Embracing Reality: Mindfulness, Acceptance and Affect Regulation; Integrating Relational Psychoanalysis and Dialectical Behavior Therapy

In this essay, I introduce the reader to possibilities for integrating Dialectical Behavior Therapy (DBT) and Relational analytic treatment, when working with patients who present with frequent intense affect storms and chronic self-injury. I offer a brief summary of DBT and explore my integrative work with Barry, a man tormented by early trauma, unrelenting affect instability and a long history of self-injury. I describe the integration into our analytically oriented work of Buddhist ideas related to acceptance, and specific Mindfulness exercises designed to help him calm his mind and body and distract himself from self-injury. I also present a rationale and concrete procedures for the introduction into Relational work of Behavioral structures and techniques designed to help a patient alter behaviors outside of the consulting room. I explore conceptual and clinical overlaps of the two models, including the shared model of mind. I also consider basic differences between these two ways of working and the complementary roles played by these differences in an integrative treatment. Additionally, I explore the complexity of the therapist's internal process when working integratively.