Reality is Complex

Reality is Complex and in Polarity

A dialectical perspective holds that reality in complex, oppositional, and in polarity. Again, we intuitively recognize this from our lives and clinical work. Say a 12-year-old runaway (built like a 15-year-old) is admitted to a psychiatric unit by police. The file shows he's had horrible physical abuse as a child and mild developmental disability. As you interview him he appears to have manic symptoms with extreme irritability. Multiple drugs show in the tox screen. He's admitted for observation. At this point you think, “Huh, there is this and there is that, and then there is this other piece, wow, this is complicated.” But then he physically threatens the petite, beloved social worker in a sexually graphic way; now there is high emotion among the staff. 

As soon as someone on the inpatient unit takes the position of being flexible on program rules, it elicits someone else's description of why in this case no exceptions to the rule should be made. One person thinks the client can be reasonably discharged, which prompts someone else on the team to give reasons why that is not a good idea. We often respond to complexity in oppositional or polarized ways. The existence of “yes” gives rise to “no”, “all” to “nothing”. Maybe it is the nature of reality or may be simply the nature of human perception or language. 

Whatever the reason, we often fall into processes in which oppositional elements are in tension with each other. When applied to human conflict, often both opposing positions may be true or contain elements of the truth (e.g., there are valid reasons to discharge and to delay discharge). Taken together, these first two dialectical assumptions mean no one ever has a “whole” perspective on a client. Therapists are like the blind men each touching a part of an elephant and each being certain that the whole is exactly as the part they are touching. “An elephant is big and floppy,” “no,no, long and round and thin,” “no, no, no, solid like a wall.” Each has an alternative perspective. Each is true and each is partial.

From this view, then, smart, reasonable, people will disagree. Polarized divergent opinions are seen as inevitable when problems are complex. Nothing is wrong: the client isn't pathologically splitting the team; the therapist isn't (necessarily) naïve or narcissistic. It is simply the nature of the phenomenon. No one person on a treatment team has a lock on important. Therefore, DBT puts a large emphasis on dialogues that lead to synthesis. How does the piece I hold fit with yours to make a more complete, coherent, or workable whole? Together we search for what is valid and polarized or divergent positions rather than striving for a unified front. Rather than artificially resolve a conflict by dropping one end of the dialectic or fighting only for one position, effort is made to stay engaged without appeasing, capitulating, dominating, or accepting the invalid.

Doing Dialectical Behavior Therapy (A Practical Guide by Kelly Koerner).

Reality is complex... Photo by Elena.