A Pragmatic View of Disturbed Self-Reflection in Personality Disorders: Implications for Psychotherapy

Patients with personality disorders suffer from impairment in self-reflective capacities. This is not a matter of making incorrect judgments about self-experience but reflects problems with (a) labeling internal experience consistent with the type and level of bodily arousal, (b) seeing how thoughts and feelings are connected to one another within the flow of daily life, and (c) realizing that one's own ideas about interpersonal relationships are subjective and fallible and not direct perceptions of external reality. The authors offer a discussion and definition of each of these three impairments and then offer suggestions for how to address these impairments in psychotherapy.