This chapter has three sections. The first reviews how routine therapeutic work also facilitates self-development. The second discusses how to reconcile and integrate different self-representations and self states. The final section examines the importance of self-directedness in promoting integration.

Setting the Stage: The Contribution of Earlier Therapeutic Work

The three-component structure of the self – the self as knower, known, and agent – used to organize this phase of treatment also provides a useful way to think about how routine interventions impact the self.

Strengthening the Self as Knower

Strengthening the self as knower is crucial in constructing a more coherent self and a life worth living. Unless patients trust their basic feelings and wants, there is no basis for elaborating a sense of who they are and what they want from life. Earlier, it was noted that our sense of self is based on our subjective experience of (i) personal unity and coherence, (ii) personal continuity across time, (iii) clarity and certainty about self-knowledge, and (iv) authenticity and conviction about basic emotions and wants. Experiences of unity and continuity anchor us to our world and provide the sense of stability and permanence needed for self-development. We also need to feel a sense of certainty and authenticity about our experiences, especially our emotions, if we are to interact effectively with the world. When we do not trust our basic experiences, we are deprived of the information needed to make decisions, leaving us uncertain about how to act and creating an existential distrust of the information we receive from others. Since all aspects of the self as knower are impaired in borderline personality disorder (BPD), construction of a more adaptive self begins by strengthening these features.

Patients’ certainty about the authenticity of basic experiences is increased by validation and its effects may be increased by drawing patients’ attention to how they are becoming more certain about their experiences and more confident in their judgements. Simple comments such as, “You seem to be more sure about your feelings,” or “You seem to doubt yourself less” reinforce confidence and strengthen the self as knower.