Mechanisms of Change in Dialectical Behavioural Therapy: Theoretical and Empirical Observations (Lynch, T; Chapman, A; Rosenthal, M.Z.; Kuo, J.R. 7 Marsha M. Linehan – 2006).

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 62(4), 459–480 (2006).

Despite increased attention to treatment development for borderline personality disorder (BPD), very little research has examined the basic processes or mechanisms underlying
patient change.

it has demonstrated efficacy in RCTs for chronically depressed older adults (Lynch, Morse, Mendelson, & Robins, 2003) and eating disordered individuals (

reductions in several problems associated with
BPD, including self-injurious behavior, suicide attempts, suicidal ideation, hopelessness, depression, and bulimic behavior. (See Robins & Chapman, 2004, for a review.)

From Theory to Practice: Dialectical Philosophy and the Biosocial Theory
of Borderline Personality Disorder Philosophical Foundations

Marsha Linehan discovered an important shortcoming in standard cognitive and behavioral treatments: They focused almost exclusively on helping patients change their thoughts, feelings, and behaviors. A treatment solely focused on change often was not palatable to these patients, who often felt invalidated and criticized and dropped out of treatment. On the flip side, a treatment focused entirely on acceptance invalidated the seriousness of the patients’ suffering and the urgent need to produce change

As a worldview, dialectical philosophy
most often is associated with Marxist socioeconomic principles, but the philosophy of
dialectics actually extends back thousands of years

According to Hegel, the process by which a phenomenon, behavior, or argument is
transformed is the dialectic,

applied to the understanding of
human suffering, this ontological principle of interrelatedness and wholeness leads to a
systemic and contextual conceptualization of behavior. DBT treats the whole

the transaction
between a biological tendency toward emotional vulnerability and an invalidating rearing
environment produces a dysregulation of the patient’s emotional system.

invalidation is the critical socially mediated etiological process

emotional vulnerability is the key biological factor.

The invalidating environment is characterized by punishing,
ignoring, or trivializing the individual’s communication of thoughts and emotions as well
as self-initiated behaviors and may involve sexual, physical, and emotional abuse (Wagner
& Linehan, 1997).

the inevitable sequelae of dysregulated emotions,
or as maladaptive methods of altering emotional experiences. For example, impulsive
or self-destructive behaviors such as self-injury, suicide attempts, or disordered eating
may occur in direct response to or function to regulate

the ultimate goal is
not to achieve an objective “distance” from one’s experience, but rather to enter into,
participate in, and become “one with” experience (

learning to control the focus of attention, not the object

By allowing emotions to be experienced (exposure)
without judgment, new associations are acquired (the emotion “just is,” the thought “just
is,” the memory “just is”). With repeated practice,

in the patient’s life, DBT provides an opportunity to learn new associations with
stimuli that elicit intense emotional pain.

For instance, the socially anxious individual who avoids giving speeches
in response to a verbal rule (“If I publicly speak, I will be humiliated”) may fail to learn
that public speaking is nonthreatening, even if he or she gives a successful speech. Literal
belief in these types of verbal rules leads the individual to experience thoughts, feelings,
and situations as dangerous (i.e., “If I think X, a very bad thing will happen”) and to
evaluate certain thoughts as “bad” and/or equivalent to an unwanted action

observe a “thought as a thought”
without believing it is literally true

does not work by altering

it encourages the development

metacognitive awareness (i.e. seeing thoughts as thouhts, not literally true)

Indeed, BPD patients frequently describe a negative, shameful, or otherwise aversive
sense of self, which is likely maintained by literal belief in negative self-judgments.
Mindfulness may function to create a new sense of self

the difficulty individuals who have BPD
have in disengaging attention from emotional stimuli

DBT operationally defines the specific
behaviors involved in validation in a unique manner. As such, DBT involves six levels of
validation: (1) active listening, and awakeness to and interest in the patient; (2) accurate
reflecting of the patient’s feelings, thoughts, or behaviors; (3) articulating unverbalized
feelings or thoughts, or “mind reading”; (4) expressing that the patient’s dysfunctional
behavior is logical in view of past learning history or biological factors; (5) expressing
that the patient’s behavior is normative, wise, or expected given the current context; and
(6) acting in a manner that is genuine, or “radical genuineness.”

BPD individuals often suffer from identity disturbance, involving persistent and markedly
disturbed, distorted, or unstable self-image or sense of self (American Psychiatric
Association, 1994; Koenigsberg et al., 2001). Therefore, the ability to organize experiences,
predict future events, and engage in effective social interactions may be compromised
as well. Within

In turn, heightened arousal interferes with cognition and task performance

people tend to “gravitate toward and stay in environments that are compatible with their
self-conceptions” (Swann, 1983, p. 39).

to help the patient reduce emotion dysregulation
in the service of building a life worth living

For instance, many BPD patients engage in various behaviors
(i.e., self-injury) that they are rather averse to disclose and discuss, let alone in an
excruciatingly detailed chain analysis.

Shame has been described as a painful state that disrupts ongoing
behavior and cognition

The action tendencies
associated with shame include the urge to hide, withdraw, disappear, or avoid thinking
about aspects of the shameful behavior

Requiring the patient to talk in detail about shameful events or behaviors may work
very similarly to mindfulness or opposite action

The patient implements
emotion regulation skills to attenuate feelings of sadness and shame, discards her
razor blades, and seeks social contact and support or advice

Reducing Emotion Dysregulation and Building Skills:
Emotion Regulation Skills and Opposite Action

the biosocial theory that BPD is fundamentally a disorder of pervasive emotion dysregulation

Against Men

Against Men

After Miguel James’ “Against the Police”

My entire Oeuvre is against men.
If I write a Love poem it is against men.
And if I sing the nakedness of bodies I sing against men.
And if I make this Earth a metaphor I make a metaphor against men.
If I speak wildly in my poems I speak against men.
And if I manage to create a poem it’s against men.
I haven’t written a single world, a verse, a stanza that isn’t against men.
All my prose is against men.
My entire Oeuvre
Including this poem
My whole Oeuvre
Is against men.

 

One Way Street: Alberni St. (Burrard to Thurlow)

after Walter Benjamin, sui generis of the poetic city

Hermes (755 Burrard St)

Regarding the virtue of lightness, Calvino says, “At certain moments I felt that the entire world was turning into stone: a slow petrification.” The stare of the Medusa, seemingly inescapable, escapes Perseus, who wears winged sandals. “To cut off Medusa’s head without being turned to stone, Perseus supports himself on the very lightest of things, the winds and the clouds, and fixes his gaze upon what can be revealed only by indirect vision, an image caught in the mirror.” Victoria Beckham once boasted of owning the most number of the most expensive handbags in the world: the Birkin bag. It was named after Jane Birkin, who, in 1983, was seated next to Hermes chief executive Jean-Louis Dumas. “Birkin had placed her straw bag in the overhead compartment of her seat, but the contents fell to the floor.” Dumas made her a black satchel, the first Birkin, to help with the weight of her belongings. Here there are no traces of Hermes, his movement or his lightness. Kim Kardashian, patron saint of shameless consumption, once made headlines for using a $50,000 Hermes Birkin as a diaper bag. “My Birkin carries all of my essentials,” she says. So the Medusa comes alive again.

 

Tiffany & Co. (723 Burrard St)

I once read that the mere sight of the colour “Tiffany blue” was enough to invoke feelings of affection, endearment, and tenderness in women who saw it. It was from a magazine of pop psychology, which despite its normative assumptions, made sense to a ten year old at the time. Tiffany blue, also known as robin’s egg blue and forget-me-not blue, was shortly patented through the Pantone institute, with the number 1837, the same number as the year the company was founded. Now it’s praised as a landmark in marketing, branding, design. When I was 13, I bought three colours of acrylic paint to mix for my reproduction of Tiffany blue: sea foam green, cobalt blue, and white. I painted a ring-sized cardboard box, stuffed a Hershey’s kiss in it, and gave it to my big sister, who still wouldn’t stop crying.

 

Jaeger-LeCoultre (1012 Alberni St)

An ordinary part of horology is the expectation of complications. Complications take a technical connotation here – it not only pertains to the difficulty that confronts horologists, but rather the intricacies of timepieces that desire to show features beyond mere date and time. The second most complicated wristwatch movement in the world belongs to a watch designed by Jaeger LeCoultre. The Hybris Mechanica Grande Sonnerie with 182 movements, 27 complications, and over 1300 parts. My mother once stepped on a less complicated watch as a punishment. It was a light pink Baby G one, and it belonged to me. After that it was clear to me that she valued time above watches.

 

Michael’s (1022 Alberni St)

Any one who pays full price for anything is a fool. Those were wise words from my old nanny, who made her living out of loving me. She would dust off the coloured chalk from my hands after I drew hopscotch boxes on the pavement. I want to find her, and tell her that in this street, they sell bundles of Chalk Markers at half price. In the city, there would be no need to hose down the pavement because the rain would do it for us.

 

Kobe Japanese Steakhouse (1042 Alberni St)

Where was the California roll created? The historical dispute between Vancouver and Los Angeles still remains. What is more interesting to me is that Tokyo doesn’t care.

 

Coast (1054 Alberni St)

The imperial ruins of fresh oysters: Kusshi (stellar bay) $3.75, Royal Miyaki (baynes sounds) $2.75, Gems (read island) $2.75, Okeover (okeover inlet) $2.75, Malpeque (pei) $3.95, Joyce Point (sawmill bay) $2.75.

Excerpts from Claudia Rankine’s Citizen: An American Lyric

“Yes, and the body has memory. The physical carriage hauls more than its weight. The body is the threshold across which each objectionable call passes into consciousness—all the unintimidated, unblinking, and unflappable resilience does not erase the moments lived through, even as we are eternally stupid or everlastingly optimistic, so ready to be inside, among, a part of the games.”