Elements that enhance therapeutic alliance and short-term outcomes in metacognitive reflection and insight therapy: A session-by-session assessment.

Abstract

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.

A meta-analysis of client-therapist perspectives on the therapeutic alliance: Examining the moderating role of type of measurement and diagnosis

“…In addition, the STAR includes a focus on understanding the meaning of the client's subjective experience ("I believe my clinician has an understanding of what my experiences have meant to me"). This emphasis on the importance of making sense of the subjective experience is in line with recent research on people with schizophrenia showing that metacognitive mutual exploration of meaning enhanced TA and outcomes [56].…”

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

“…Interestingly, one recent study showed that two specific elements, insertion of the therapist's mind (Element Two) and discussion of the therapeutic relationship (Element Five) were related to better outcome. 49 To date, MERIT research has focused exclusively on individual interventions in outpatient settings. Work is needed to explore whether and how these procedures might be expanded to group, family and inpatient settings as well as persons with other conditions including those identified as clinical high-risk as well as other nonpsychotic disorders.…”

“…48 This is consistent with a recent analysis of ten treatment completers within a MERIT trial that found significant improvement in metacognitive capacities. 49 Two randomized-controlled trials have also reported positive outcomes and good patient acceptance rates without evidence of adverse effects. In one trial, 20 participants with first episode psychosis and poor insight were randomized to receive 6 months of MERIT or treatment as usual.…”

Special challenges in psychotherapy continuation and adaption for persons with schizophrenia in the age of coronavirus (COVID-19)

“…Of note, in order to guide adherence in elements 7 and 8, an assessment tool, the Metacognition Assessment Scale -Abbreviated (MAS-A, Lysaker et al, 2005) is used to assess patient's metacognitive and therefore choose appropriate levels of intervention. Accumulating evidences for the effectiveness of this therapy comes from randomized controlled trials, qualitative studies and case reports (e.g., de Jong, Hasson-Ohayon, van Donkersgoed, Aleman, & Pijnenborg, 2018;de Jong et al, 2019;Lavi-Rotenberg et al, 2020;Vohs et al, 2018), but the application of it under global crisis context is only now taking place.…”