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Dialectical Behaviour Therapy is based on a bio-social theory of borderline personality disorder.
Linehan hypothesises that the disorder is a consequence of an emotionally vulnerable individual growing up within a particular set of environmental circumstances which she refers to as the 'Invalidating Environment'.
On the other hand they have internalised the characteristics of the Invalidating Environment and tend to show 'self-invalidation'.
They invalidate their own responses and have unrealistic goals and expectations, feeling ashamed and angry with themselves when they experience difficulty or fail to achieve their goals.
This extreme mood dependency is seen as being a typical feature of patients with BPD.However, it is in the nature of such an environment that the demands that she is allowed to make on others will tend to be severely restricted.The child's behaviour may then oscillate between opposite poles of emotional inhibition in an attempt to gain acceptance and extreme displays of emotion in order to have her feelings acknowledged.Dialectical Behaviour Therapy is an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way which is optimistic and which preserves the morale of the therapist.The technique has been devised by Marsha Linehan at the University of Washington in Seattle and its effectiveness has been demonstrated in a controlled study, the results of which will be summarised later in this paper.
These two features constitute the first pair of so-called 'dialectical dilemmas', the patient's position tending to swing between the opposing poles since each extreme is experienced as being distressing.