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Objective: Preliminary evidence has found metacognitive capacity is associated with therapeutic alliance and with other outcomes in psychotherapy among persons with schizophrenia. The current study explored: (a) before to after changes in clients’ metacognition capacity following Metacognitive Reflection and Insight Therapy (MERIT) and (b) whether the use of specific therapeutic elements of MERIT were followed by higher ratings of therapeutic alliance at the end of each session as well as with short-term outcome as measured prior to the next session, in a session-by-session intensive data collection. Method: Two hundred twenty-one sessions of 10 completers with schizophrenia who took part in an ongoing MERIT trial were analyzed. Measures of therapeutic alliance (short version of the Working Alliance Inventory), general outcome (Outcome Rating Scale), and metacognition (Metacognition Assessment Scale–Abbreviated) were used. Results: Findings showed significant change in 2 domains of metacognition, self-reflectivity and mastery, following therapy. In addition, the presence of 2 specific MERIT elements, the introduction of the therapist’s mind and reflecting on the progress in therapy within a given session, were related to better outcomes in the following week. Finally, reflecting on the progress was also followed by higher therapeutic alliance. Conclusions: Metacognitively oriented therapy may positively affect both therapeutic alliance and short-term outcome. Specifically discussing the therapist’s and client’s experiences of what is occurring in therapy may positively affect short-term outcome and could be applicable to other psychotherapy approaches.

Objective: Metacognition among people with schizophrenia is associated with desired outcomes but can also lead to the experience of psychological pain, affecting the individual's sense of meaning in life. The aim of the current study was to investigate whether the effect of metacognition on meaning in life was dependent on one's level of self-compassion. Hypotheses were that both metacognition and selfcompassion would be positively associated with meaning in life, and that the association between metacognition and meaning in life would be greater among people with high self-compassion than among people with low self-compassion. Method: The baseline data of 33 adults with schizophrenia, who were enrolled in a metacognitive reflection insight therapy (MERIT) trial, were used. Participants filled out self-report questionnaires regarding meaning in life and self-compassion, and were interviewed for an assessment of their metacognitive abilities. Analysis included a calculation of correlations and multiple linear regression models. Results: Correlational analysis showed that 2 subscales of self-compassion (self-kindness and mindfulness) and 1 subscale of metacognition (mastery) were related to meaning in life. Consistent with our hypotheses, regression analysis showed a moderating effect of self-compassion. Metacognition was found to have a positive significant correlation with meaning in life among participants who reported high levels of self-compassion. This effect was insignificant among participants reporting low or moderate levels of self-compassion. Conclusions: Among individuals with schizophrenia, self-compassion seems to be crucial in the ability to successfully utilize metacognition for attaining meaning in life. Implications for psychotherapy with people who have schizophrenia are discussed. Impact and ImplicationsMetacognition was found to have a positive significant correlation with meaning in life among participants who reported high levels of self-compassion and not among participants reporting low/moderate levels of self-compassion. These results highlight the importance of factors that enhance resilience and positive regard such as self-compassion in negotiating the paradoxical effects of awareness on outcome measures, among people with schizophrenia.

Objective:Cognitive representations of an illness have an important impact on psychological outcomes. The current systematic review explored 1) the characteristics of illness representations held by parents of children and adults with serious mental illness (SMI), and 2) the associations of these representations with both parents’ and patients’ psychological outcomes.Method:PSYINFO and PUBMED were screened for eligible studies published between January 2000 and August 2018. Selection was based on PRISMA guidelines. Reference lists of these papers were checked for additional references. Two independent coders extracted all relevant data.Results:The search resulted in 31 relevant studies, which were divided, by type of methodology, into three sections: quantitative, qualitative, and mixed quantitative-qualitative. In each section, findings were divided in accordance with the two research questions.Conclusion:Parents struggle to make meaning of their child’s illness, often holding stigmatizing ideas about the illness and blaming themselves for its existence. More longitudinal studies that include both of the child’s parents, as well as interventional studies, are needed to expand our knowledge of ways to help parents construct more beneficial representations of their children’s illnesses.

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