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

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Behav

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Beh

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Behav

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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


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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• 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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• 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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• 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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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


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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


EmotionalVulnerability

EmotionalVulnerability

Active PassivityActive

PassivityUnrelenting

CrisesUnrelenting

Crises

Self-InvalidationSelf-Invalidation

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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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


– 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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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


– 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


– 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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Level 4: IncompletenessLevel 4: Incompleteness

Capacity for Joy and FreedomCapacity for Joy and Freedom






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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Capacity for JoyCapacity for Joy





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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EmotionalVulnerabilityEmotional

VulnerabilityActive

PassivityActive

PassivityUnrelenting

CrisesUnrelenting

Crises

Self-InvalidationSelf-Invalidation



Apparent CompetenceApparent

Competence

Documents

1 Dialectical Theory Part I Dialectical Theory Part I