Dialectical Behavior Therapy – Its Relevance for Japan in Social Transition

Japan is not immune from the global trend of tensions between the acceptance of diversity, the rejection of it, or the ambivalence in between. Emerging recognition of LGBTQ rights (Chi, 2016; Tamagawa, 2018), the shift in gender roles and lifestyle choices (Kanomata, 2012), the rise of intercultural marriage and the number of children born into to these families (Takeda, 2008), the increase of Japanese with a global perspective (Ota, 2011), or increasing number of foreign workers and students in cultural and linguistic adjustment processes (Ishikawa, 2014; Niikura, 2008) in a still largely conformist, monoculture, monolinguistic, inward-looking communities are examples of the tensions. The tensions seem to amplify invalidations experienced by individuals who identify themselves as minorities in the transforming society, which in turn increase their emotional vulnerability.

Dialectical behavior therapy (DBT)’s biosocial theory posits transactions between an invalidating environment and an individual’s emotional vulnerability as the factor for the development of borderline personality disorder (Linehan, 1993). In this presenter’s clinical work over the past four years in Tokyo produced enough samples to hypothesize that some, if not all, traits of BPD are present among these minority individuals. They are: a) affective lability especially of anger, b) chaotic relationships and chronic interpersonal crises, c) difficulties with sense of self, d) self-harm and other impulsive behaviors, and e) dissociative responses in stress situations (Linehan, 1993). DBT was effective to work with these individuals with its dialectical worldview (D) to understand and validate their private experiences; behavior procedures (B) that balances acceptance of emotional pain and change of problematic behaviors; and therapeutic relationship (T) that is genuine and equal.

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