The Role of Interpersonal Connection, Personal Narrative, and Metacognition in Integrative Psychotherapy for Schizophrenia: A Case Report

The recovery movement has not only challenged traditional pessimism regarding schizophrenia but also presented opportunities for the possibilities for psychotherapy for people with the disorder. Though in the past psychotherapy models were often pitted against one another, recently there have been emergent reports of a range of integrative models sharing an emphasis on recovery and a number of conceptual elements. These shared elements include attention to the importance of interpersonal processes, personal narrative, and metacognition, with interest in their role in not only the disorder but also the processes by which people pursue recovery. This article explores one application of this framework in the psychotherapy of a woman with prolonged experience of schizophrenia and significant functional impairments

Recovery and serious mental illness: a review of current clinical and research paradigms and future directions

Introduction: Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways, as an objective outcome, versus a subjective process. Areas Covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert Commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one’s experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI

Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis

Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT’s capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed

Comparing Narrative-Informed Occupational Therapy in Adult Outpatient Mental Health to Treatment as Usual: A Quasi-Experimental Feasibility Study with Preliminary Treatment Outcomes

This paper describes implementation of narrative-informed occupation-based service delivery in outpatient community mental health that addresses (1) the need for outcome data on occupational therapy in this setting, (2) an ongoing mental health provider shortage, and (3) a need for innovative approaches to supporting mental health. We found a significant improvement from baseline to post-intervention in occupational participation. Dose of occupational therapy was significantly related to improvements in roles, habits, values, long-term goals, social environment, and readiness for change. This study supports future, larger effectiveness studies of narrative-informed occupation-based intervention delivered by occupational therapists in outpatient community mental health

Metacognition and social cognition in schizophrenia:Stability and relationship to concurrent and prospective symptom assessments

Objective: Schizophrenia has been linked with deficits in the ability to form complex representa- tions about oneself and others. Less clear is whether these deficits are stable over time, and whether they are related to symptoms. Method: We assessed metacognition capacity, affect recognition, executive function, and symptoms at baseline and 6 months later for 49 adults with schizophrenia. Results: Paired t tests revealed assessments of metacognition and affect recognition were stable across measurements points. Metacognition was related to concurrent assessments of positive, negative and disorganized symptoms. Multiple regressions revealed metacognition was related to prospective assessments of negative symptoms after controlling for baseline negative symptoms and executive function. Conclusions: Metacognitive deficits are a stable feature of schizophrenia relatedwith negative symptoms