Metacognitively Oriented Psychotherapy for Adults with Psychosis

Research suggests that recovery from serious mental illness is possible but can occur only when persons are directing their own recovery. One set of barriers to this process are deficits in metacognition, or the ability for... [ view full abstract ]

Research suggests that recovery from serious mental illness is possible but can occur only when persons are directing their own recovery. One set of barriers to this process are deficits in metacognition, or the ability for form complex and integrated ideas about oneself and others and then use that knowledge to respond to psychosocial challenges. Enduring, trait-like deficits in metacognition can arise for different reasons including stigma, trauma, isolation, symptoms and neurocognitive compromise. Metacognitive deficits for example, make it difficult for persons with serious mental illness to form the kinds of ideas about themselves and others needed to question irrational beliefs, ward off self-stigma and process losses and suffering. Accordingly, it has been asserted that recovery oriented treatment should include forms of psychotherapy that could enhance metacognitive capacity. One particular treatment, MERIT, seeks to facilitate the growth of metacognitive capacity through intensive individual therapy.  To stimulate metacognition, MERIT calls for eight interrelated elements that should occur within every session. These eight elements can be divided further into three groups of elements. The first four MERIT elements are: i) positioning the patient’s agenda as primary, ii) sharing of the therapist’s thoughts without disrupting dialogue, iii) eliciting a narrative episode(s), and iv) defining a psychological problem. The fifth and sixth elements of MERIT focus on the therapeutic relationships in which these first four elements occur within a series of interpersonal processes within session and reflection upon the effects of the session on patients’ mental states. In the final two elements of MERIT clinicians are directed to collaboratively reflect upon the material that has emerged across the first six MERIT elements at the levels commensurate with patients’ metacognitive capacity. This workshop will detail the eight elements of MERIT and discuss how they can help therapists creatively use existing skills to promote recovery.