Marsha M. Linehan

“The Dialectical Dilemma for the Patient The borderline individual is faced with an apparently irreconcilable dilemma. On the one hand, she has tremendous difficulties with self-regulation of affect and subsequent behavioral competence. She frequently but somewhat unpredictably needs a great deal of assistance, often feels helpless and hopeless, and is afraid of being left alone to fend for herself in a world where she has failed over and over again. Without the ability to predict and control her own well-being, she depends on her social environment to regulate her affect and behavior. On the other hand, she experiences intense shame at behaving dependently in a society that cannot tolerate dependency, and has learned to inhibit expressions of negative affect and helplessness whenever the affect is within controllable limits. Indeed, when in a positive mood, she may be exceptionally competent across a variety of situations. However, in the positive mood state she has difficulty predicting her own behavioral capabilities in a different mood, and thus communicates to others an ability to cope beyond her capabilities. Thus, the borderline individual, even though at times desperate for help, has great difficulty asking for help appropriately or communicating her needs. The inability to integrate or synthesize the notions of helplessness and competence, of noncontrol and control, and of needing and not needing help can lead to further emotional distress and dysfunctional behaviors. Believing that she is competent to “succeed,” the person may experience intense guilt about her presumed lack of motivation when she falls short of objectives. At other times, she experiences extreme anger at others for their lack of understanding and unrealistic expectations. Both the intense guilt and the intense anger can lead to dysfunctional behaviors, including suicide and parasuicide, aimed at reducing the painful emotional states. For the apparently competent person, suicidal behavior is sometimes the only means of communicating to others that she really can’t cope and needs help; that is, suicidal behavior is a cry for help. The behavior may also function as a means to get others to alter their unrealistic expectations—to “prove” to the world that she really cannot do what is expected.”
― Marsha M. Linehan, Cognitive-Behavioral Treatment of Borderline Personality Disorder