“Barefoot on the Rocks”: Addressing Shame and Guilt in a Woman Suffering From Borderline Personality Disorder With Combined Individual and Group Metacognitive Interpersonal Therapy

Guilt and shame can be very relevant when treating personality disorders. Understanding how they block the patients' capacity to figure out they can fulfill their wishes is central for a fine-grained case formulation, and for counteracting their contribution to symptom and goal fulfillment. To this purpose we will describe how Metacognitive Interpersonal Therapy, delivered in a combined individual and an open-group format, addressed pathological emotions of shame and guilt in the case of Martina, a woman suffering from Borderline PD with avoidant and dependent traits. We show how the therapists adopted a combined individual and group format, working through the therapeutic alliance, using experiential techniques such as guided imagery, rescripting, body work, and role-play. Through this process, Martina came to realize that her core problem was related to a core self-idea of being "shattered" and "harmful" which she held as true and that made her impossible to access the very idea of deserving to be treated. Therapy helped her figure out the origins of these ideas which generated intense guilt and shame and to process them until she was able to contact a sense of self-confidence and dignity, and finally to pursue her own wishes.