Disturbed personality functioning and psychotherapy technique

Traditional techniques in psychodynamic psychotherapy involve clarifications leading to interpretations. In order for patients to understand the therapist, they have to be in a state that permits reflective awareness. Patients at higher levels of self-coherence are more likely to have such capacities, and so therapists can be more exploratory and challenging in terms of interpretations and clarifications. Patients with disturbed levels of self and relationship schematization are vulnerable, under stress, to enter states impoverished in terms of capacities for reflective awareness. Alternative techniques of clarification are indicated, and several are illustrated in this article. These alternatives may avoid the negative effects of patients feeling criticized by receiving a distorted view of a therapeutically intended interpretation.