Mending the Mind

Abstract

Cognitive behavior therapy (CBT) offers an alternative paradigm to psychoanalysis for understanding human behavior and the mechanisms of change. Dialectical behavior therapy (DBT) grew out of this tradition conceived originally for the treatment of suicidal patients with borderline personality disorder. Unlike psychoanalysis, DBT does not recognize unconscious meanings or motivations and instead focuses on sequences of measurable behavior and the contingencies that reinforce them. The treatment protocol emphasizes a deficit model and is structured around specific targets and goals combined with “skills” training (i.e., specific skill sets to help with emotional, cognitive, and behavior dysregulation) Combining an overarching dialectical philosophy, emphasis on the therapeutic relationship and mindfulness, DBT offers a comprehensive therapeutic approach including individual sessions and group work. The directive methods of CBT have often been viewed as antithetical to analytic reflection; such active therapeutic techniques on the part of the psychoanalyst are often seen as impeding the necessary free associative processes necessary for the acquisition of insight and for change. Whereas psychoanalysts help patients recognize dysfunctional patterns of behavior within the transference and alternative ways to view the transaction, they often do not help a patient implement new behaviors into their lives in systematic ways. Both psychoanalysis and DBT have much to offer and to gain. In time translation and mutual inclusion of new ideas may help bridge the gap.