Duality: Lessons from DBT

May is National Mental Health Month. So far this year, I’ve tried to be even more open about my journey with borderline personality disorder (BPD), and I like to think my first step in doing this was my initial post on what it’s like to deal with the illness. Since January, I’ve embarked on an emotional journey full of successes, failures, and–perhaps most important–moments in between.

Last week, I finished a three-and-a-half month dialectical behavioral therapy (DBT) course recommended by my therapist. DBT is a framework that focuses on “dialectics,” or the concept of opposing ideas existing at once, through four distinct modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Dialectical thinking itself is often hard for someone with BPD to understand, as we often operate in a state of black-and-white thinking (i.e., “This person will never love me,” or, “This illness will always prevent me from pursuing my goals”). DBT helps find the gray area, reminds us that harmony between dichotomies can exist–good and bad, never and always, logic and emotion, all and nothing, self-respect and respect for others–and that recognizing and forming balance between the black and the white is how we can begin to heal.

So every Wednesday for sixteen weeks, I gathered with a group of individuals across backgrounds to learn about the fundamentals of the skills surrounding DBT, led by an expert instructor and social worker. We all showed up around that wooden table for different reasons–some of us dealing with addiction recovery, some working on coming to terms with past trauma, and some, like me, trying to find middle ground within the opposing forces in their brains.

At first, it was hard to fathom. It seemed like an intangible set of principles that I felt I’d never grasp. Sometimes, it still feels that way. But the biggest thing I’ve taken away from DBT is that a lot of these skills have been within me all along–I just needed to hone them. Here are some of my biggest takeaways from this course. Writing them down, I think, is a form of practice–and I strongly encourage anyone who might be looking for different ways to build a life worth living to research DBT.

I don’t think I’ll ever stop learning or practicing. But now that I have the tools, I’m slowly beginning the process of building up my life again.

Use “and,” not “but.”

This might appear to be a small, even insignificant change, but practicing it in speech and thought has really made a difference for me. As I said, DBT is about the nature of duality in our everyday lives. It’s easy to say something like, “I’m a good person, but I struggle with mental health.”

Yet, both are true. One does not negate the other. Struggling with mental health does not change the fact that you are a good person. Saying, “I’m a good person, and I struggle with mental health” recognizes both realities without invalidating either one.

  • I have BPD, and I am working on improving my life.
  • I am a good writer, and I am bad at math.
  • I can be highly emotional, and I can make rational decisions.

When someone asks me to explain dialectical thinking now, I often reference the use of “and,” not “but.” “And” statements create thought patterns that are nonjudgmental, allowing two thoughts to exist at once that a black-and-white mindset might frame as opposing forces. We’re often our own harshest critics, and learning how to look at ourselves without judgment is difficult. But this, at least to me, is a start.

Balance acceptance and change.

I hate this. I hate this. I want to die. I want to die. I want to die. No, stop that. You’re fine. Get over it. I want to die…

Thoughts these are pretty common when you have BPD. You feel things–very strongly–and then berate yourself for feeling the way you do.

I’ve learned that part of growth within the context of DBT is accepting that feelings are just that: feelings. They are no more or less valid than anyone else’s, they are not “good” or “bad,” and all emotions come from somewhere. Accepting that you need both emotions and logic to orient yourself in the surrounding world is the first step in acknowledging feelings instead of pushing them away.

But acceptance does not equal defeatism. Acceptance does not mean, “I’m going to feel this way the rest of my life and I just have to deal with it.”

This is where change comes in. Yes, I feel things and feel them strongly, but how can I work on managing the intensity of my emotional reactions? What can I change about how I tolerate stressful situations? DBT provides a number of ways to identify certain triggers, situations, and aspects of relationships that elicit an emotional response and how to deal with them–whether it be through distress tolerance like distracting with a favorite activity, or “checking the facts” of a particular social situation when your emotions have taken the wheel.

I’m still learning how to find this balance, to allow myself to feel what I feel and–notice the conjunction I used there–work towards changing my mindset and some of my habits.

Communicate what you need from others.

This is the hardest skill for me. Another side of BPD is operating on the assumption that you are a burden, that your illness is yours to carry alone. DBT challenges this through its interpersonal effectiveness module, which helps people maintain effective relationships and foster safe spaces for ending damaging ones.

One of the very first assumptions we were asked to make as participants in DBT is that people are doing the best they can. Our loved ones are doing the most with the skills they have, and sometimes, it’s on us to fill in the gaps in terms of what we need from them–because no one is a mind-reader.

DBT provides a structure, called DEARMAN, for telling important people in our lives what we need from them. I practiced using this structure once so far, and every part of me seemed to reject the idea of asking for anything. What if I asked for too much? What if my needing something pushed them away? I looked down at my hands; I wrung my fingers, my voice shook. Something I need to reinforce for myself is the idea that asking for what you need is okay. The duality here is, of course, that people are doing the best they can, and there is room for them to improve–we just have to let them know what we need.

I struggle with this every day. Oftentimes, it feels easier to keep quiet, to avoid “bothering” those I care about. I can’t say that I’ve mastered this, and perhaps I never will. But if DBT has taught me anything, it’s not to say “never.”

Create a life worth living.

This is a tough one. It’s actually one of the primary goals of DBT: honing kills for creating a life worth living. What does this mean, exactly?

To me, it’s letting DBT skills work in tandem: engaging thoughtfully with the world around you, learning how to tolerate stressful situations, regulating emotions, and interacting more effectively with others. This is not something you can achieve overnight, and I don’t know when I’ll wake up one day and decide I’ve done it successfully. Life ebbs and flows. There will be days when I feel I’ve taken twenty steps back, and days where I’ve made leaps forward. But the phrase from Rent I’ve had tattooed on my shoulder for six years, “No day but today,” is perhaps more important for me to remember than ever.

Creating a life worth living begins with taking each day and finding something good in it. Participating in activities that I know will make me happy (like sitting down to write this post). Setting small, manageable goals.

There will be days when I feel like I can’t do this or anything else I’ve outlined here. And that’s fine. Because of the dialectical nature of the world, there will be days I do just fine. And that’s fine too.

Feeling okay and feeling not-okay. Winning and losing. Crying and laughing. Loneliness and wholeness. Fear and comfort.

They exist at once, all around us. Our job as humans is to just embrace them all, wholeheartedly, as they come.