A rational model for maximizing the effects of therapeutic relationship regulation in personality disorders with poor metacognition and over-regulation of affects

Background. The therapeutic relationship plays a key role in personality disorder (PD) psychotherapy. Some aspects of therapeutic relationship regulation appear important for treatment of PD clients, including those with constricted relational schemas, poor metacognition, and over-regulation of affects described here. Aim. To propose a rational model for how and when to work on the therapeutic relationship by treating the underlying personality pathology. Method. Formalize a step-by-step procedure for performing operations such as validation of clients’ experiences, creating a sense of sharedness, assessing the quality of the therapeutic relationship in order to prevent and repair ruptures in the alliance, selfdisclosing by the therapist, and metacommunication on the basis of clients’ responses to treatment. Conclusion. We discuss the implications of this model for further research into the PD therapy process.