CHAPTER 8 Dialectical Dilemmas and Secondary Targets

Created: 2022-03-12

Table of contents(testing)


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1. BIOSOCIAL THEORY AND DIALECTICAL DILEMMAS

Emotional Vulnerability

Invalidating Environment

매개 변인으로서의 Emotional Intelligence(발달이 잘 안 됐을 때 chronic and severe emotional dysregulation)

Rather than the objective, scientific perspective of the biosocial theory, the dialectical dilemmas represent the subjective perspective of the individual. For instance, emotional vulnerability is a scientifically defined construct, seen from the “outside-in,” when we are considering the biosocial theory; but the same term, when used to name one of the dialectical dilemmas, refers to the “inside-out” perspective of one who is suffering from uncontrollable, agonizing emotional responses. -> move from the language of theory to the language of personal experience.

Once the particular dialectical dilemmas and patterns are identified, and a language to describe them that fosters collaboration is developed, the therapist and patient can work persistently on fading out the extreme patterns and replacing them with skillful ones that are conceptually located in the middle path between the two extremes.

2. THE NATURE OF THE THREE DIALECTICAL DILEMMAS IN CLINICAL CONTEXT

Emotional Vulnerability versus Self-Invalidation

Effective modulation of emotions

Active Passivity versus Apparent Competence

Communication of distress and the effective request for help

Unrelenting Crisis versus Inhibited Grieving

Processing of significant losses and traumatic events

3. DERIVING DBT'S SECONDARY TARGETS FROM THE DIALECTICAL DILEMMAS

4. SOME SUGGESTIONS FOR WORKING WITH PATIENTS AROUND DIALECTICAL DILEMMAS

  1. 한쪽 극성이 시사되면 다른 쪽 극성도 지니고 있을 가능성을 고려하라.
  2. 어려운 용어를 피하고 내담자와 상호협력하여 내담자 눈높이에 맞는 언어를 사용하라.
  3. 행동들이 어떤 식으로 패턴을 이루어 primary target behavior로 이어지는지 내담자와 치료자가 함께 볼 수 있어야 하고, secondary target을 정함에 있어서도 상호협력이 중요함.
  4. secondary target을 명확하게 설정하여 diary card에서 발생 빈도와 발생의 결과를 모니터링할 수 있다.
  5. It is my experience that the more clearly I can conjure up(떠올리다) this image of my patients as functional individuals in their particularly troublesome domains of functioning, and the more I can specifically identify skill sets that will serve them toward actualizing that functional..

5. FROM DIALECTICAL DILEMMAS TO SECONDARY TARGETS TO TREATMENT PLANNING: A CASE EXAMPLE

6. WHY JUST THREE DIALECTICAL DILEMMAS?