Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy.

Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals' abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient's purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.

Change in internalized stigma and social functioning among persons diagnosed with severe mental illness.

This study examined the relationship between change in internalized stigma and social functioning over time. Thirty-five individuals with severe mental illness completed measures of self-stigma, social functioning and symptoms at baseline, 4 months, and 7 months. Change in self-stigma was significantly negatively related to change in social functioning, controlling for negative symptoms.

Suspiciousness and low self-esteem as predictors of misattributions of anger in schizophrenia spectrum disorders.

While it is widely recognized that many with schizophrenia have significant difficulties in correctly identifying the emotions of others, less is known about the causes and correlates of particular forms of misattribution, including mistakenly seeing anger in others. One possibility is that persons with high levels of suspiciousness and low levels of self-esteem are at risk to attribute their poor feelings about themselves to the malice of others. To explore this possibility, we identified 52 persons with a schizophrenia spectrum disorder who made significant numbers of errors on the Bell-Lysaker Emotional Recognition Test. We then performed a cluster analysis based on measures of suspiciousness from the Positive and Negative Syndrome Scale and self-esteem from the Rosenberg Self-Esteem Schedule, and found the following four groups: a) High Suspiciousness/High Self-Esteem; b) Mild Suspiciousness/High Self-Esteem; c) High Suspiciousness/Low Self-Esteem; and d) Minimal Suspiciousness/Low Self-Esteem. Comparisons between groups revealed that as predicted the High Suspiciousness/Low Self-Esteem group made significantly more misattributions of anger than other groups, even when levels of depression were controlled for statistically. Implications for addressing the misattributions of anger in schizophrenia are discussed.

Early narcissistic transference patterns: an exploratory single case study from the perspective of dialogical self theory.

Persons exhibiting narcissistic personality traits are difficult to treat in psychotherapy, in particular because of the problems they have in building up a sound therapeutic relationship. We discuss the hypothesis that the threats to a therapeutic alliance emerge both from patients' maladaptive patterns of behaving towards others and from therapists being affected by these patterns and becoming a part of a dysfunctional dialogue. We examine this phenomenon in terms of Dialogical Self Theory and suggest that a patient can be conceptualised as embodying a cast of characters weaving a problematic dialogue both within the self and with other selves. Via the analysis of the transcripts of the first four audiotaped sessions of a psychotherapy involving a woman with narcissistic traits we identified one early dominant dialogical pattern in which a contemptuous and a contemptible character faced each other, shadowing characters in search for help. Such a pattern is consistent with the literature on interpersonal processes in narcissism. The therapist was involved in the pattern from the third session, suggesting that countertransference with individuals displaying narcissistic personality traits is caused more by the pathology than by their therapist's characteristics. Implications for treatment are discussed.