Reflection and Recovery from Psychosis during the Time of COVID-19: Adaptation in Psychotherapy in the United States / La reflexión y la recuperación de la psicosis durante el COVID-19: adaptación en la psicoterapia de EE UU

In response to the coronavirus (COVID-19) pandemic several adaptations have allowed us to continue to provide one form of recovery-oriented psychotherapy to persons with psychosis: Metacognitive Insight and Reflection Therapy (MERIT). These successful adaptations have included the incorporation of patients' experience of the pandemic and the exploration of challenges from temporary changes in therapy platforms to deepen reflections about patients' self-experience, their experience of intersubjectivity and their own agentic responses to psychosocial challenges

En respuesta a la pandemia del coronavirus (COVID-19) varias adaptaciones han permitido que sigamos facilitando una de las formas de psicoterapia orientada a la recuperación de las personas que padecen psicosis: la terapia de percepción metacognitiva y reflexión (MERIT). Estas adaptaciones satisfactorias incluyen la incorporación de la experiencia de los pacientes de la pandemia y el uso de los desafíos que plantean los cambios temporales en las plataformas terapéuticas con objeto de profundizar en la reflexión sobre la autoexperiencia de los pacientes, su experiencia en intersubjetividad y sus propias respuestas a los desafíos psicosociales

Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation.

Historical and newly emerging models of schizophrenia suggest it is a disorder characterized by the fragmentation of the experience of the self and the world, leading to the interruption of how a unique life is unfolding in the world. It has been proposed that psychotherapy might therefore promote recovery by facilitating the development of a greater ability to integrate information about the self and others. In this paper we explore how the supervision of a metacognitively-oriented psychotherapy can assist therapists to experience and conceptualize fragmentation within sessions, join patients in the gradual process of making sense of their psychiatric problems and life challenges, and ultimately envision and achieve recovery. Common challenges and responses within supervision are described and discussed.

Metacognitive Reflection and Insight Therapy (MERIT) for Persons With a Schizophrenia Spectrum Disorder and Interpersonal Trauma.

Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties engaging in goal-directed activities in social and vocational settings. Against this backdrop, the authors provide a case report of the effects of metacognitive reflection and insight therapy (MERIT) provided over the course of seven months to assist a client with persistent schizophrenia. Eight elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this article, these elements helped the client to move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and that of others. He then could use these representations to understand and effectively respond to life challenges.

Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder.

Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal-directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.

Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches.

Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.