I’ll admit sometimes I eat brownies for breakfast. If they happen to be out, and I’m whirling through the kitchen to get dressed and upright on the moped and into the hospital, I’ll grab a brownie and chase it with a pot of coffee.

I’m getting help. Actually, I’ve invented my own Crisis Hotline for others. I call it Dialectical Brownie Therapy (DBT), an adaptation of a cognitive treatment known as dialectical behavioral therapy, and I’ve been learning to practice on my current psychiatry rotation. For my version of DBT, as in real Dialectical Behavior Therapy, the goal is to seek a synthesis between two extremes, between feeling overly controlled and feeling out of control.

When I eat brownies for breakfast, I get caught in the Hegelian dialectic between 1) my own out of control emotional vulnerability of wanting the goodness of a gooey brownie regardless of the health consequences and 2) the over controlling invalidating environment that shames me for wanting to eat chocolate for breakfast and oversimplifies the ease of reaching for the banana or granola instead. I get caught between blaming myself and blaming others for the problem of brownies for breakfast. Only after significant work at distress tolerance did I arrive at a revolutionary conclusion: I am fine to have brownies for breakfast (acceptance) AND the brownies need to be radically different, healthier (challenge).This is the fundamental approach to DBT—be both entirely supportive of yourself and entirely challenging—at the same time. I love a good paradox. This is also the mark of a good teacher, and, consequently, the mark of a good doctor.  Support students/patients while you challenge them. Constant support AND unrelenting challenge. So, I put a can of black beans and ¼ cup of flax seeds into this chocolaty pan of goodness. Now my brownie breakfast has protein and fiber and I can eat them with peace and sublime satisfaction.

Dialectical Brownie Therapy: Bean and Flax Brownies (Recipe adapted from the HyVee Seasons Fall 2013 magazine. Theory adapted from Marsha Linehan, PhD, and Hegel)

• 1 (15 ounce) can black beans, rinsed and drained
• 1/4 cup flax seeds
• 1 1/2 cup  semi-sweet chocolate chips
• 1/4 cup  unsalted butter
• 3/4 cup  olive oil
• 1 3/4 cup  sugar
• 1 tablespoon vanilla extract
• 3 large eggs
• 1 1/3 cups all-purpose flour
• 1/2 cup plus 2 tbsp. unsweetened cocoa powder
• 1 teaspoon baking powder
• 1/4 teaspoon salt
• 1/2 cup  mini semi-sweet chocolate chips

Preheat oven to 350 degrees. Grease a 9-by-13-inch pan with non-stick cooking spray.

Puree black beans and flax seeds until smooth. This will look so gross. Practice self-soothing.

Place puree, semi-sweet chocolate, and butter in a large heat-safe bowl over pot of boiling water. Whisk until melted, add olive oil and eggs one at a time. Mix thoroughly, remove from heat.

In a large bowl, sift flour, cocoa powder, baking powder and salt. Mix. Add chocolate mixture to flour mixture and stir. Pour into baking pan and smooth top. Sprinkle mini chocolate chips on top.

Bake brownies for 35 minutes. They may seem underdone but they will continue to bake in the pan after being removed from oven.

Each time I bring one of these brownies to my lips I get the warm fuzzies knowing how supportive I am being of myself. The brownies can be healthier still—maybe next time I make these, I’ll add bananas or something.

By appropriating the acronym for my silly brownie blog post, I mean no disrespect, and wish to convey no satire. I have high esteem for the real DBT and think the whole world and their grandmothers should practice these skills on the regular.

Rachel is a fourth year medical student at Mayo, where she practices narrative medicine, food and jazz as personal subspecialties on her way to a career in psychiatry. A girl from Portland, OR, she is (as you might suspect) rather granola, and you can follow her foodie adventures with her not-so-vegetarian bulldog and vegan backyard chickens on Twitter @hammer_rachel.

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