Basing on Vygotsky’s cultural-historical methodology, Bakhtin’s conception of inner dialogue, and some ideas of object relations theory, the authors propose an integrative approach to self-awareness in psychotherapy. Serious attention is paid to the predictors of borderline personality disorders and comorbid illnesses: pathogenic family conditions of personality development and, in consequence of them, splitting and structural distortions of self-awareness. The descriptive-analytic, semiotic and dialogical procedures of analysis of verbal communications between patient and psychotherapist were elaborated and approbated.