The Dual-Dialectical Conceptualization in Psychotherapy

Duality, Contradiction, and Complementarity in Philosophy

From its inception, the discipline of philosophy has been heavily steeped in arguments concerning duality (sometimes plurality), and contradictory elements have dominated the realm of philosophical thought, reasoning, and knowledge. In some instances, however, philosophical arguments complement one another, as exemplified by the complementarity of the premise that A cannot exist without that which is not A (non-A), and vice versa. In the following section, we examine the positions and views of four well-known philosophers—Descartes, Hegel, Heidegger, Derrida—whose writings document the notions of contradiction, duality, and complementarity within their conceptualizations, reasoning, and knowledge.

René Descartes (1596-1650) is perhaps the most famous rationalistic philosopher. His attempts to achieve certainty in the face of skepticism mark the origins of modern epistemology. Descartes’s reasoning can be summed up by the expression “cogito ergo sum” (“I think, therefore I am”) in his Discourse on Method. Two points are of interest with respect to Descartes. The first concerns dualistic-contradictory reasoning: One proves one’s existence (matter) from something that is not matter—one’s thoughts or mind. “I think, therefore I am.” Without your thoughts you cannot prove your existence. Here we have a dependency of contrasts, in that thought provides proof of existence. The second point concerns language, which is equivalent to thought and contemplation. Without the use of linguistic expression, Descartes could not have expressed his famous “cogito ergo sum,” an expression that is composed of words. Here again, we see a combination of dual, contradictory, and complementary conceptualizations: thought vs. existence, and language vs. reasoning (Descartes, Rene; Laurence J. Lafleur, trans., 1960).

According to Georg Wilhelm Friedrich Hegel (1770-1831), all logic (and, hence, all of reality) is dialectical in character. Aristotle believed that the study of logic was an investigation into the fundamental structure of reality itself, and as Kant noted in the Antinomies, serious thought about one general description of the world commonly lead to contemplation of its opposite. But Hegel did not assume this to be the end of the matter, and made a further assumption that two concepts held in opposition can always be united by means of a shift to some higher level of thought. Thus, the human mind invariably moved from thesis to antithesis to synthesis, using each synthesis as the thesis for a new opposition to be transcended by yet a higher level in a perpetual waltz of intellectual achievement (Mueller, 1958).

Martin Heidegger (1889-1876) noted that although traditional learning focused on what is, an examination of the boundaries of ordinary knowledge by studying what is not might be far more illuminating. Heidegger argued that it is nothing that shapes being in general. It is nothing that reveals the most fundamental transcendent reality, beyond all notions of what is slipping over into what is not. According to Heidegger, even in historical tradition nothing is shown to be concomitant to being rather than to its opposite. The only genuine philosophical question is: why there is something rather than nothing? Heidegger’s philosophy is based on the dual, contradictory, and complementary elements of being vs. nothing and death as the key to life (Heidegger, 1962).

Jacque Derrida (1930-2004), one of the leading contemporary postmodern philosophers, reveals the duality, contradictoriness, and complementarity of conceptualization, all of which are deeply rooted in gramma-tology and language. A number of important tendencies underlie Derrida’s approach to philosophy, and more specifically to the Western tradition of thought.

Derrida’s reasoning is clearly demonstrated by a dualistic, contradictory, and complementary approach, exemplified by the law of identity, (“Whatever is, is”), the law of contradiction (“Nothing can both be and not be”), and the law of excluded middle (“Everything must either be or not be”). The concepts of “lack vs. self-sufficency” and “signifier vs. signified” also follow the same lines (Derrida, 1967).

The Three Rules in Psychotherapy

The first description of the dual-dialectical conceptualization and its clinical application in psychotherapy (based on the three rules of duality, contradiction, and complementarity) appeared with the Illness/Non-Illness Model: Psychotherapy for physically ill patients (Navon, 2005a, 2005b; Waxman, 2005)¹.

The three concepts of duality, contradiction, and complementarity comprise a unified system marking any cognitive, intellectual, emotional, and behavioral activity of human experience. These concepts operate within this system via a reciprocal relationship of mutual dependence of action or influence. For instance, for change to occur, a relationship must be assumed between two elements as the lowest number of elements in any united conceptual framework. These two elements should contradict each other and at the same time complement each other. These two elements cannot exist separately. Each of these two elements is dependent on its complementary element.

Duality refers to the existence of two elements, objects, concepts, human expressions, or states of mind that contradict each other and/or complement one another (Oxford Dictionary, 1996). Examples of duality include an object and the perception of the object, and the conscious and the unconscious (Kahn, 1998).

Contradiction refers to a logical falsehood, a statement that, by virtue of its form, cannot be used to make a true assertion, as in the following statement: “Sugar is sweet and sugar is not sweet” (Seddon, 1966). In addition, a contradiction can exist between two elements, objects, concepts, human expressions, or state of minds that oppose each another: cold vs. hot, justice vs. injustice, something vs. nothing (Kahn, 1998).

Complementarity refers to a situation in which two elements co-exist and the existence of one element is dependent on the existence of a second element. In the structural family therapy approach, the behavior of one family member creates the behavior of another family member, and the two behaviors complement one another (Oxford Dictionary, 1996). Examples of duality include an object and the perception of the object, and the conscious and the unconscious (Minuchin, 1981).

The definition of complementarity resembles central aspects discussed by Levi-Strauss in The Raw and The Cooked (Levi-Srauss, 1969). The existence of something new (“cooked”) serves to define and bring into existence its “raw” complement, which would have been meaningless or incomprehensible before the notion of “cooked” evolved. Similarly, culture brings nature into being, and homosexuality brings heterosexuality into existence.

Words, Contradictions, and Opposites

By learning to understand and speak words, children accelerate and intensify their humanization because words help them isolate, categorize, and relate to the various aspects of the human experience. Words help children concentrate, remember, imagine, reason, and act in an increasingly human way. When repeated aloud and then internalized, words are transformed from adult directions to self-directions (Luria & Yudovich, 1971).

Among the words children must learn, “yes” and “no” are especially prominent, with their polarity heightening and socializing children’s ability to act in their own interests. In other words, in order to survive children must organize everything in their world in a way that best enables them to approach, obtain, and keep. Children discover what they find tasty, what they should avoid or escape, what they should throw away, and what they should spit out. Children express these psychophysical attractions and repulsions by means of primitive sounds and motions that relay pleasure and pain, acceptance and rejection, and eventually, affirmation and denial. The words “yes” and “no” contradict and complement each other. Yes cannot exist without No. The logical symbol of “X” contradicts “Non X,” where “Non X” can be everything that is never, and will never be, “X”. “X” and “Non X” also have a complementary relationship, since “Non X” cannot exist without the presence of “X”. It is true that these symbols are known only negatively, only by their exclusion from their opposites. This point was expressed more precisely by Ferdinand de Saussure, who argued for the existence of a relational conception among the elements of a language, with words and their meanings defined by comparison and contrast to one another (de Saussure, 1993).

How do children learn words and concepts? They learn them concretely by means of dual, contradictory, and complementary rules. Similarly, hundreds of other concrete contradictions and complements eventually are internalized, among them dry vs. wet, light vs. heavy, and light vs. dark. As children develop, they learn to comprehend many other abstract concepts, such as true vs. false, despair vs. hope, justice vs. injustice, and acceptance vs. denial. There are two ways to achieve a contradiction in written or spoken language (Wike, 1982):

Duality, Contradiction, and Complementarity in Major Psychotherapy Theories

Most of the major and well-established psychotherapeutic theories are characterized by a dual-dialectical conceptualization based on the three rules of duality, contradiction, and complementarity. The following is a review some of these psychoanalytic theories, among them object relation theories, intersubjective theories, narrative theory, and structural analysis of social behavior theory.

Sigmund Freud (1955) described his theoretical concepts of id, ego, and superego as separate and merged later. Two other well-known Freudian concepts are the life instincts vs. the death instincts. Freud stated that the life instincts cannot be separated from the death instincts. Finally, the duality of the pleasure principle vs. the reality principle represents the notion that even if the pleasure principle dominates, there are sufficient ways and means for making what is in itself non-pleasurable into a subject to be recollected and worked over in the mind. Pleasure and reality must maintain a dual, contradictory, and complementary relationship.

According to Jacques Lacan’s conceptualization of real vs. lack, culture is created by the separation of lack from real. Furthermore, according to Lacan’s conceptualization of the mirror stage, self-integrity contradicts and simultaneously complements the imaginary, while “integrated” and “fragmented” are also in a contradictory and complementary relationship (Lacan, 1968).

According to the object relation theory of Melanie Klein (Klein & Riviere,1953), love and preserving life forces contradict hate and destructive impulses, because love complements hate. Klein further claims fear of losing a loved mother is the only way to create good objects. Therefore, Klein’s theory is based upon a dual, contradictory, and complementarity conceptualization.

Wifred Bion’s concept of projective identification asserts that without the patient’s projection of any intolerable emotion upon the therapist, no constructive therapy can be carried out, because the therapist must contain and hold the patient’s intolerable emotion (Bion, 1962, 1977). Thus, therapy should involve a complementary relationship between therapist and patient.

Ronald Fairbairn suggested that the chief aim of psychoanalytical treatment was to promote a maximum “synthesis” of the structures into which the original ego has been split. His theoretical conceptualization included the libidinal vs. the anti-libidinal ego (Fairbairn, 1952). This dual-dialectical conceptualization is both contradictory and complementary.

Donald Winnicott clearly demonstrated a dual-dialectical conceptualization by introducing the contradictory and complementary concept of mother vs. infant. According to Winnicott (1982), the potential space both joins and separates the infant (child) and the mother (object).

Thomas Ogden utilized a typical dual-, contradictory-, and complementary conceptualization by introducing the concept of the paranoidschizoid pole vs. the depressive pole, claiming the existence of a constant dialectical tension between these two experiential poles (Ogden, 1992).

Heinz Kohut proposed the notion that most human infants are born with a nuclear self, which is a biologically determined psychological entity, already in place. That self then encounters what Kohut referred to as the virtual self, which is an image of the newborn’s self that resides in the minds of the infant’s parents. Under optimal circumstances, the interaction between the nuclear and virtual selves will lead to the child’s gradual organization into a cohesive self, in which a living, in-depth self becomes the organizing center of the ego’s activities. Along the way, however, the grandiose self—the self that emerges from the normal infantile experience of oneself as omnipotent and the center of all experience—can also appear (Kohut, 1984).

Stephen Mitchell used the notion of intersubjectivity to describe the field around the intersection between two subjectivities, the interplay between two different, subjective worlds, that defines the analytic situation (Mitchell, 1988; Mitchell, & Aron, 1999). In this conceptualization, a dual, contradictory, and complementary relationship exists between two subjective worlds.

According to Jessica Benjamin, intersubjective theory postulates that the other must be recognized as another subject in order for the self to fully experience its subjectivity in the other’s presence (Benjamin, 1990, 1995). This postulation demonstrates the existence of a dual, contradictory, and complementary conceptualization.

In Daniel Stern’s conceptualization of the mother-baby relationship, a baby that is less responsive is a less “recognizing” baby, and a mother who reacts to her apathetic or fussy baby by over-stimulating or withdrawing is a mother who feels despair that the baby does not recognize her. Here, too, a clearly dual, contradictory, and complementary relationship between mother and baby is demonstrated (Stern, 1985).

In Narrative Therapy, Michael White and David Epston described the concepts of externalization vs. internalization. Because these two concepts share a dual, contradictory, and complementary relationship, externalization enables the individual to be differentiated from his problem (White, 1986; White & Epston, 1990).

Lorna Benjamin’s theory of structural analysis of social behavior (SAAB) utilized the concept of complementarity, for example in the two axes of love-hate and enmeshment-differentiation (Benjamin, 1974).

The Differentiation/Integration Approach

According to the Illness/Non-Illness Model (Navon 2005a, Navon 2005b), patients who are physically ill and/or disabled are deeply concerned with the negative life impact of their conditions: “My illness/disability doesn’t let me move on in … ”; “If I weren’t sick or disabled, I could do whatever I wanted… ”; “If I were really well, I’d be free”. Phrases such as these are frequently heard at mental health clinics. These verbal expressions are one-sided and do not represent the whole picture. The subjective reality of these patients is represented through concepts colored by duality, contradiction, and complementarity. This subjective reality is described according to the various theories of pyschotherapy. Such patients repeatedly revert to the seriousness of their plight and, together with their therapist, often become stuck so that the psychotherapeutic interaction cannot go forward. Consequently, the patient sometimes loses interest in the therapy or even quits, bringing about (or perhaps perpetuating) an impasse in any future medical and psychotherapeutic encounters (Jaber et al., 1997).

To overcome such “stuck” situations in therapy, a novel psychotherapeutic tool known as differentiation/integration work was created (Navon, 2005a, Navon, 2005b). This tool assists in distinguishing and differentiating between the two conditions that demonstrate the dual-dialectical paradigm of physically ill patients: illness vs. non-illness. At the outset of therapy, the patient holds the notion that everything in his/her life is illness. Yet this is only one frame of reference. In response, the therapist suggests that the patient look for non-illness themes in his/her verbal expressions. This procedure can be carried out in the clinic only because patients’ verbal expressions are dualistic, contradictory, and complementary in nature (Navon, 2005).

Example:

In the following example, a patient with Crohn’s disease describes his illness narratives, and the therapist differentiates between illness themes and non-illness themes. The following statements are categorized as illness or non-illness statements according to the patient’s verbal expressions (in quotations):

The management of differentiation work does not preclude all talk of illness, but rather offers the patient the potential to loosen the ties of imprisonment to illness and to achieve a balance, placing emphasis less on illness and more on non-illness and the good things in life.

The differentiation work approach can be applied to any stuck situation during the course of psychotherapy. According Freud’s psychoanalytic theory, for example, whenever a patient expresses fear because of his/her death instincts, the therapist can raise the dual, contradictory, and complementary concept of life instincts. It is possible to apply the same procedure c to Freud’s other dual-dialectical concepts: pleasure principle vs. reality principle, and fulfillment of wishes vs. restraint and protection. As mentioned, differentiation work can be applied to any theory that includes a dual-dialectical conceptualization based on the three rules of duality, contradiction, and complementarity.

Conclusion

According to classical cognitive therapy (Beck, 1976; Beck & Beck, 2011), patients suffer because of their ongoing perspective about a given experience or stimulus, and therapy is curative because it supplies patients with a different perspective, a new way of seeing the same thing. As a result, alternative feelings and behaviors are inevitable.

This paper makes a novel contribution by proposing that a patient’s pathology can be reduced to a single choice, to one option, only after the therapy has introduced the dual, contradictory, and complementary alternative. Thus, it is possible to say something that Beck never said: in presenting alternatives, the therapist turns the patient’s own experience into one alternative, when previously the patient had experienced it as everything, as complete, and as “reality” without an alternative. According to the terms used by Levi-Strauss, the therapist provides something that is “cooked,” and shows the patient that he had been thinking in “raw” terms. This novel idea of introducing an alternative that is dual, contradictory, and complementary differs from classical cognitive therapy.

Patients seek therapy because they cannot find an answer or an alterative solution to their problems. The problem they bring to therapy is usually stuck and one-sided. Hence, the therapist must propose a tool that can liberate the patient’s perception of the problem to create a change. To use a traffic metaphor, the patient haddriven into a dead end, and the therapist needs to redirect to a bypass road, to an alternate solution. Now the patient has an alternative and can choose between the road that is blocked and the open road. The differentiation/integration approach is geared to release patients from situations that appear to have no alternatives. Only if the patient’s verbal material is transformed and translated from one frame to two frames can a change occur in therapy. The therapist should suggest two alternatives to the same problem, thus offering the patient two alternatives to choose from. These dual alternatives are in a contradictory and complementarity relationship.

In this paper, I have proposed a psychotherapeutic conceptualization that can bring about a change in how patients view their presenting problem. A review of the major theories in psychotherapy reveals that all of them share the rules of duality, contradiction, and complementarity. At the onset of therapy, patients usually consider their problems in a completely negative light. They see only one aspect of a problem and feel “stuck” and helpless to bring about a change. Understandably, without guidance patients cannot see the dual, contradictory, and complementary nature of their problems. By introducing this concept of duality, contradiction, and complementarity, the therapist liberates the patient and enables him or her to change thoughts, emotions, and behavior patterns. Therapy helps the patient differentiate between negative and positive behavior patterns and to make a choice, thus bringing about a sense of mastery and control over life.

As an integral constituent of the social constructionist movement in psychology (Gergen, 1985), postmodern therapists subscribe to the notion that reality assumptions (and we all make them) develop from communication, language, and conversation with others. This would imply that present knowledge is expanded upon within a social context and that language both shapes and is shaped by reality (Goldenberg & Goldenberg, 1996). This type of theoretical orientation is based on social constructivism (de Shazer, 1988; Efran, Lukens, & Lukens, 1988). The concept of three rules presented in the current paper is an addition to the field of social constructivism, in which language and meaning are the core ingredients of psychotherapeutic interaction with patients.