If you try to fail and succeed in doing so, which have you done?

Marsha Linehan is the current high guru in the community of therapists who treat Borderline Personality Disorder (BPD). Her "Dialectical Behavior Therapy" or DBT is touted as the most "empirically-validated" of all psychotherapy treatments for BPD. This claim is wildly overblown, as DBT is only empirically validated for the treatment of one symptom of BPD called parasuicidality. Parasuicidality includes suicide attempts as well as non-suicidal self-injurious behavior (SIB) such as cutting or burning oneself. Even improvement in that symptom seems to dissipate after two years in her studies. Patients in DBT are also hospitalized less that other BPD patients, but that is probably because DBT therapists will not hospitalize a BPD patient under most circumstances when other types of therapist might.

Another bone I have to pick with Dr. Linehan is the idea of hers that BPD patients show "apparent competence." What this means is that BPD patients often appear to have very good social skills, but they often do not seem to be able to use in emotionally-charged situations. Apparently, Dr. Linehan thinks that BPD patients do not really have these social skills, so the skills must be taught to them in her skills groups. Patients in DBT have to attend these groups in addition to individual psychotherapy.

My question is this: How can you demonstrate a competency that you do not have through repeated performance? Oh, you might fool someone once or twice, but BPD patients can demonstrate social skills over and over again. In fact, they are excellent judges of character, and can determine another person's vulnerabilities quicker than almost anyone else, in order to provoke from another person any reaction they want. They are well known to be master manipulators. How can they do that if they lack social skills? This question also brings into question their often-seen tendency to "split," or act as if they think people are either all good or all bad. Supposedly they can not "integrate" good and bad images of others, but more on that in a future post.

I think it more likely that they have the compentencies in question, but are choosing not to use them in certain situations. It is far simpler to fake incompetency than competency.

Some readers may have seen the movie "The Killing Fields" about the genocide in Cambodia. The Khmer Rouge killed anyone with an education. In the true story portrayed in the movie, a physician survives by pretending to be an illiterate peasant. In this case, acting as if he were incompetent was the most competent thing he could have done.