Dialectical Behaviour Therapy involves a combination of, and a dialectic between, two complementary therapeutic processes. The first involves radical acceptance or validation of the person and his or her experience, while the second involves change-oriented strategies aimed at developing the skills to manage overwhelming emotions and the maladaptive behaviours that follow.
Achieving the right balance between acceptance and change is a difficult challenge that requires ongoing critical reflection on practice in supervision. Keeping this difficulty in mind helps to prevent discouragement.
It is essential to start with acceptance-based strategies before introducing change-based strategies. A strong and secure therapeutic relationship based on absolute acceptance is necessary before change can be effectively introduced.
A key environmental factor theorised as contributing to the problem of overwhelming emotion targeted by DBT is growing up in a pervasively invalidating environment in which the client’s behaviour or expressions of their thoughts or feelings are frequently met with responses that suggest they are invalid, faulty or inappropriate (Robins & Chapman, 2004).
Hence while the long term aim is to change maladaptive behaviours, focusing too early on change is thought to repeat the invalidating environment of the individual’s early experience (Thorpe & Olson, 1997).
On the other hand, practitioners must also be aware of the common tendency to stay too long with acceptance. When clients have experienced extreme adversity and have few resources available in their environment, practitioners may be reluctant to raise the question of change for fear of invalidating the client’s experience or raising overly high expectations of the client. This position does not help the client if there are in fact changes they can make to improve their own situation.
The acceptance elements of DBT draw primarily from client-centred and emotion-focused therapeutic traditions, as well as acceptance-based practices of Buddhism and other contemplative spiritual traditions (McMain & Korman, 2001; Robins & Chapman, 2004).