Dialectical Thearpy Anti Thesis, Thesis, And Dialectial Failure

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a form of cognitive-behavioral therapy that was

originally developed by psychologist Marsha Linehan to treat individuals with borderline
personality disorder (BPD).

However, it has since been adapted for a wide range of mental health issues, particularly
those involving intense emotions, self-harm, and difficulty with interpersonal
relationships.

DBT emphasizes balancing acceptance and change through dialectical thinking, where
seemingly opposing ideas can be true at the same time.

Key Components of DBT:

1. Core Principles

 Dialectics:
o DBT is rooted in dialectical thinking, which emphasizes the integration of
opposites.
o In DBT, this often means accepting oneself as they are (acceptance) while
simultaneously working to change harmful behaviors (change).
 Mindfulness:
o A key component of DBT is increasing awareness of the present moment
without judgment.
o This helps individuals become more aware of their emotions and reactions.
 Behavioral Approach:
o DBT focuses on identifying patterns of behavior that lead to distress and
then finding more effective coping strategies.

2. Therapy Structure

DBT is typically delivered in four primary modes:

 Individual Therapy:
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o One-on-one sessions with a therapist focusing on personal challenges,

problem-solving, and motivation.
 Skills Training Groups:
o Group sessions that teach specific DBT skills, often run like classes.
o These skills are broken down into four core modules (explained below).
 Phone Coaching:
o Between sessions, clients can access phone coaching for real-time assistance
in applying DBT skills during crisis situations.
 Therapist Consultation Teams:
o Therapists working in DBT often attend regular consultation meetings with
other DBT practitioners to support each other and ensure the treatment is
delivered effectively.

3. DBT Skills Modules

DBT’s effectiveness comes from teaching a set of four skills-based modules that help
clients manage emotions and interpersonal situations.

 Mindfulness:
o This module teaches clients to focus on the present moment and develop
awareness of their thoughts and feelings without reacting impulsively.
o Skills include observing, describing, and participating in current experiences
non-judgmentally and effectively.
 Distress Tolerance:
o Focuses on managing crises without making them worse. It emphasizes
accepting reality as it is, especially during distress.
o Skills include distraction, self-soothing, improving the moment, and radical
acceptance.
 Emotion Regulation:
o Helps clients understand and manage their emotions more effectively.
o The goal is to reduce emotional vulnerability and instability.
o Skills include identifying emotions, changing emotional responses, and
increasing positive emotions through self-care and lifestyle changes.
 Interpersonal Effectiveness:
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o Teaches strategies for building and maintaining healthy relationships.

o It includes skills for assertiveness, setting boundaries, and balancing self-
respect with relationship needs.
o Skills include to handle interpersonal conflicts, called DEAR MAN
 Describe,
 Express,
 Assert,
 Reinforce,
 Mindful,
 Appear confident,
 Negotiate

4. Stages of DBT Treatment

DBT is structured into four stages:

 Stage 1:
o Focuses on stabilizing the individual, reducing self-harm behaviors, and
improving life-threatening behaviors.
 Stage 2:
o Addresses emotional suffering and helps clients move past feelings of
hopelessness or trauma that lead to emotional dysregulation.
 Stage 3:
o Works on developing self-respect, problem-solving, and day-to-day happiness.
 Stage 4:
o Focuses on achieving goals and finding meaning in life.

Who Can Benefit from DBT?

DBT has been proven effective for individuals with:

1. Borderline Personality Disorder (BPD)

2. Mood disorders (such as depression and bipolar disorder)
3. Eating disorders
4. Substance abuse issues
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5. Self-harm and suicidal ideation

6. Post-Traumatic Stress Disorder (PTSD)

Goals of DBT:

 Building a Life Worth Living:

o The ultimate goal of DBT is to help individuals create a life that is fulfilling,
even in the face of intense emotions and challenges.
 Balancing Acceptance and Change:
o DBT aims to balance accepting things as they are while working toward
meaningful change.

Dialectical Behavior Therapy (DBT) is a comprehensive and evidence-based

psychotherapeutic intervention primarily designed to treat individuals with severe emotional
dysregulation, such as those with Borderline Personality Disorder (BPD).

At the core of DBT is a dialectical approach, which balances the need for acceptance of
current emotional states and behaviors with the necessity for change.

The following detailed explanation aims to provide understanding of DBT, focusing on its
theoretical foundation, clinical components, step-by-step implementation, and a clinical
example for application.

1. Theoretical Framework

Dialectics in DBT

Dialectics is the philosophical underpinning of DBT.

It refers to the synthesis of opposites—integrating two seemingly contradictory ideas to form

a balanced perspective.

In clinical DBT, dialectical thinking applies to the balance between acceptance and change:
 Dialectical Thearpy Anti Thesis, Thesis, And Dialectial Failure

 Acceptance:
o The individual is encouraged to accept themselves as they are, which validates
their emotional experience.
 Change:
o At the same time, clients are guided to change behaviors and cognitions that
are maladaptive or self-destructive.

This dialectical approach helps clients who feel overwhelmed by their emotions to develop
a more nuanced view of their experiences, allowing for more effective

- emotional regulation and

- behavioral control.

Bio-Social Theory of Emotional Dysregulation

DBT is rooted in the bio-social theory, which postulates that emotional dysregulation
results from the interaction between biological predispositions (e.g., heightened
sensitivity, impulsivity) and an invalidating social environment, which lead to extreme
responses.

For instance, a person with BPD might have a biological tendency for intense emotions,
which is exacerbated by an environment that dismisses or criticizes these emotions, leading to
extreme responses such as self-harm or aggression.

2. Key Clinical Components of DBT

DBT treatment is delivered across four primary modes, each designed to address different
aspects of emotional dysregulation.

These modes work synergistically to help the client balance emotional acceptance and
behavioral change.

A. Individual Therapy
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o In one-on-one sessions, the therapist works with the client to set goals, reduce
life-threatening behaviors (such as self-harm or suicide attempts), and
problem-solve real-life issues using DBT skills.
o The therapist also addresses dysfunctional thoughts, emotional patterns, and
behaviors.

Goals in Individual Therapy:

o Reduce life-threatening behaviors (suicidal or self-harming).

o Reduce therapy-interfering behaviors (missing sessions, not engaging).
o Decrease quality-of-life interfering behaviors (substance use, conflict).
o Increase the client’s use of DBT skills in everyday life.

Therapist's Role:

 The therapist uses validation techniques to acknowledge the

client's feelings, while also pushing for behavioral change using
problem-solving strategies.

B. Skills Training Group

In a classroom-like setting, clients learn DBT skills grouped into four main modules:

1. Mindfulness:
o Teaches clients how to observe and describe thoughts and emotions without
judgment.
o It forms the foundation for other skills and allows clients to be aware of their
emotional states.
o Example Skill: Observing a thought without attaching meaning to it.
2. Distress Tolerance:
o Focuses on how to survive crises without making them worse.
o Skills in this module help clients tolerate intense emotional pain without
resorting to harmful behaviors.
o Example Skill: Radical acceptance (accepting reality as it is).
3. Emotion Regulation:
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o Teaches clients how to reduce emotional vulnerability and manage intense

emotions effectively.
o Example Skill: Identifying and labeling emotions.
4. Interpersonal Effectiveness:
o Focuses on developing effective communication strategies, maintaining
relationships, and balancing self-respect with relationship goals.
o Example Skill: DEAR MAN (Describe, Express, Assert, Reinforce, Mindful,
Appear confident, Negotiate).

C. Phone Coaching

Clients can reach out to their therapist between sessions for real-time coaching.

This helps them apply DBT skills in challenging situations (e.g., when they feel the urge to
self-harm or experience overwhelming emotions).

The therapist coaches the client to use skills like distress tolerance or emotion regulation.

Example:

o A client calls in distress, feeling the urge to engage in self-harm.

o The therapist guides them through a distress tolerance skill

o e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle

relaxation.

D. Therapist Consultation Team

Therapists working with DBT clients regularly meet in consultation teams to discuss cases,
receive support, and ensure they are providing effective treatment.

This mode helps therapists remain motivated and effective, avoiding burnout from working
with high-risk clients.

3. DBT Treatment Process: A Step-by-Step Approach

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A. Pretreatment: Client Orientation and Commitment

 Objective: Orient the client to DBT, explain its structure, and gain commitment to the
treatment process.
 Tools: Use a DBT Agreement to outline expectations (e.g., attending all sessions,
practicing skills, engaging in phone coaching).
 Example: A client who struggles with frequent suicidal ideation is informed that their
first priority in therapy will be reducing self-harm behaviors before focusing on other
life goals.

B. Stage 1: Stabilization and Behavioral Control

 Focus: The primary goal in this stage is reducing behaviors that pose a threat to life,
therapy, or the client's quality of life.
 Techniques: Chain analysis (breaking down the sequence of events leading to
maladaptive behavior), validation, and behavioral strategies to develop alternative
coping mechanisms.
 Example: A client who self-harms whenever they feel overwhelmed may be guided
through a chain analysis to identify emotional triggers and then taught distress
tolerance skills to manage those triggers without self-harm.

C. Stage 2: Reducing Emotional Suffering

 Focus: Addressing traumatic or intense emotional experiences that have led to

emotional dysregulation.
 Techniques: Exposure to painful emotions, distress tolerance, and mindfulness
practices.
 Example: A client with unresolved trauma is taught emotion regulation skills to
process past trauma while learning to control emotional reactivity in the present.

D. Stage 3: Building a Life Worth Living

 Focus: Improving day-to-day functioning and relationships by helping the client

pursue long-term goals, self-respect, and effective communication.
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 Techniques: Use of interpersonal effectiveness skills and goal-setting to improve

relationships and establish meaningful life activities.
 Example: A client who struggles with setting boundaries in relationships is taught the
DEAR MAN skill to assert their needs effectively while maintaining self-respect.

E. Stage 4: Enhancing Happiness and Meaning

 Focus: At this final stage, the client works on finding deeper meaning and fulfillment
in life.
 Techniques: Continued use of mindfulness and interpersonal effectiveness skills to
enhance overall life satisfaction.
 Example: A client begins pursuing a new career path, applying DBT skills to manage
work-related stress and build healthier relationships with colleagues.

4. Clinical Example

Case: Alex’s Self-Harm and Emotional Dysregulation

 Presenting Problem: Alex, a 25-year-old, presents with self-harming behaviors,

frequent emotional outbursts, and a history of tumultuous relationships. They have
attempted suicide twice in the last year.
 DBT Treatment Plan:
o Stage 1: Stabilization and Behavioral Control:
 Goal: Reduce self-harm incidents. Teach distress tolerance skills,
such as radical acceptance and the STOP skill (Stop, Take a step back,
Observe, Proceed mindfully).
o Stage 2: Reducing Emotional Suffering:
 Goal: Teach emotion regulation strategies to help Alex identify and
label emotions, reducing their intensity.
o Stage 3: Building a Life Worth Living:
 Goal: Focus on interpersonal effectiveness to improve Alex’s
relationships using DEAR MAN.
o Stage 4: Enhancing Happiness:
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 Goal: Help Alex find meaning in personal goals and work through self-
fulfillment strategies.

5. Table: Overview of DBT Treatment

Example
DBT Component Purpose Clinical Application
Skills/Techniques
Individual Therapy Reduce life- Validation, Chain Address self-harm
threatening and Analysis behaviors through
therapy-interfering analysis of triggers
behaviors
Skills Training Group Teach clients Mindfulness, Distress Clients practice skills
essential emotional Tolerance, Emotion like DEAR MAN for
regulation skills Regulation assertiveness
Phone Coaching Provide in-the- TIPP, Radical Guide client through
moment support Acceptance distress without self-
harm
Therapist Consultation Support and enhance Case discussions, Prevent therapist
Team therapist effectiveness therapist support burnout and ensure
high-quality care
Stage 1: Stabilization Reduce harmful STOP skill, Chain Focus on safety and
behaviors Analysis reducing life-threatening
behaviors
Stage 2: Emotional Process painful Emotion Regulation skills Help clients regulate
Suffering emotions overwhelming emotions

Stage 3: Building Life Goals Develop long-term Interpersonal Guide client toward
goals Effectiveness, DEAR relationship-building
MAN and goal achievement
Stage 4: Happiness Focus on meaning Mindfulness, Goal- Support clients in
and fulfillment Setting finding personal
meaning in life

Explanation of DBT Skills Categories

DBT Skills Table

Clinical
Skill Name Explanation Category Description Real-Life Example
Application
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Wise Mind Integrates Mindfulness Balances Helps clients A client is angry and
emotional and emotional make wants to quit their job
rational mind and decisions that impulsively, but Wise
thinking for reasonable integrate logic Mind helps them pause
balanced mind for a and emotion and think through the
decisions balanced view consequences.

Observe Being aware of Mindfulness Notice Increases self- A client notices their
thoughts, experiences awareness anger rising during a
feelings, and and thoughts and prevents conflict without
surroundings without impulsive immediately acting on it.
without reacting or reactions
reacting judging
Describe Putting words Mindfulness Put words to Helps clients A client says, "I feel
to experiences experiences to articulate tight in my chest and
to increase increase clarity feelings and anxious" during a panic
clarity and reduce gain attack, increasing their
confusion emotional awareness.
clarity
Participate Fully engaging Mindfulness Engage fully in Encourages A client immerses
in the present the present clients to themselves in playing
moment moment focus on the piano to stay
without without present tasks grounded during an
distractions overthinking and emotions anxious episode.
Non- Observing Mindfulness Observe Reduces self- A client experiences
Judgmental thoughts and without criticism and sadness without labeling
Stance emotions labeling enhances it as "wrong" or "bad"
without thoughts or emotional but simply allows the
labeling them emotions as acceptance feeling to be.
as good or bad "good" or
"bad"
One-Mindfully Focuses on one Mindfulness Focus attention Increases A client focuses solely
thing at a time fully on one attention and on eating lunch, ignoring
with full task or reduces their phone to prevent
attention experience at a distractions distractions and stay in
time the moment.
Effectiveness Doing what Mindfulness Do what Guides clients A client, despite wanting
works, not works, not to act in ways to argue back in a
what feels what feels that achieve conflict, chooses a calm
justified or justified or desired response to resolve the
comfortable comfortable outcomes situation.
STOP Skill Prevents Distress Stop, Take a Prevents A client about to self-
impulsive Tolerance step back, impulsive or harm remembers to
reactions by Observe, harmful STOP and take a
creating a Proceed actions in moment to pause and
moment to mindfully moments of breathe before making a
pause crisis decision.
TIP/TIPP Reduces Distress Temperature, Calms the A client experiencing a
extreme Tolerance Intense body during panic attack dips their
emotions exercise, Paced emotional face in cold water to
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through body- breathing, distress, calm down, as suggested

based Paired muscle regulating in the TIP skill.
strategies relaxation emotions
Distract with Temporarily Distress Activities, Helps clients A client watches a
ACCEPTS shifts focus Tolerance Contributing, temporarily favorite movie to distract
from Comparisons, distract from from intense sadness.
distressing Emotions, overwhelming
thoughts Push away, emotions
Thoughts,
Sensations
Self-Soothe Using the five Distress Engage the Provides a A client lights a calming
senses to Tolerance five senses to soothing and lavender candle and
comfort and calm and non-harmful listens to music to self-
calm oneself comfort way to cope soothe during emotional
oneself with distress distress.
IMPROVE the Reframes Distress Imagery, Shifts focus A client practices deep
Moment distress by Tolerance Meaning, from distress breathing and visualizes
shifting to Prayer, to positive or a calm beach during a
positive or Relaxation, calming stressful work
calming One thing in activities presentation.
activities the moment,
Vacation,
Encouragemen
t
Pros and Cons Weighs Distress Weigh the Encourages A client considering
benefits and Tolerance advantages and mindful breaking up with a
drawbacks of disadvantages decision- partner lists the pros and
actions to of acting making in cons of staying in the
promote impulsively vs. times of relationship.
thoughtful using skills emotional
decisions crisis
Radical Fully accepting Distress Fully accepting Reduces A client accepts their
Acceptance reality without Tolerance the reality of suffering by chronic illness instead of
resisting or the situation helping wishing for things to be
fighting without clients come different, which reduces
against it fighting it to terms with their emotional
reality suffering.
Turning the Choosing to Distress Actively Helps clients A client who is
Mind accept reality Tolerance choosing shift mindset frustrated by a canceled
over resisting acceptance toward event chooses to accept
it over resistance acceptance, it instead of resisting the
preventing reality of the situation.
escalation
Willingness vs. Willingness is Distress Willingness: Encourages A client, although angry
Willfulness acceptance of Tolerance open to life as flexible, about their friend’s
the situation, it is; adaptive behavior, chooses
Willfulness is Willfulness: behaviors willingness and remains
stubborn stubbornly rather than open to conversation
resistance resisting reality defiance instead of cutting ties.
Opposite Doing the Emotion Doing the Reduces the A client who feels angry
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Action opposite of Regulation opposite of intensity of and wants to isolate

what the what emotions unhelpful or themselves chooses
emotion urges dictate to distressing instead to reach out and
in order to change emotions connect with a friend.
change it emotional
experience
Check the Analyzes Emotion Analyze the Helps clients A client upset over a
Facts situations to Regulation situation to correct friend's late text checks
ensure that determine if emotional the facts and realizes
emotional emotional responses they may be busy,
responses are response fits based on reducing their emotional
appropriate the facts distorted overreaction.
thinking
Accumulate Build positive Emotion Engage in Enhances A client plans a fun
Positive experiences Regulation enjoyable and emotional weekend activity to build
Emotions through meaningful resilience by positive emotions and
(Short-term) enjoyable activities to building counteract depression.
activities boost mood positive
experiences
Accumulate Build positive Emotion Build a life Increases A client commits to
Positive experiences Regulation worth living by overall life long-term personal
Emotions through life working satisfaction growth by pursuing a
(Long-term) goals toward long- and reduces new career, increasing
term goals vulnerability their overall sense of
to negative purpose.
emotions
Build Mastery Engages in Emotion Engage in Helps clients A client who feels
tasks that Regulation activities that feel more incompetent begins
increase increase competent mastering new cooking
competence confidence and and capable in skills, boosting their
and confidence a sense of their daily confidence.
control lives
Cope Ahead Prepares for Emotion Plan and Reduces A client who has a
future stressful Regulation rehearse emotional difficult family dinner
situations by coping reactivity by coming up rehearses
rehearsing strategies for preparing for how to use skills like
coping anticipated stressful DEAR MAN to stay
strategies challenges situations in calm and assertive.
advance
PLEASE Promotes Emotion Treat Physical Promotes A client starts exercising
physical well- Regulation illness, balance physical well- regularly and eating
being to reduce Eating, avoid being to balanced meals to reduce
emotional mood-Altering reduce emotional ups and
vulnerability substances, get emotional downs.
adequate vulnerability
Sleep, Exercise
DEAR MAN A structured Interpersonal Describe, A structured A client uses DEAR
method for Effectiveness Express, method for MAN to ask their boss
assertive Assert, assertively for a raise, clearly
communicatio Reinforce, expressing expressing their needs
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n and conflict Mindful, needs and while staying confident

resolution Appear maintaining and respectful.
confident, self-respect
Negotiate
GIVE A technique to Interpersonal Be Gentle, act Helps A client uses GIVE to
maintain and Effectiveness Interested, maintain and listen actively and
strengthen Validate, use improve validate their partner
relationships an Easy relationships during a disagreement,
with kindness manner by focusing which helps prevent
on kindness escalation.
and
understanding
FAST Helps Interpersonal Be Fair, no Maintains A client sticks to their
individuals Effectiveness Apologies, self-respect in values and refuses to
maintain self- Stick to values, interpersonal apologize for setting
respect during be Truthful interactions, boundaries in a
interactions especially friendship, helping them
when under maintain self-respect.
pressure to
compromise

1. Mindfulness Skills

Mindfulness skills help clients stay grounded in the present, increase awareness, and respond
thoughtfully to emotions rather than react impulsively. These skills form the foundation of all
DBT work.

Mindfulness is foundational in DBT, helping clients become aware of their emotions,

thoughts, and surroundings without judgment. These skills allow individuals to observe and
describe their experiences without getting caught up in emotional reactions.

 Clinical Application: Mindfulness skills are useful when clients need to slow down
and focus on the present moment. For example, a client struggling with anxiety can
use the Observe skill to notice their thoughts and feelings without becoming
overwhelmed by them.

2. Distress Tolerance Skills

Distress tolerance skills are designed to help clients survive emotional crises without making
the situation worse. These skills focus on short-term relief from distress rather than solving
the problem immediately.

These skills focus on helping clients cope with crises without engaging in self-destructive
behaviors. They emphasize short-term survival strategies when emotions are high, rather than
immediate problem-solving.
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 Clinical Application: A client experiencing intense emotional distress, such as anger

or anxiety, may use the STOP skill to pause before reacting impulsively or
destructively.

3. Emotion Regulation Skills

Emotion regulation skills help clients understand and manage their emotions more
effectively. They focus on reducing emotional vulnerability and building positive emotional
experiences.

These skills teach clients how to understand and regulate their emotions more effectively.
They involve reducing vulnerability to negative emotions and building positive emotional
experiences.

 Clinical Application: A client who struggles with intense mood swings may use the
Opposite Action skill when they feel angry or sad, engaging in behaviors opposite to
the emotion (e.g., going for a walk when feeling depressed).

4. Interpersonal Effectiveness Skills

These skills assist clients in navigating interpersonal situations while maintaining self-
respect. They emphasize assertiveness, conflict resolution, and relationship-building

Interpersonal effectiveness skills help clients develop healthy communication strategies,

maintain relationships, and navigate interpersonal conflicts while preserving their self-
respect.

 Clinical Application: In a situation where a client feels their needs are not being met
in a relationship, they can use DEAR MAN to assertively express their feelings and
desires in a way that respects both themselves and the other person.

Using DBT Skills in Treatment Planning

When creating a DBT treatment plan for a client, the therapist selects skills based on the
client’s current stage of therapy and their specific emotional and behavioral challenges. The
table of skills above can guide clinicians in selecting the appropriate interventions during
each stage of DBT, such as distress tolerance for crisis management or interpersonal
effectiveness for relationship challenges.
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In summary, the DBT skills cover a range of strategies that help clients address emotional
dysregulation, navigate distress, and improve their interpersonal relationships. The table
format provides a structured way for clinicians to select relevant skills and apply them within
the treatment framework.

Dialectical Behavior Therapy (DBT)

Dialectical thinking is central to Dialectical Behavior Therapy (DBT), and it draws from the
philosophical principles of dialectics.

In this framework, "thesis" and "antithesis" represent opposing forces, while the
"synthesis" or resolution involves integrating these opposites.

Here's how it works in DBT, and the idea of dialectical failure:

1. Thesis

A thesis refers to an initial idea, belief, or behavior.

In the context of therapy, this could be a client’s strongly held viewpoint or emotional stance.

For example, a person might have the belief:

 "I need to be perfect in everything I do."

2. Antithesis

The antithesis is the opposing idea or behavior that challenges the thesis.

In the therapy context, this might represent the opposite or counter-belief.

For example:
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 "Nobody is perfect, and it’s okay to make mistakes."

3. Dialectical Synthesis

The synthesis is the outcome that integrates both the thesis and antithesis. It’s a balanced or
middle-ground solution that reconciles the extremes, leading to growth and flexibility.

For example:

 "While I strive to do my best, it’s okay if I make mistakes, as I can learn from them."

In DBT, this process is used to help clients move away from extreme thinking or behaviors
(like all-or-nothing thinking) and find a more balanced perspective.

4. Dialectical Failure

“Dialectical failure” occurs when the synthesis process doesn't happen, and the person
gets stuck in rigid, polarized thinking (either fully in the thesis or fully in the antithesis).

This failure to integrate opposing views can lead to emotional distress or dysfunctional
behaviors.

For example

- if someone clings rigidly to the thesis ("I must be perfect") and rejects the antithesis,
they may experience anxiety and shame.

Similarly, rejecting both sides can lead to ambivalence, confusion, or avoidance of the
conflict altogether, resulting in failure to achieve personal growth or change.

In therapy, the goal is to support the individual in finding a “dialectical synthesis” that
promotes emotional regulation and balanced thinking.

step by step framework visual for addicts addicton and recovery in these ideas
 Dialectical Thearpy Anti Thesis, Thesis, And Dialectial Failure

To visualize addiction and recovery in terms of dialectics, the steps can be mapped out using
the thesis, antithesis, and synthesis framework.

Here's how a step-by-step dialectical model might look in addiction and recovery:

1. Addiction Cycle (Thesis)

 Thesis: Addiction presents as the dominant behavior or belief.

 The person might feel:
o “I need this substance or behavior to cope with life and feel good.”
o They rely on the addictive substance or behavior to manage emotions, escape
reality, or numb pain.

2. Emergence of Conflict (Antithesis)

 Antithesis: The person begins to encounter negative consequences or awareness of

harm:
o “This substance/behavior is hurting me, and I need to stop.”
o The individual starts to feel the effects of addiction on their health,
relationships, and well-being, but they may still be pulled back to the
addiction.

3. Crisis Point (Dialectical Tension)

 Crisis: Here, the thesis and antithesis are in direct conflict, creating a crisis or tension.
The person feels torn between:
o “I need the substance” and “This is destroying me.”
o At this stage, feelings of guilt, shame, or hopelessness are common.
 Dialectical Thearpy Anti Thesis, Thesis, And Dialectial Failure

o The tension builds and can lead to either further entrenchment in the
addiction or the desire for change.

4. Seeking Help (Antithesis Strengthening)

 Antithesis Deepens: The person may seek external help (therapy, support groups,
etc.) and begins to seriously question the addiction.
o “I need to change; I can’t do this alone.”
o This is where the individual starts considering recovery and receives external
support to strengthen their desire for change.

5. Recovery Process (Synthesis)

 Synthesis: A balance begins to emerge.

 The person integrates both the recognition of their addiction and the desire to live
a healthier life:
o “I can learn to cope with life without the substance/behavior.”
o Recovery involves adopting new coping strategies, building support systems,
and developing healthier beliefs and behaviors.

6. Relapse and Reintegration (Dialectical Failure/Challenge)

 Relapse: If dialectical failure occurs (inability to maintain the balance), relapse

may happen:
o “I can’t cope without the substance; I’m back to where I started.”
o The person may return to addictive behavior, but the recovery process views
relapse as part of growth rather than failure, leading to opportunities to re-
enter the dialectical cycle.
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7. Long-Term Recovery (Ongoing Synthesis)

 Ongoing Synthesis: With continued work, the individual becomes more adept at
managing the push and pull between old habits (thesis) and healthier coping
mechanisms (antithesis).
 The synthesis becomes an ongoing practice in life:
o “I can manage life’s challenges without needing the addiction.”

This cycle shows the tension between addiction (thesis) and recovery efforts (antithesis),
ultimately aiming for synthesis in recovery, but acknowledging the possibility of dialectical
failure (relapse) and the need for reintegration and growth.
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 Dialectical Thearpy Anti Thesis, Thesis, And Dialectial Failure

Here is the visual diagram representing addiction and recovery using the thesis-antithesis-
synthesis framework.

It walks through the stages of addiction, conflict, crisis, recovery, and relapse in a cyclical
process.
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Addiction Defined — The Jellinek Curve

Addiction is a progressive and fatal disease.

It can be described as compulsion, loss of control, and continued use despite harmful
consequences.

Compulsion — an overwhelming, irresistible urge to use or continue using a substance.

Loss of control — over the amount of substance used, the amount of time using the
substance, or behavior while using.

Continued use — even though the substance use causes problems.

Addiction is progressive, meaning it worsens over time. Addiction is

a process — with characteristic signs, symptoms, feelings, and
behaviors.
As a process, it has stages or phases. Dr. E. M. Jellinek, an early
researcher in the science of alcoholism, developed the Phases of
Addiction model in the 1940s, which described the progressive
nature and stages of alcohol addiction — from early social drinking
through later stages that include constant drinking, physical
deterioration, and chronic cycles of obsessive drinking.
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The original graphic only

represented the “down” or negative
consequences of active alcoholism.
In the 1950s, British psychiatrist, Dr.
Max Glatt, developed the “up” side
of the curve.

The combined model is what today is

know as the Jellinek Curve and has
been used for substance use and other additions such as gambling,
eating, sex, and buying.

The Jellinek Curve illustrates the progressive nature of the addiction

process by showing signs and symptoms associated with the phases
of addiction — and recovery

In developing the R1 content, one of our

primary objectives is to give individuals an
easy and concrete way to assess themselves
in evidence-based models.

The four theories that we’ve been most

excited about are

1) Stages of Change,
2) Phases of Addiction
3) Relapse Phases & Warning Signs, and
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4) Recovery Capital.

All four topics are anchored in behaviors linked to proven researched models. The R1
Learning System enables individuals to assess and discover where they are in these models
based on their own situations and circumstances. Our goal today is to use the Phases of
Addiction model to help individuals explore their own experiences, clarify where they are in
their recovery, and identify goals and healthy coping strategies for action. Let’s start by
examining the 5 Phases of Addiction and understanding each phase.

Two outcomes of every session include 1) individuals expressing their ability to finally put
into words what they’ve been experiencing for years in a concrete way and 2) that they feel
hope in seeing that addiction is a disease and that it can be arrested. These are not just
intellectual outcomes of the sessions but emotionally driven insights because of the
experiential nature of the Discovery Cards. Each individual walks away with an
understanding of the 5 Phases of Addiction, where they think they are in the model, and at
least one goal for their treatment plan. The model, simple definitions, and behavioral
examples on color categorized cards are central to each activity. Here are
a few examples of the information presented.

In the earliest phase of the disease, the Progressive Phase, social use
turns to using for relief or relaxation and tolerance to alcohol and drugs
starts to develop. Drinking and/or using become a more central focus of
life and individuals often attempt to conceal the amount and/or frequency of use. Discovery
Cards examples include:

 I drink or use occasionally for relief

 I need to drink or use more to get the same effect
 I am starting to have memory blackouts
 I hide my drinking or using
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In the Crucial Phase of the disease, the amount and/or frequency of

use increases and problems begin to emerge. Attempts at control
become more difficult and individuals begin to suffer physical and
emotional consequences. Interests other than drinking or using are
crowded out as drinking or using come to dominate the individual’s
thoughts and actions. Discovery Cards examples include:

 I can’t stop drinking or using like others can

 I frequently feel remorseful
 I repeatedly fail to control my drinking or using
 I avoid family and friends

In the Chronic Phase, physical and emotional problems mount and

control over the time of day, frequency, and quantity of use disappear.
Attempts to quit meet with repeated failure and drinking/using becomes
a compulsive behavior. Excuses and rationalizations become inadequate
in concealing the effects of the problem from others and from the
individual. Discovery Cards examples include:

 I am staying drunk or high for longer periods

 My physical condition is deteriorating
 I am not thinking clearly
 I am crossing my own moral boundaries
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Abstinence is the key to the Rehabilitation Phase. Individuals gain acceptance that addiction
is a disease and see that a cure is available. Honest attempts are made to seek help from
professionals as well as other individuals in recovery. Finally, lifestyle changes are initiated
to establish a basis for a sober life. Discovery Cards examples include:

 I honestly desire help

 I understand that addiction can be arrested
 I understand that alcoholism/drug addiction is an illness that can be treated
 I have stopped drinking or using

The Recovery Phase brings improved physical and emotional health

and the adoption of new behaviors to support ongoing recovery.
Personal and professional relationships are repaired and hope and
happiness are restored as the self-reinforcing cycle of sobriety takes
root. Discovery Cards examples include:

 I am developing new interests

 I get regular rest and sleep
 My family and friends see and appreciate my efforts
 I am building a new network of stable friends

We encourage you to take a moment and see what you’ve learned so

far. Write down your answers to the questions below and share them with another person.

What is the Jellinek Curve?

The Jellinek Curve was created by E. Morton Jellinek and later revised by Max Glatt. E.M.
Jellinek was among the first to take a scientific approach to understanding alcoholism and
addiction and is also credited with being one of the first to support a disease model for
displaying the trajectory of addiction.
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The Jellinek Curve is a model of addiction that attempts to identify the progressive stages of
alcoholism (though it can be used for most forms of substance abuse), detailing particular
events and circumstances resulting from addiction throughout each phase. This concept was
first introduced in the Quarterly Journal of Studies on Alcohol and Drugs. It marked a shift in
the idea of alcoholism as a journey through addiction in distinct phases of alcoholism, rather
than a moral failure.

It can also be used as a tool to track progress within the context of Alcoholics Anonymous,
but it can complement any treatment modality. One can use it to track not only those
progressive phases of alcohol addiction but almost any substance that may induce a mental or
physical dependence.

Understanding alcoholism and addiction is easier with the Jellinek approach and the unique
view on the disease model of alcoholism. Therapy approaches that utilize the Jellineck Curve
and the 4 stages of alcoholism often see improvements faster and have longer-lasting results.
This alcohol and drug addiction chart is constructive for addiction and recovery with clinical
services.

R1’s Contribution — Advancing the Model

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As with Max Glatt, who built on Elvin Jellinek’s original work and added the right side of the
curve in the 1950s, R1 Learning hopes to build on this proven and helpful model as new
research and understanding of addiction evolve.. We are working to include the medical red
cross on future versions of the Jellinek curve to represent individual’s predispositions (risk
factors) for addiction based on both the disease model and current research. This idea evolved
out of a series of conversations with Mr. Larry Gourdine in 2019. His deep knowledge and
breadth of experience in the field have been instrumental to this fundamental idea. Our goal
will be to highlight these factors for substance use prevention and stigma reduction. Here are
a few examples of the risk factors we’ve identified to date and which we will expand upon in
future posts.

 Genetic predisposition – family history

 Brain characteristics and chemistry – dopamine and serotonin
 Psychological factors – e.g., stress, personality traits like high impulsivity or
sensation seeking, depression, anxiety, eating disorders, personality disorders, other
psychiatric disorders
 Environmental influences – e.g., exposure to physical, sexual, or emotional abuse or
trauma; substance use or addiction in the family or among peers; access to an
addictive substance; exposure to popular culture references that encourage substance
use
 Starting substance use – alcohol, nicotine, or other drug use – at an early age

References
Glatt M.M. (Ed.) Drug Dependence: Current Problems and Issues. Surrey, MTP Press
Limited, 1977.

Glatt M.M. A Guide to Addiction and Its Treatment. New York, Springer, 1974.

Glatt M.M. “Alcoholism and Its Relationship to Other Types of Dependence.” In: A Guide to
Addiction and Its Treatment. New
York, Springer, 1974.

Jellinek E.M. Disease Concept of Alcoholism. New Haven, CT, Hillhouse Press, 1960.
 Dialectical Thearpy Anti Thesis, Thesis, And Dialectial Failure

Jellinek E.M. “Phases in the Drinking History of Alcoholics: Analysis of a Survey Conducted
by the Official Organization of
Alcoholics Anonymous.” Quarterly Journal of Studies on Alcohol. Vol. 7, pp. 1—88, 1946.

Jellinek E.M. (Ed.) Alcohol Addiction and Chronic Alcoholism. New Haven, CT, Yale
University Press, 1942.

Understanding the Jellinek Chart

The Jellinek Curve describes the typical pattern of how people with addiction experience
addiction and recovery. It can be separated into three main phases:

 The Crucial Phase

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 The Chronic Phase

 The Rehabilitation Phase

The Crucial Phase

The crucial phase represents the time during which addiction begins to take hold. It often
starts with social drinking before progressing into occasional relief drinking. An increased
dependence and guilty feelings, social avoidance, and loss of willpower typically follow this.
This results in increased periods of intoxication, including binge drinking, and an inability to
moderate or otherwise restrict use—ultimately leading down into the lowest section of the
curve.

The Chronic Phase

There is a loop at the bottom of the Jellinek Curve where people often become trapped in the
cyclical nature of addiction, spiraling further into the depths of obsessive drinking patterns or
drug use. It is during this vicious cycle of dependence that. This is when outside help
becomes necessary to initiate and follow through with the recovery process.

The Rehabilitation Phase

Beginning with an honest desire for help, the path curves upward steadily. After one stops
drinking, foggy thinking clears, and thoughts of a new life emerge as one releases themselves
from addiction.

Self-esteem is rebuilt, new connections are forged, and courage and a strong support network
encourage individuals to continue walking the road to recovery. The rehab process for a sober
life is complicated and can take a period, but the eventual outcome is well worth it.

Keeping that hopeful but realistic thinking is a part of using Jellinek’s Curve. It is why
support services that utilize this approach often have patients with faster recovery and who
enjoy a more extended time sober.
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How the Jellinek Curve Offers Hope for Recovery

The Jellinek Curve is a helpful educational tool , no matter what stage of addiction, for both
addicts and their families, in understanding forms of addiction and talking about the need for
treatment and recovery.

 It allows a person to remember better and understand the timeline of addiction

and recovery.
 It helps people struggling with active addiction to see their progression through
addiction more,
 It helps highlight what they have already lost and the risks that lie ahead if they
continue using.
 It shows what is possible with proper recovery support.

Even those who feel trapped at the bottom of the curve have the potential for rehabilitation if
they can take that first step and ask for help breaking free of the cycle. Seeing the many
benefits of treatment and recovery listed out can also provide motivation, something to hold
onto when the road to recovery begins to feel rocky.

Charting Your Own Course to Addiction Recovery

The Jellinek Curve visibly illustrates that recovery is more than simply stopping to use
whatever a person has become dependent on. Detox alone is not enough to break the cycle;
for most, a long-term addiction treatment program is necessary to continue moving up into
the rehabilitation phase of the curve.

Notice that the curve doesn’t level out; instead, it keeps going up as one pursues the path of
recovery. This visual can be incredibly motivating to those struggling with addiction, as it
serves as a tangible reminder of how much there is to lose if one regresses—and how much
there is to gain if you keep following the curve upward. Recovery may be an uphill journey,
but the rewards are worth it. Contentment in sobriety can be found.

The Jellinek Curve can also be quite literally used to chart your progress as you change the
direction of your life and begin to move upward through the rehab phase. It is a roadmap to
healthy thinking and improving mental health as the trajectory of alcoholism or drug
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dependence takes a swing for the better. Milestones can be set, met, and marked on a chart
printout as a visual aid for recovery.