The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement

Pěč, Ondřej; Lysaker, Paul H.; Probstova, Vaclava; Leonhardt, Bethany L.; Hamm, Jay A.; Bob, Petr

doi:10.1007/s10879-020-09452-w

Cited by 10 publications

(10 citation statements)

References 33 publications

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“…These reports are consistent with older psychoanalytic observations that persons diagnosed with psychosis experience social interactions as frightening and overwhelming (Fromm-Reichmann, 1954 ; Searles, 1965 ; Pec et al, 2020 ; Ridenour et al, 2020 ). From an existential perspective, Laing ( 1978 ) suggested the experience of psychosis involved a limited sense of self whose minimal coherence was threatened by intimacy.…”

Section: Social Cognition and Disturbances In Social Functioningsupporting

confidence: 86%

“…Importantly, however, metacognitive research by no means suggests that only one approach to treatment could promote metacognition or social recovery. To the contrary, this work suggests a range of basic conditions for the promotion of metacognition which could and have been applied to multiple forms of interventions including cognitive remediation (Cella et al, 2015 ); metacognitive training (Moritz et al, 2018 ), psychoanalysis (Ridenour et al, 2019 ; Pec et al, 2020 ), shared decision making (Zisman-Ilani et al, 2021 ) and social practice (Rice et al, 2020 ). These basic conditions have been proposed to include joint reflection between the clinician or peer and the identified patient, the rejection of stigmatizing beliefs about mental illness, and flexibility for the identified patients to develop and change their goals as they progress.…”

Section: Metacognition and Disturbances In Social Functioningmentioning

confidence: 99%

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Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

et al. 2021

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Many with psychosis experience substantial difficulties forming and maintaining social bonds leading to persistent social alienation and a lack of a sense of membership in a larger community. While it is clear that social impairments in psychosis cannot be fully explained by symptoms or other traditional features of psychosis, the antecedents of disturbances in social function remain poorly understood. One recent model has proposed that deficits in social cognition may be a root cause of social dysfunction. In this model social relationships become untenable among persons diagnosed with psychosis when deficits in social cognition result in inaccurate ideas of what others feel, think or desire. While there is evidence to support the influence of social cognition upon social function, there are substantial limitations to this point of view. Many with psychosis have social impairments but not significant deficits in social cognition. First person and clinical accounts of the phenomenology of psychosis also do not suggest that persons with psychosis commonly experience making mistakes when trying to understand others. They report instead that intersubjectivity, or the formation of an intimate shared understanding of thoughts and emotions with others, has become extraordinarily difficult. In this paper we explore how research in metacognition in psychosis can transcend these limitations and address some of the ways in which intersubjectivity and more broadly social function is compromised in psychosis. Specifically, research will be reviewed on the relationship between social cognitive abilities and social function in psychosis, including measurement strategies and limits to its explanatory power, in particular with regard to challenges to intersubjectivity. Next, we present research on the integrated model of metacognition in psychosis and its relation to social function. We then discuss how this model might go beyond social cognitive models of social dysfunction in psychosis by describing how compromises in intersubjectivity occur as metacognitive deficits leave persons without an integrated sense of others' purposes, relative positions in the world, possibilities and personal complexities. We suggest that while social cognitive deficits may leave persons with inaccurate ideas about others, metacognitive deficits leave persons ill equipped to make broader sense of the situations in which people interact and this is what leaves them without a holistic sense of the other and what makes it difficult to know others, share experiences, and sustain relationships. The potential of developing clinical interventions focused on metacognition for promoting social recovery will finally be explored.

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Section: Social Cognition and Disturbances In Social Functioningsupporting

confidence: 86%

Section: Metacognition and Disturbances In Social Functioningmentioning

confidence: 99%

Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

et al. 2021

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“…As already begun elsewhere, work is needed to systematically consider how those theories may illuminate some of the core processes observed in MERIT. 79 Finally, there is a need to broaden and enrich methods for assessment and conceptualization of therapeutic processes. For example, assessing session-by-session changes in addition to pre-post changes will provide rich data on trajectories of improvement.…”

Section: Discussionmentioning

confidence: 99%

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

Lysaker¹,

Gagen²,

Klion

et al. 2020

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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.

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“…This is also consistent with narrative research, which has found that a sense of purpose is less discernable in the life stories of persons with psychosis [ 41 , 123 , 124 ]. More generally, without a sense of one’s purposes and possibilities to anchor a growing sense of self, the symbolization of self and experience might diminish as found in psychoanalytic accounts of the subjective experience of psychosis [ 125 – 127 ] and match what has been described as a lack of existential agency [ 128 ]. Finally, without purposes emerging in response to and alongside possibilities, and thus without a working sense of who one is, a sense of the uniqueness of one’s experience might also wane, leading to states described by phenomenologists of self-experience in psychosis as minimal and lacking the quality of mineness, or what is referred to as ipseity [ 129 , 130 ].…”

Section: The Unique Experimental Theoretical and Clinical Implications Of Metacognitive Research In Psychosismentioning

confidence: 99%

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

et al. 2021

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Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised – as often occurs in psychosis – results in the loss of persons’ sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.

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The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement

Cited by 10 publications

References 33 publications

Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition

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

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

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