Psychopathology can be seen as a dysfunction in the inner and interpersonal dialogues people conduct with both internalized and real-world others, and psychotherapy as a dialogical co-construction of meaning. This chapter focuses on persons with personality disorders (PD) with limited ability to perceive and describes their inner world and poor understanding of what is passing through others' minds. In a dialogical therapy context, the chapter develops the idea that in persons with PD a barrier to healing is their inability to describe aspects of themselves and others in mentalistic terms, thus preventing the formation of a full-fledged, flexible, adaptive and open-to-innovation dialogical self. The chapter overviews the common aspects of dialogically oriented therapies. It provides an overview of what metacognitive dysfunctions are, and why they hamper healing. The chapter discusses technique elements that may help in treating more severe sufferers by taking into account their metacognitive disorders.