding yourself.
• Using a weighted blanket might be another way for you to feel safe and cope with dissociation.

Scent or Smell
• What is a perfume or scent that makes you happy? Now is the time to use it.
• You can make your entire home smell like a French or Spanish garden if you drop a little lavender oil in a pot of simmering water.
• Baking cookies or bread can also create a relaxing and soothing aroma.
• Go outside and smell the air. Can you smell the grass? Can you tell if it’s about to rain or snow?

Sound
• Listen to music that makes you happy at full volume. (Check out these songs if you need ideas.)
• Call someone who has a soothing voice and talk to them for five minutes.
• Sing loudly.
• Put on your headphones or earbuds and listen to a podcast about DBT. (Don’t do anything else. Just listen.)
• Go to a quiet room or shut off any potential sources of noise. Allow yourself to be quiet for a few moments.

Sight or Vision
• Find pretty Instagram accounts or start an Instagram account where you collect relaxing images.
• Look at old photographs that create feelings of happiness and connection.
• Watch videos of baby animals playing. (Corgi videos increase my happiness.)
• Paint or color. Create something pretty now.

Movement
• Jump on a rebounder or trampoline. (I have a bellicon rebounder in my office. I love it!)
• Use a balance board.
• Practice gentle stretching.
• Do a headstand.
• Run up and down your stairs as quickly as you can.
• Stomp your feet—hard.
• Practice progressive muscle relaxation.

Want more? Check out these resources about BPD and DBT:

• My Dialectical Life

• BPD Crisis Resources

• Seven Self-Help Ideas for BPD

• Changing Your Emotions with Music

• Coping Statements for Self-Harming Behaviors

Please note: I participate in Amazon's affiliate program. That means that I may receive a small commission from items purchased through many of the links contained in this article.

Helpless or Hopeless? | Borderline Personality Disorder Experiences

Many people with a diagnosis of borderline personality disorder will, at times, identify with the following descriptions of their experience:

• I cannot cope as well as others.
• I need more help than most people.
• People need to be near me in order for me to regulate my emotions.
• When people leave, I feel empty.
• I don’t like who I am.
• I cannot be helped.
• I feel disconnected from others.
• I am a disappointment.
• I cannot trust others.

It’s important to note that even people who do not have a mental health diagnosis will say these things to themselves on tough days. Individuals who have a lot of self-confidence or believe in their ability to solve problems and be successful have moments where they believe that they are “not enough” or feel misunderstood.

In the late 1960s, psychologist Martin Seligman began to develop a theory about a behavior he called “learned helplessness.” He believed that people could learn how to feel helpless through a series of life events or circumstances. These catalysts for learned helplessness might include early abuse or neglect or it may occur due to a traumatic event or even through developmental trauma—any recurring childhood adversity such as living with a chronic illness, frequent moves or changes in schools, or long-term exposure to domestic violence.

Within the framework of dialectical behavior therapy (or DBT)—an evidence-based treatment for emotional dysregulation—we often think of the role of traumatic invalidation in the lives of people who are suffering with challenges such as suicidal thinking or self-injurious behaviors. Traumatic invalidation is any invalidating event that continues to have negative consequences for the individual long after the trauma has ended. Examples of traumatic invalidation may include being the child of a parent addicted alcohol, repeated bullying in middle school, or growing up in a home where the emotional needs of a sensitive child were either ignored or dismissed.

Thankfully, there are many excellent treatments to help individuals move from a place of learned helplessness to learned hopefulness. We might even think of hopefulness as a crucial life skill that we can nurture and develop over time. DBT is just one treatment that may be effective (in fact, self-validation and self-acceptance are coping strategies I teach my clients) but psychodynamically-based approaches such as mentalization-based treatment or transference-focused psychotherapy may also help to unravel the knots that keep people from believing that they be both happier and healthier. Supportive treatment with a focus on self-compassion is something else that can be very beneficial for people who are struggling with the idea that life will always be challenging. In particular, I love recommending the work of Christopher Germer, PhD.

I encourage people coping with symptoms of BPD (as well as their families) to imagine that they are neither helpless nor hopeless. There are small choices you can make today to help yourself feel better. You are worthy of a life-changing recovery.

Your past doesn’t have to dictate your future.

Interested in reading more? Check out:

• Why Validation Matters—an interview with therapist Corrine Stoewsand

• How to Recover from BPD

• Coping with Emotional Crises

• Why Do People with BPD Feel Empty?

Please note: I participate in Amazon's affiliate program. I may receive a small
commission from items purchased through many of the links contained in this article.

Should Family Members Learn Dialectical Behavior Therapy?

In 2011, when I created a daily email list where I teach a skill from dialectical behavior therapy each day, I saw individuals with a diagnosis of borderline personality disorder (BPD) as the primary audience but over the years, I’ve learned that family members and friends need dialectical behavior therapy (DBT), too.

Living with someone who has been diagnosed with BPD can be full of ups and downs. When one family member is suffering with intense and ever-changing emotions, most loved ones or caregivers are thrown into the chaos that results from unrelenting crisis after unrelenting crisis.

It's so painful for everyone involved. Until people get the help they need, the stress can be overwhelming.

You are not alone.

Friends and family members often wonder, "I'm not the one who needs help. Do I really need these skills?"

But most families need both education and support when it comes to navigating treatment options and finding experts who can help. A research article published in 2019, showed that, “…a trusting and collaborative relationship between carers, nurses and health professionals demonstrated improved outcomes for the carer and consumer.” Because BPD can be such a stigmatized diagnosis, another article published in 2015 noted additional needs for family support, education, and even training.

BPD is—ultimately—a family problem with a family solution.

DBT isn't just for the person with the problem; it's for anyone who has a desire to cope more effectively with the challenges that often occur when one is living with someone who has a mental health diagnosis.

Learning just a few DBT skills can help you feel more relaxed, in control of your own reactions, and mindful of your emotions. If your son, daughter, or spouse is learning DBT with a trained mental health professional then you can begin to share a unique therapeutic language that will lead to greater understanding, trust, and healing. The changes you make in taking care of yourself can help those you love.

As an intensively-trained DBT therapist, I want for you to find the peace you are seeking.

If you care about someone with BPD, please check out my family course here. There is help. There is hope.

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If you are looking for additional information on helping a family member who has been diagnosed with BPD, please check out these books.

• The BPD Wellness Planner for Families by Amanda L. Smith

• The Power of Validation by Karyn Hall and Melissa Cook

• Genuine Validation: Compassionate Communication That Transforms Difficult Relationships at Home and Work by Corrine Stoewsand

• The Highly-Sensitive Child: Helping Our Children Thrive When the World Overwhelms Them by Elaine Aron

Please note: I participate in Amazon's affiliate program. That means that I may receive a small commission from items purchased through many of the links contained in this article.

An Interview with Corrine Stoewsand, PhD—Therapist and Author of Genuine Validation

Yay! I love new books that I can recommend to my clients and their families. Please share this book with others. —Amanda L. Smith, LCSW

Please tell us about you and your book. How did you get started?
I started thinking about writing a book on this subject over 8 years ago when I was teaching and developing a lot of mindfulness programs. One day I was contemplating how to explain all the ways to validate and there was a moment when the chapter titles seemed to just cascade into my mind and I felt this urgency to put this together (Presence, Acceptance, Empathy, Compassion, Wisdom, and Respect). At that time many of the teachers and trainers in Dialectical Behavior Therapy (DBT) were talking about levels of validation and giving them numbers that we were expected to memorize. I don’t really connect with numbers as much as I do with words and I remember being very judgmental about having to identify the type of validation by its number. I think that is what starting to make me think about finding the right words to categorize, remember, and understand different aspects to validation. These words organized everything for me.

Who did you have in mind as you were writing your book?
I had many people in my head accompanying me through the book – family members, colleagues, students, clients, teachers, friends… All the examples come from real people with the names and perhaps a detail changed to protect their identity fully. I have known many people who were sensitive to the pain of invalidation and I thought a lot about them. I have been teaching family workshops for 15 years—classes for people with a loved-one touched by borderline personality disorder.

What is validation?
Validation is the act of corroborating or confirming that a person’s internal experience (including feelings, emotions, thoughts, desires, etc.) is important, authentic, legitimate, understandable and/or that it makes sense. It is an important concept that Marsha Linehan developed in a robust form in her treatment, Dialectical Behavior Therapy for persons who are emotionally sensitive, vulnerable and who can suffer intense emotional dysregulation.

Are some people naturally validating? 
I have met some people who are amazing validators to everyone around them including themselves. It seems some people are born and raised with it and it just comes naturally. On the other hand, I have also met some people who suffered a terribly invalidating environment and, if you ask them, they are able to turn around every invalidating comment into a kind, supportive and validating response. Nobody taught them but they have an innate empathy and deep sensitivity.

Dr. Stoewsand is the author of Genuine Validation.

How has validation made a difference in your own life?
When I first began to understand validation, it was a life changer. It was the single most important social-emotional skill I ever learned. When I really got it I felt like I knew what to say and how to say things to other people. I improved my own confidence and my ability to communicate with others, including my own family. I learned to stop giving advice. I stopped scolding others and telling them what they are doing wrong. I understood how patterns of invalidating responses led to so much insecurity, confusion, suffering, and chronic mental illnesses which made validation skills all the more important and powerful.

What advice would you give to someone who is learning how to validate others?
The very first baby steps would be to:

1. Learn what is invalidating and stop doing it. Do not give unsolicited advice, do not criticize others, and do not emit judgments and evaluations as if they were facts.

2. Just start by listening fully without interruption and try to be open and empathic of the other person’s experience.

Is there a "perfect" or "right" way to validate others?
There is only one person who gets to decide if the validation was “right.” That is the person who is being validated.

Who has inspired your work?
“My families” are my greatest source of inspiration. What I mean is that I have been teaching workshops for family members of persons diagnosed with borderline personality disorder every week for over a dozen years. Of all the skills that I teach, validation is the most important and the most transformative.

Family members, mostly parents of young adults, arrive to the first couple of classes desperate, anxious, and confused. By the end of the course most of the families have begun to experience transformations in their relationships. They are hopeful for the first time in years. I leave every class filled with inspiration for the opportunity to touch the lives of so many families. I don’t know who is more grateful – them or me.

What's next for you in your work?
The book is about to be published in Spanish – which is the language in which I have been teaching this subject for the past 15 years. I am working on my next book with a colleague which includes all the skills that we teach in our family workshops in Buenos Aires, Argentina. I am also planning an online course to accompany the book for people who want more experiential learning.

I hope to reach many more people who are interested in having deeper relationships and healthier communication. This is an era in which we urgently need to develop empathic connection and compassion communication to counter the historic political economic, technological, and environmental challenges that we are facing today.

Congratulations, Dr. Stoewsand! Check out her book by clicking here.

Please note: I participate in Amazon's affiliate program. That means that I may receive a small commission from items purchased through many of the links contained in this article.

How to Recover from Borderline Personality Disorder

Most people with a diagnosis of BPD want quick and lasting relief from their symptoms that may include depression, anxiety, feelings of hopelessness, difficulty controlling anger, self-sabotaging behaviors, suicidal thinking, self-injury, and substance abuse.

While you may not have asked for BPD, you are responsible for taking steps to help yourself feel better.

Recovery from BPD requires us to:

• Work exceptionally hard in therapy or treatment

and at the same time

• Be patient with ourselves

Dialectical behavior therapy (DBT) is an evidence-based treatment for BPD. That means that there is lots of evidence to show that it is highly effective in helping people get better and stay better.

Within DBT we strive for the synthesis of opposing views and ideas so that we can let go of black and white thinking patterns.

That synthesis (or balance) is most commonly referred to as Wise Mind.

Wise Mind is a place where we are acting neither out of Emotion Mind nor Reasonable Mind. We honor both but cling to neither. It's here where we begin to let go of some of our black and white thinking and find room for a middle path. You already know that this is a much healthier place to live.

Finding the dialectic between the two has been challenging.

Work exceptionally hard in therapy or treatment

People who keep a diary card every day, make every therapy appointment, consistently reach out and ask for help, and put their recovery first will see some pretty significant (and lasting) results anywhere between six and twelve months. Having a mental health diagnosis can be emotionally and fiscally devastating and from a relational and financial perspective, making an investment in an evidence-based treatment like DBT can yield great returns.

This same idea is true for any goal we set in life. The harder we work, the more results we'll see. The greater the effort, the richer our reward. Hard work really does pay off.

Be patient with ourselves

The other side of working really hard to get better in the fastest time frame possible is to be patient.

Being patient means taking the time (even if it takes years) to figure out what works, what doesn't, and how we can learn and grow from our mistakes. We learn from failure in a way that we do not learn from our successes.

Patience also teaches us an important lesson in watching life unfold in just the way it was meant to transpire.

What to expect in recovery from BPD

Even though we'd like for things to be different, recovery simply doesn't happen in a nice linear and predictable way. It's usually full of encouraging starts, disappointing stops, and progress that can sometimes be challenging to spot even on the best of days.

People with a diagnosis of BPD are often under a great deal of pressure to change quickly. For example, spouses may threaten divorce or well-meaning parents may insist that their child return to college shortly after a suicide attempt. For some people, these may be effective motivators for change but for others it will only be an impediment that will stall recovery.

The secret is in honoring the dialectic between pushing for hard work and being exceptionally patient with ourselves or someone you love. The bigger secret is to know when to push and when to practice patience.

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Interested in learning more? Check out:

• Can You Diagnose Yourself with BPD? Pros and Cons of Self-Diagnosis

• 101 Coping Statements for Self-Harming Behaviors

• BPD Grounding Exercises

• Emotionally-Sensitive or BPD?

Are you ready to get the help you need today? Reach out to me at amanda@hopeforbpd.com.