Stimulating reflection and curiosity

Abstract

This case highlights multiple forms of nonreflectiveness commonly encountered in work with patients with BPD. Clinicians often feel tempted to employ therapeutic approaches that can inadvertently lead to increased rigidity, disengagement, demandingness, and dependency. Rather, clinicians should aim to stimulate greater reflection and curiosity through a humble and “not-knowing” therapeutic stance, while tailoring their interventions to address the particular forms of nonreflectiveness appearing in the moment, which can be distinguished as either black-and-white, disconnected, or concrete. For black-and-white thinking, avoid trying to change the patients’ minds overtly or more discreetly. Instead, empathically validate their perspectives, explore how they arrived at them, and cautiously share your own perspective to stimulate further reflection. For more disconnected experiences, try to “shift the frame” of the patient’s narrative, either by directing attention to aspects of the here-and-now clinical interaction or through surprising interventions that might abruptly prompt more meaningful reflection. For concrete thinking, avoid the impulse to take concrete action to appease concrete demands. Rather, explore the deeper meaning of the patient’s demands, empathically validate the underlying emotional experiences, and transparently share your own perspective on the scenario (including any dilemma you feel about “doing” versus “not doing” what is being requested).