This article situates Dialectical Behavior Therapy relative to Cognitive Behavioral Therapy, dialectical philosophy, Zen/Mindfulness, and social movements. It lays out the limits of DBT, and shows why it is an improvement over (the dominant) CBT (which commenters seem to confuse it with).
Even if you're not interested in any therapy at all, it helps to understand the distinctions and how this therapy works, because it's close to what nurturing kids or friends or colleagues requires - closer than the pretend worlds of CBT or the hand-waving of hope groups.
This article and DBT in particular highlight the key dynamic for nurturing: understanding and sympathizing with one's difficulty, while getting one to take personal responsibility by showing practical ways to actually do that.
A lot sounds like basic socialization that should come from culture, but traditional culture has been generally shredded, and online culture is toxic, so I'm glad some of the wisdom is being captured and conveyed.
STEM/technical people will find the dialectic aspect difficult, since it's embracing conflicting terms/concepts. Just think of it like differentiation and integration: using a delta to identify common features alongside the conflicting ones.
(If I had any criticism of DBT and this article, it's that DBT (and CBT) aim to heal and maintain health, but doesn't actually address or treat the wide variety of injuries; it's nursing, not doctoring.)
I found this fun and interesting. It's a bit long, but it felt like there was a lot to build out. Doing that reading while not knowing where things are going is tough, but I found the reward, the synthesis of different sides, to be a surprisingly good conclusion to the piece.
And just having the pleasure of this paragraph, I think, will impact me forever:
> Most people I spend time with — leftists prone to anxiety and depression — are skeptical of "self-improvement." Many of us, following the critic Mark Fisher, think that depression reflects an encounter with the harshness of reality, rather than a merely pathological distortion. We definitely want to feel better, but we don’t want to be hijacked by acronyms or worksheets or positive thinking in the process. We try to attribute suffering to crappy world systems rather than personal deficiencies. We find ways to trust that our negative emotions signify something other than our own inadequacy — that they contain a deeply rational response to the world’s irrational injustice.
There's a pattern to suicide: people don't commit suicide merely because they're miserable, or because they think their situation is hopeless. It is also necessary to believe that you have lots of options, but all of them are unacceptably bad.
Indian sustenance farmers didn't have high rates of suicide, until they got access to microcredit.
Schizophrenics, who often have distorted feelings of agency (e.g. seeing something on the TV, they may feel with deep certainty that they somehow caused that thing to happen), have sky-high suicide rates.
Men, for whatever reasons, have higher feelings of agency than women. And men of course have much, much higher rates of suicide than women - even though in terms of pain, misery etc. it's not clear women have it that much better.
Black Americans and Native Americans in the US both have a history of being subject to racism and oppression. But the former, stereotyped by racism as being basically good for nothing, have low suicide rates. Native Americans, whose racist oppression was historically accompanied by painting them as great noble spirits etc. have sky-high suicide rates. Economic conditions don't explain the disparity well, difference in sense of agency does.
So, blaming things outside yourself, whether correctly or not, may be a defensive psychological reaction to misery. Fisher thought something could be done; if he had had a weak sense of agency, he wouldn't have done all that writing for one thing.
It's a fantastic paragraph. It lays one of Fisher's most striking claims at the feet of the reader and simply asks, "And you agree, right?"
If you do, sally forth, you've probably walked down this road before. You know it well. If you don't, it gracefully folds in to give you a glimpse into how the other side lives and thinks with just enough detail to feel real. Either way is a good time in a sense.
> We try to attribute suffering to crappy world systems rather than personal deficiencies.
> We find ways to trust that our negative emotions signify something other than our own inadequacy — that they contain a deeply rational response to the world’s irrational injustice.
Believes suffering is caused by impermanent and changeable features of the world, and that the only alternative is a personal "deficiency"? Believes negative emotions are rational and arise due to clear causation by external forces? I've heard that one before.
What the article calls "dialectic" is called "non-dualism" in Buddhism; the author has gotten to the point where they recognize them, but maybe not to the important part which is to remember they aren't real. (Note that something being real or not real is also an incorrect dualism.)
That's not very promising. Most versions of Zen are made-up export products designed to flatter Westerners. Kind of like the samurai movie honor bushido stuff.
(Japanese people think Buddhism is a thing you do at funerals. If you get into it more seriously, I vaguely understand it's mostly a religion that tells you not to have sex.)
In this case the more important question is whether it actually works.
> Most versions of Zen are made-up export products designed to flatter Westerners. Kind of like the samurai movie honor bushido stuff.
I don't think so. If you go to a zenkai or a sesshin held by a western zendo, and then go to one at a Japanese temple, you won't notice too many differences, apart from the language. Many American zen teachers trained in Japan at some point, or their teachers did, and they brought these practices back more or less verbatim. In fact, in many American zendos, students chant the same sutras, _in Japanese_, as in Japanese zendos. Plus, there are regulatory bodies, like the Soto Zen school, that certify affiliated western zendos as authoritative. It's not made-up, it's hardly an "export product," and it certainly isn't designed to flatter anyone.
That seems like a rambling, self-published book by a Vajrayana practitioner with an axe to grind against Zen, for some bizarre reason. But there are plenty of real books about the rise of American Zen, or Buddhism in the west, that are well-researched. _Zen in America_ by Helen Tworkov is one.
> Japanese people think Buddhism is a thing you do at funerals.
Not at all. Buddhism, and Zen especially, permeate Japanese culture very deeply. Japanese aesthetics, architecture, landscape design, visual art, calligraphy, the tea ceremony, and the martial arts, have all been strongly influenced by Zen. And it's all over pop culture, too—just think of how pervasive Daruma dolls are—that's Bodhidharma, the founder of Zen. Sure, Buddhism is at funerals, but it's everywhere, else, too.
> If you get into it more seriously, I vaguely understand it's mostly a religion that tells you not to have sex.
Maybe you're thinking of Christianity? Unless you're a monk, attitudes towards sex are fairly liberal in Buddhism. There are bodhisattva precepts that caution against misusing sex, but nowhere does anyone tell you not to have it. In fact, it's largely unconcerned with it, let alone "mostly a religion that tells you not to have" it. Western religions are very concerned with telling you what to do and not do, but Buddhism is concerned with liberation.
> > Japanese people think Buddhism is a thing you do at funerals.
> Buddhism, and Zen especially, permeate Japanese culture very deeply. Japanese aesthetics, architecture, landscape design, visual art, calligraphy, the tea ceremony, and the martial arts, have all been strongly influenced by Zen. And it's all over pop culture, too—just think of how pervasive Daruma dolls are—that's Bodhidharma, the founder of Zen. Sure, Buddhism is at funerals, but it's everywhere, else, too.
Your statement may be true but so is the grandparent's. (Although I agree that there isn't much about not having sex; mainly you hear about monks don't eat meat, or at least not while people are looking)
As someone who’s likely soon wrapping up 18 years of psychodynamic-based therapy, where I learned to ask all right questions (and opportunity cost could have bought a brownstone in brooklyn), but didn’t get any actionable answers, I really appreciated the timeliness of this article.
I like CBT. I just don't do it enough. I do like it when I do it though. (behavioral experiments). I think it is important to have goals and results and feedback, as without those, you'd be wandering aimlessly challenging your thoughts/beliefs to no end. I hope to get more consistent in it.
I am generally very good at forming and maintaining habits, but often life gets in the way. Also, it is good to have an external view, sometimes you feel like you're doing shit when you're not. I need an accountability partner I guess. Let's see how it goes. Thanks.
As a practicing Psychotherapist for over 25 years, I never came across anyone who practiced DBT.
I had heard that some Psychiatric nurses liked it.
I always understaood that it was a modern extention of CBT. The go to, cheap as chips, not very good, therapeutic self brainwashing technique.
Big claims of curing depression, eating disorders and a raft of other mentally distressing diagnoses in a miraculous 6 weeks, have all fallen by the wayside. After 10 weeks the symptoms always return and the client is not fixed in any way.
governments love it, because its cheap, and they can say they are addressing the mental health crisis in society, of which, they are solely and fully responsible for.
The psychologist undergraduate go to, to prove that CBT works and they are good at using graphs and figures.
A new client felt 10/10 depressed at his first session. At session 3 he was 8/10 depressed. At session 6 he was 6/10 depressed. clearly CBT cures depression by filling in a few forms. Write that up in your dissertation and get your degree.
Could this possibly be due to the fact that the client, for the first time in his life, actually had the opportunity to talk about his problems. Nothing to do with being taught how to use a CBT model.
The incessant form filling is totally, for me anyway, anti-therapy.
I worked in many different organisations over the years that banned outright the use of CBT.
Concerning how widespread DBT is: In the last five years in grad school, I knew many people doing a psychology PhD and DBT was one of the major training focuses for their clinical psychology curriculum. I would say the characterization given by this article matches very closely with what they told me over the last ~5 years.
My impression of DBT compared to CBT, based on what my friends told me, is that DBT is much more confrontational. I remember one friend even specifically said that it took her a long time to "unlearn" the therapist's natural response to affirm and validate, but then redirect negative feelings with skills.
But psychodynamic is directionless and in a way that never seems to help either, and hides behind the lack of measurement. It could be amazing with a wise Irvin Yalom figure, but 99% of us aren't interacting with somebody that thoughtful.
How well, generally, do you think therapy works?
What works best?
Honestly, as somebody who filled out way too many CBT forms - there's a good chance you only get the score improvement because people don't want to get the provider in trouble with their employer.
The scoring sheets are, pretty much, bullshit. So are the endless worksheets.
I'm not even sure I can follow what I'm reading. It complains that evil capitalists started manipulating people in the 20th century so they wouldn't want to unionize, and that savvy leftist psychologists realized that these same skills could be used to self-manipulate patients into not wanting to cut themselves?
That isn't an accurate summary of what the article says. The part you mentioned is telling about early manegerial sciences trying to fix workplace issues that arose during industrialization. The article itself doesn't offer any stance towards whether that was a good or a bad thing, which it would need to do if it "complains", as you said.
The article is mainly a nuanced perspective on DBT (Dialectic Behavioral Theory) and it focuses on the conundrum of patients finding themselves between finding value in their identity as an victim, the consequenxes it has for them and the condition which contributed to that trauma that remain unaddressed if they do just that:
> People often share a manifesto called the “Emotional Distress Bill of Rights” (subtitled “#RightToBeSuffering”). “I should not be held so personally responsible to take actions to be better,” it says. “Others (and systems) should be held far more accountable for better treatment of me.”
Imagine you live in an ancient society where cannibalism exist. If cannibals tried to eat you and you have a trauma of surviving that, you could go at the problem in two ways: (1) Blame a society that allows cannibalism to exist and try to reshape said society or (2) Focus on yourself and figure out how to move on from the trauma, how to deal with the consequences of said trauma and so on.
Doing the latter without changing the circumstances that lead you becoming victimized can feel like you become complicit in perpetuating the problem (in our example cannibalism).
This, other than the retelling of the origin story of that form of therapy, is probably the main point this article makes.
Worth reading for all.
This article situates Dialectical Behavior Therapy relative to Cognitive Behavioral Therapy, dialectical philosophy, Zen/Mindfulness, and social movements. It lays out the limits of DBT, and shows why it is an improvement over (the dominant) CBT (which commenters seem to confuse it with).
Even if you're not interested in any therapy at all, it helps to understand the distinctions and how this therapy works, because it's close to what nurturing kids or friends or colleagues requires - closer than the pretend worlds of CBT or the hand-waving of hope groups.
This article and DBT in particular highlight the key dynamic for nurturing: understanding and sympathizing with one's difficulty, while getting one to take personal responsibility by showing practical ways to actually do that.
A lot sounds like basic socialization that should come from culture, but traditional culture has been generally shredded, and online culture is toxic, so I'm glad some of the wisdom is being captured and conveyed.
STEM/technical people will find the dialectic aspect difficult, since it's embracing conflicting terms/concepts. Just think of it like differentiation and integration: using a delta to identify common features alongside the conflicting ones.
(If I had any criticism of DBT and this article, it's that DBT (and CBT) aim to heal and maintain health, but doesn't actually address or treat the wide variety of injuries; it's nursing, not doctoring.)
I found this fun and interesting. It's a bit long, but it felt like there was a lot to build out. Doing that reading while not knowing where things are going is tough, but I found the reward, the synthesis of different sides, to be a surprisingly good conclusion to the piece.
And just having the pleasure of this paragraph, I think, will impact me forever:
> Most people I spend time with — leftists prone to anxiety and depression — are skeptical of "self-improvement." Many of us, following the critic Mark Fisher, think that depression reflects an encounter with the harshness of reality, rather than a merely pathological distortion. We definitely want to feel better, but we don’t want to be hijacked by acronyms or worksheets or positive thinking in the process. We try to attribute suffering to crappy world systems rather than personal deficiencies. We find ways to trust that our negative emotions signify something other than our own inadequacy — that they contain a deeply rational response to the world’s irrational injustice.
Fisher died by suicide in 2017.
https://en.wikipedia.org/wiki/Mark_Fisher
Be careful here.
There's a pattern to suicide: people don't commit suicide merely because they're miserable, or because they think their situation is hopeless. It is also necessary to believe that you have lots of options, but all of them are unacceptably bad.
Indian sustenance farmers didn't have high rates of suicide, until they got access to microcredit.
Schizophrenics, who often have distorted feelings of agency (e.g. seeing something on the TV, they may feel with deep certainty that they somehow caused that thing to happen), have sky-high suicide rates.
Men, for whatever reasons, have higher feelings of agency than women. And men of course have much, much higher rates of suicide than women - even though in terms of pain, misery etc. it's not clear women have it that much better.
Black Americans and Native Americans in the US both have a history of being subject to racism and oppression. But the former, stereotyped by racism as being basically good for nothing, have low suicide rates. Native Americans, whose racist oppression was historically accompanied by painting them as great noble spirits etc. have sky-high suicide rates. Economic conditions don't explain the disparity well, difference in sense of agency does.
So, blaming things outside yourself, whether correctly or not, may be a defensive psychological reaction to misery. Fisher thought something could be done; if he had had a weak sense of agency, he wouldn't have done all that writing for one thing.
But not before encouraging everyone to blame things on "capitalism" which even Marx would have said would be solved by more capitalism.
(Namely cost of living in Anglo countries, which is largely caused by their practically feudalist land usage policies.)
What edition of Marx are you reading?
I mean, late stage capitalism hasn't been working out so great; so he kind of has a point.
It's a fantastic paragraph. It lays one of Fisher's most striking claims at the feet of the reader and simply asks, "And you agree, right?"
If you do, sally forth, you've probably walked down this road before. You know it well. If you don't, it gracefully folds in to give you a glimpse into how the other side lives and thinks with just enough detail to feel real. Either way is a good time in a sense.
> We try to attribute suffering to crappy world systems rather than personal deficiencies.
> We find ways to trust that our negative emotions signify something other than our own inadequacy — that they contain a deeply rational response to the world’s irrational injustice.
Believes suffering is caused by impermanent and changeable features of the world, and that the only alternative is a personal "deficiency"? Believes negative emotions are rational and arise due to clear causation by external forces? I've heard that one before.
https://en.wikipedia.org/wiki/Three_marks_of_existence
What the article calls "dialectic" is called "non-dualism" in Buddhism; the author has gotten to the point where they recognize them, but maybe not to the important part which is to remember they aren't real. (Note that something being real or not real is also an incorrect dualism.)
DBT is based on Zen Buddhism, created by a psychologist suffering from borderline personality disorder
That's not very promising. Most versions of Zen are made-up export products designed to flatter Westerners. Kind of like the samurai movie honor bushido stuff.
https://vividness.live/zen-vs-the-u-s-navy
(Japanese people think Buddhism is a thing you do at funerals. If you get into it more seriously, I vaguely understand it's mostly a religion that tells you not to have sex.)
In this case the more important question is whether it actually works.
> Most versions of Zen are made-up export products designed to flatter Westerners. Kind of like the samurai movie honor bushido stuff.
I don't think so. If you go to a zenkai or a sesshin held by a western zendo, and then go to one at a Japanese temple, you won't notice too many differences, apart from the language. Many American zen teachers trained in Japan at some point, or their teachers did, and they brought these practices back more or less verbatim. In fact, in many American zendos, students chant the same sutras, _in Japanese_, as in Japanese zendos. Plus, there are regulatory bodies, like the Soto Zen school, that certify affiliated western zendos as authoritative. It's not made-up, it's hardly an "export product," and it certainly isn't designed to flatter anyone.
> https://vividness.live/zen-vs-the-u-s-navy
That seems like a rambling, self-published book by a Vajrayana practitioner with an axe to grind against Zen, for some bizarre reason. But there are plenty of real books about the rise of American Zen, or Buddhism in the west, that are well-researched. _Zen in America_ by Helen Tworkov is one.
> Japanese people think Buddhism is a thing you do at funerals.
Not at all. Buddhism, and Zen especially, permeate Japanese culture very deeply. Japanese aesthetics, architecture, landscape design, visual art, calligraphy, the tea ceremony, and the martial arts, have all been strongly influenced by Zen. And it's all over pop culture, too—just think of how pervasive Daruma dolls are—that's Bodhidharma, the founder of Zen. Sure, Buddhism is at funerals, but it's everywhere, else, too.
> If you get into it more seriously, I vaguely understand it's mostly a religion that tells you not to have sex.
Maybe you're thinking of Christianity? Unless you're a monk, attitudes towards sex are fairly liberal in Buddhism. There are bodhisattva precepts that caution against misusing sex, but nowhere does anyone tell you not to have it. In fact, it's largely unconcerned with it, let alone "mostly a religion that tells you not to have" it. Western religions are very concerned with telling you what to do and not do, but Buddhism is concerned with liberation.
> > Japanese people think Buddhism is a thing you do at funerals.
> Buddhism, and Zen especially, permeate Japanese culture very deeply. Japanese aesthetics, architecture, landscape design, visual art, calligraphy, the tea ceremony, and the martial arts, have all been strongly influenced by Zen. And it's all over pop culture, too—just think of how pervasive Daruma dolls are—that's Bodhidharma, the founder of Zen. Sure, Buddhism is at funerals, but it's everywhere, else, too.
Your statement may be true but so is the grandparent's. (Although I agree that there isn't much about not having sex; mainly you hear about monks don't eat meat, or at least not while people are looking)
>made-up export products designed to flatter Westerners
https://en.wikipedia.org/wiki/Upaya
Well, and most Catholics only go to mass once a year. If then.
There is a bit more to it, if you’re interested though.
Most westerners also do a lot more Yoga than typical Indians.
Marcuse wants to have a word.
I'd encourage you to flesh out this comment. I've never read Marcuse, and I'm curious what you had in mind.
[flagged]
Long reads can be fine, different readers might need to pull in different parts of the context.
As someone who’s likely soon wrapping up 18 years of psychodynamic-based therapy, where I learned to ask all right questions (and opportunity cost could have bought a brownstone in brooklyn), but didn’t get any actionable answers, I really appreciated the timeliness of this article.
I like CBT. I just don't do it enough. I do like it when I do it though. (behavioral experiments). I think it is important to have goals and results and feedback, as without those, you'd be wandering aimlessly challenging your thoughts/beliefs to no end. I hope to get more consistent in it.
I am generally very good at forming and maintaining habits, but often life gets in the way. Also, it is good to have an external view, sometimes you feel like you're doing shit when you're not. I need an accountability partner I guess. Let's see how it goes. Thanks.
As a practicing Psychotherapist for over 25 years, I never came across anyone who practiced DBT.
I had heard that some Psychiatric nurses liked it.
I always understaood that it was a modern extention of CBT. The go to, cheap as chips, not very good, therapeutic self brainwashing technique.
Big claims of curing depression, eating disorders and a raft of other mentally distressing diagnoses in a miraculous 6 weeks, have all fallen by the wayside. After 10 weeks the symptoms always return and the client is not fixed in any way.
governments love it, because its cheap, and they can say they are addressing the mental health crisis in society, of which, they are solely and fully responsible for.
The psychologist undergraduate go to, to prove that CBT works and they are good at using graphs and figures.
A new client felt 10/10 depressed at his first session. At session 3 he was 8/10 depressed. At session 6 he was 6/10 depressed. clearly CBT cures depression by filling in a few forms. Write that up in your dissertation and get your degree.
Could this possibly be due to the fact that the client, for the first time in his life, actually had the opportunity to talk about his problems. Nothing to do with being taught how to use a CBT model.
The incessant form filling is totally, for me anyway, anti-therapy.
I worked in many different organisations over the years that banned outright the use of CBT.
Concerning how widespread DBT is: In the last five years in grad school, I knew many people doing a psychology PhD and DBT was one of the major training focuses for their clinical psychology curriculum. I would say the characterization given by this article matches very closely with what they told me over the last ~5 years.
My impression of DBT compared to CBT, based on what my friends told me, is that DBT is much more confrontational. I remember one friend even specifically said that it took her a long time to "unlearn" the therapist's natural response to affirm and validate, but then redirect negative feelings with skills.
> As a practicing Psychotherapist for over 25 years,
I'm trying to find a therapist after about 20 intermittent years of disappointing therapy experiences.
I find CBT trite ( https://slatestarcodex.com/2015/07/16/cbt-in-the-water-suppl... )
But psychodynamic is directionless and in a way that never seems to help either, and hides behind the lack of measurement. It could be amazing with a wise Irvin Yalom figure, but 99% of us aren't interacting with somebody that thoughtful.
How well, generally, do you think therapy works? What works best?
In your experience, what have you seen that works?
Honestly, as somebody who filled out way too many CBT forms - there's a good chance you only get the score improvement because people don't want to get the provider in trouble with their employer.
The scoring sheets are, pretty much, bullshit. So are the endless worksheets.
I'm not even sure I can follow what I'm reading. It complains that evil capitalists started manipulating people in the 20th century so they wouldn't want to unionize, and that savvy leftist psychologists realized that these same skills could be used to self-manipulate patients into not wanting to cut themselves?
That isn't an accurate summary of what the article says. The part you mentioned is telling about early manegerial sciences trying to fix workplace issues that arose during industrialization. The article itself doesn't offer any stance towards whether that was a good or a bad thing, which it would need to do if it "complains", as you said.
The article is mainly a nuanced perspective on DBT (Dialectic Behavioral Theory) and it focuses on the conundrum of patients finding themselves between finding value in their identity as an victim, the consequenxes it has for them and the condition which contributed to that trauma that remain unaddressed if they do just that:
> People often share a manifesto called the “Emotional Distress Bill of Rights” (subtitled “#RightToBeSuffering”). “I should not be held so personally responsible to take actions to be better,” it says. “Others (and systems) should be held far more accountable for better treatment of me.”
Imagine you live in an ancient society where cannibalism exist. If cannibals tried to eat you and you have a trauma of surviving that, you could go at the problem in two ways: (1) Blame a society that allows cannibalism to exist and try to reshape said society or (2) Focus on yourself and figure out how to move on from the trauma, how to deal with the consequences of said trauma and so on.
Doing the latter without changing the circumstances that lead you becoming victimized can feel like you become complicit in perpetuating the problem (in our example cannibalism).
This, other than the retelling of the origin story of that form of therapy, is probably the main point this article makes.