Dialectical Behavior Therapy (DBT) proposes biosocial model for the development of borderline personality diosrder. The bio side of the model is explained in the emotional vulnerability section of the page, "borderline personality disorder. " Here, the social side of the model is explained.
Role of the environment in emotional developoment
All babies are born with emotions but without names to describe them, or elaborate tools to communicate them to people aroud them. It is the people around them who give babies the names and tools to communicate their emotions. This learning coninues throughout individuals' life. It is not difficult for many of us to say out of our experience that the way we communicate our emotions change from childhood to teenage, to early adulthood, to middle age, to old age as our environment as well as larger social context change.
When there is a goodness of fit between individuals and their environment, individuals can tolerate and meet the environment's expectations and demands. What happenes then if there is no goodness of fit ? Remember that the diagnosis of personality disorder is only possible, according to DSM-V, when one's behaviors deviate significantly from the norms and expectations of one's culture? When there is no goodness of fit, individuals' behaviors are deemed unacceptable and dysfunctional.
How does invalidation happen?
Just as individuals with borderline personality disorder do not intend to manipulate people around them, their environment does not mean to invalidate their experiences or judge their behaviors. Often well meaning parents, partners, co-workers, friends, classmates, and even us, mental health professionals, can inadvertently invalidate individuals' experiences. This happens usually when the environment fails to understand the individuals' private experiences, and respond to their communication by erratic and somewhat dismissive or punitive responses.
Imagine that a boy just finished an important presetation at school, and said, "I blew it." Average responses from people around him can be like, "Oh it wasn't so bad," "I'm sure you did OK," "Don't be so hard on yourself, " or "Well, that happenes." If the boy is highly sensitive, he can easily start wondering if his perception was weird. If not, he can feel that his heart-felt disappointment about his own performance was not taken serously by the people around him. Instead of saying "thank you," to these words, as a result, he might frown, cross his arms and say, "what do you mean?" The other person reacts to the facial and body expression and say, "hey, I was just being nice, and you don't have to attack me like that." Imagine how the boy would react to the word "attack." You can see how it is a tranaction between the boy and the environment? The boy really did not feel he did well, so his communication was congruent with his subjective reality. And he felt that the environment said that there was no conguency and he was over reacting. But did the environment mean to say that there was no congruency? Most likely no. The person probably wanted to help the boy come out of his negative thought. There was no malicous intention in either side, and yet the conversation somehow escalted emotionally.
When these feedbacks are given repeatly over time, individuals get confused about their experiences, and learn not to trust their perceptions. The consequences are the extreme supression of their emotions at first to play by what seems to be the social convention, followed by extreme emotional outburst to get the wanted response from the environment.
Role of the family in particular
Remember that the personlity disorder to be dianosed, the personality traits must have been present before the early adulthood? That would naturally make us look at the family environment in particular to see if there was some form of invalidatoin in individuals' childhood. Dr. Linehan's seminal book in 1993 suggested that individuals' childhood experiences of invalidation in families could be largely grouped into the following 3 types.
a) Parents were largely unavailable when the child needed emotional support.
b) Parents dicouraged or even prohibited negative emotional talks at home. Only positive sharing were encouraged and praised.
c) Parents' message was that growing up meant becoming more and more reasonable, and less and less emotional. In other words, the child was told that they should learn how to regulate emotions by being reasonable.
Again, often families mean well. Many people who have similar childhood experiences do not develop borderline personality disorder either. As a result of transactions, however, slightly more sensitive child in slightly more invalidating environment can become highly sensitive to emotional stimuli.
What can we do to help?
As individuals learn new skills to regulate their emotions, we would like people around them to learn the mechanism of bordelrine personality traits and help them regulate their emotions. This is why DBT has a family group therapies in which teens and their guardians learn the whole skills together.
In particular, we see valiation of each other's communication extremely effective to regulate emotions. Validation means communicating that you understand what the other person is saying. Looking for what is valid in what they are communicating and acknowledge them. Validation is not agreement. Validation is not conceding. The only purpose is to encourage the individual to keep communicating so that as they talk, they learn to understand their own emotions. This is very important because as soon as the individuals stop commuicating, they loose the chance to learn and explore their emotions.
There are six levels of validation. We want to start from Level 1 to practice. I will write an example of how you can use each level of validation to react to "I blew it" example above in brackets.
Level 1: Stay awake. Don't multitask. Pay sincere attention to what the person is saying with kindness. [Stop what you are doing. Look at him. Nod.]
Level 2: Repeat what you heard by rephrasing and summarizing. Don't over do this, though. [You don't think it went well.]
Level 3: Put the words to observable facial and body expressions. Guess what emotions that they are trying to communicate without expressing it as such. If your guess is wrong, don't push. [You sound very disappointed. ]
Level 4: Show your understanding of the person's context, history, etc. and communicate that it is understandable that the person feels the way he or she does given his / her context or history. [You put so much efforts for this presentation, so your frustration is understandable.] [This has happened to you before. It must be hard to experience this twice.]
Level 5: Normalize the person's feeling. [As this was such an important task, everyone wanted to perform his best.]
Level 6: Genuine interaction. When you use your full skills from Level 1 and 5 and when you know you have enough information about what the person is trying to communicate, only then, communicate your feeling, opinion, further questions and suggestions.
We all tend to jump to Level 6 without doing enough of Levels 1-5. Levels 1-5 are the foundation for the level 6 to work. It is not that you have follow the order. In the conversation, you mix levels 1-5 accordingly. Validation alone can not only help individuals calm down, but also improve the relationship so much that it is worth a try.
Linehan, M. (1993). Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.