Impoverished Self-Narrative and Impaired Self-Reflection as Targets for the Psychotherapy of Personality Disorders

Recent years have seen theory and research in psychiatry and psychotherapy identifying which facets of the psychopathology of personality disorders (PD) should be treatment targets. This paper focuses on four elements: a) impoverished autobiographical narrative/use of generalized memory; b) lack of conscious sense of agency; c) poor awareness of emotions and their triggers; d) loss of fantasy/reality distinction. These all impact PD sufferers’ well-being and social functioning. I first describe the four elements and provide some empirical evidence for them and then propose technical processes for tackling the dysfunctions both directly and through therapy relationship work. I will provide examples of the pathology and treatment from the cases of two patients suffering from wide-ranging and severe PD.