Finding a Dialectical Balance Between Process and Procedure


  • Gillian C. Galen
  • Blaise A. Aguirre
  • Julianne Wilner Tirpak




The case of "Jane" (Marks, 2022) provides a detailed examination of the evidenced-based treatment, Dialectical Behavior Therapy (DBT), in the treatment of a woman with complex and multifaceted psychiatric difficulties by Michael Marks, an advanced doctoral student clinician in a DBT training clinic. Marks’ presentation provides an excellent example of the challenges clinicians face when treating patients with borderline personality disorder (BPD) and many of the common and multiple co-morbidities that frequently accompany the BPD diagnosis. While DBT is sometimes dismissed as a treatment that just teaches skills, Marks demonstrates the technical demands and nuances that therapists must use to correctly and effectively treat suicidality, emotion dysregulation, mood dependent behaviors, and significant interpersonal deficits that often have destructive and painful consequences. The three authors bring a variety of perspectives in commenting on Marks’ case study. The first is a psychologist who is a senior DBT therapist and the Program Director and Director of Training at an established adolescent DBT Continuum of Care Program; the second is an internationally active psychiatrist who is the Medical Director of the same Continuum of Care Program and a Behavioral Tech DBT Trainer; and the third is a post-doctoral psychology fellow working with the first two authors. A major theme in our discussion will be the challenge, when delivering DBT, of how to balance  between technical interventions, on the one hand, and emotional experiencing, on the other. In exploring this theme, we will answer the questions, what was left out and what does it feel like?  




How to Cite

Galen, G. C., Aguirre , B. A. ., & Tirpak, J. W. . (2022). Finding a Dialectical Balance Between Process and Procedure . Pragmatic Case Studies in Psychotherapy, 18(1), 94–101.