Self knowledge and self reflection

Personality disorder integrated care pathway
NHS Highland

Knowledge of oneself and one’s condition is crucial for effective self-management. Self-knowledge can be usefully divided into two components – general knowledge about the disorder which is attained through educational interventions, and specific self-knowledge which is attained through self-observation and self-reflection.

Education about personality disorder should be an early component of any treatment process and can be effectively delivered in a number of different formats. Education and awareness-raising about personality disorder among clinicians is equally important. Increasing capacity for self-reflection and understanding of the mental states of oneself and others is a major goal in the treatment of personality disorder. These skills are basic to self-regulation of emotion and impulse control, and are pre-requisite to changing unhelpful thoughts and emotions. In addition, they are necessary for effective interpersonal functioning and fundamental to the development of an integrated sense of self.

Self reflection:

  • Self-reflection brings most benefit when used as a consistent strategy throughout the treatment process and not as something that is undertaken intermittently.
  • It is useful to highlight wherever possible the importance of reflecting upon one’s thoughts, emotions and actions, and the value of trying to understand the behaviours of other people in terms of their possible mental states.
  • A questioning style which encourages self-reflection around thoughts, emotions and behaviours is more useful than simply providing patients with “the answers”. Supporting self-reflection may be carried out informally or in a more structured manner such as behavioural / functional analysis.

People with personality disorder can confuse their own judgements or appraisals of a situation with the facts of the matter even more frequently than other people. Generation of alternative perspectives and examination of a problem from different angles can enhance understanding of difficulties in terms of internal states.

While patient self-reflection should be a primary treatment target, self-reflection in clinicans is equally important. Strong emotions can be experienced when working with this patient group, and understanding the origin of these emotional states can prevent inappropriate emotion-driven behaviour on the part of the clinician. Supervision of clinicians working with this patient group is important and should assist in self-reflection. Depending on the intensity of intervention that the clinician is providing, supervision may occur within usual clinical supervision arrangements or specific supervision may be required as a necessary component of a particular psychological therapy.