In this article the authors present a method and a scale for the evaluation of the metacognitive profiles of psychotherapy patients. There will be a description of the metacognitive function and of the alterations that occur to it during treatment. Various hypotheses will then be considered: (1) that the metacognitive function has a modular structure; (2) that for each type of psychopathological condition there is a different metacognitive deficit profile; (3) that to be successful psychotherapy needs to involve an improvement in any deficient metacognitive sub-function. There will then be a presentation of the Metacognition Assessment Scale (MAS) for the assessment of metacognitive deficits during psychotherapy. We shall then describe the first results we have on the application of the scale. Finally there will be an analysis of two patients suffering from Personality Disorders and a demonstration of what metacognitive deficit profile each one has and how it is modified over the course of psychotherapy treatment. The article ends with a discussion of the hypotheses made at the start in the light of the results that have emerged.

Deficits in metacognition within the narratives of persons with schizophrenia are linked with symptoms, quality of life, neurocognition and poorer awareness of illness.

Metacognitive impairment is crucial to explaining difficulties in life tasks of patients with personality disorders (PDs). However, several issues remain open. There is a lack of evidence that metacognitive impairments are more severe in patients with PDs. The relationship between severity of PD pathology and the extent of metacognitive impairment has not been explored, and there has not been any finding to support the linking of different PDs with specific metacognitive profiles. The authors administered the Metacognitive Assessment Interview to 198 outpatients with PDs and 108 outpatients with no PDs, differentiating overall severity from stylistic elements of personality pathology. Results showed that metacognitive impairments were more severe in the group with PDs than in the control group, and that metacognitive dysfunctions and the severity of the PD were highly associated. Positive correlations were found between specific metacognitive dysfunctions and specific personality styles. Results suggest that metacognitive impairments could be considered a common pathogenic factor for PDs.

Shahar, G. (2013). An integrative psychotherapist's account of his focus when treating self-critical patients.

Results suggest that certain forms of metacognition mediate the influence of neurocognition upon function in schizophrenia.

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Personality Disorders (PDs) are hypothesized to involve a decrement in the capacity to understand one's own thoughts and feelings. Patients may not, for example, recognize their own emotions or put together integrated representations of self with other. Some researchers have suggested that this deficit varies between the different PDs. However, empirical evidence that might confirm or disconfirm this hypothesis is scarce. The goal of the present research is to evaluate the metacognitive capacity in four participants, two with Narcissistic Personality Disorder and two with Avoidant Personality Disorder. Using the Metacognition Assessment Scale to analyse the transcripts of their first year of psychotherapy, we have found that three of the four participants displayed difficulties in recognizing their inner states and in linking them to the environmental and psychological causes behind them. There was, additionally, a milder deficit in the ability to integrate multiple images of self with other.