Marsha Linehan (1991) pioneered this treatment, based on the idea that psychosocial treatment of those with Borderline Personality Disorder was as important in controlling the condition as traditional psycho- and pharmacotherapy were. Concomitant with this belief was a hierarchical structure of treatment goals. Paramount among these was reducing parasuicidal (self-injuring) and life-threatening behaviors. Next came reducing behaviors that interfered with the therapy/treatment process, and finally reducing behaviors that reduced the client's quality of life. In 1991, Linehan published results of a study that seems to do remarkably well at achieving these goals. The Theory: Basically, DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, they don't have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task. How it works: Dialectical Behavioral Therapy (DBT) consists of two parts:

1. Once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem. Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship. The emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crisis. Telephone contact with the individual therapist between sessions is part of DBT procedures. (Linehan, 1991) DBT targets behaviors in a descending hierarchy:

* decreasing high-risk suicidal behaviors

* decreasing responses or behaviors (by either therapist or patient) that interfere with therapy

* decreasing behaviors that interfere with/reduce quality of life

* decreasing and dealing with post-traumatic stress responses

* enhancing respect for self

* acquisition of the behavioral skills taught in group

* additional goals set by patient

2. Weekly 2.5-hour group therapy sessions teach:

• Core Mindfulness Skills - These are derived from Buddhist meditation techniques to enable the client to become aware of the different aspects of experience and to develop the ability to stay with that experience in the present moment. - Treatment lasts for about 2-3 weeks.

• Interpersonal Effectiveness Skills - These focus on effective ways of achieving one's objectives with other people: to ask for what one wants effectively, to say no and be taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people (comparable to assertiveness training). - Treatment lasts for about 8 weeks.

• Emotion Modulation Skills - These skills are ways of coping with intense emotional experiences and their causes. They also allow for an adaptive experience and expression of intense emotions. - Treatment lasts for about 8 weeks.

• Distress Tolerance Skills - These include techniques for putting up with, finding meaning for, and accepting distressing situations if there is no conceivable solution at present.