Abstract
In this chapter we present the conception of psychosis from the phenomenological perspective, understood as disorders of the experience of the self. We present the case of the patient J.M. which will serve as a first-person example of all the information explained in the chapter. We will see the relationship it has phenomenology with concepts such as metacognition. It will continue with the principles of phenomenologically oriented psychotherapy and Metacognitive reflection and insight therapy (MERIT), a type of psychotherapy developed from them. We explain the work carried out with the patient J.M. based on the MERIT and the results obtained. Finally, the chapter will close by reviewing the current scientific evidence of MERIT and a summary of all that has been exposed.
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References
Arnon-Ribenfeld, N., Hasson-Ohayon, I., Lavidor, M., Atzil-Slonim, D., & Lysaker, P. H. (2017). The association between metacognitive abilities and outcome measures among people with schizophrenia: A meta-analysis. European Psychiatry: The Journal of the Association of European Psychiatrists, 46, 33–41. https://doi.org/10.1016/J.EURPSY.2017.08.002
Arnon-Ribenfeld, N., Bloom, R., Atzil-Slonim, D., Peri, T., de Jong, S., & Hasson-Ohayon, I. (2018). Metacognitive reflection and insight therapy (MERIT) among people with schizophrenia: Lessons from two case studies. American Journal of Psychotherapy, 71(4), 175–185. https://doi.org/10.1176/appi.psychotherapy.20180037
Bargenquast, R., & Schweitzer, R. D. (2014). Enhancing sense of recovery and self-reflectivity in people with schizophrenia: A pilot study of metacognitive narrative psychotherapy. Psychology and Psychotherapy, 87(3), 338–356. https://doi.org/10.1111/PAPT.12019
Cooke, A. (2017). Understanding psychosis and schizophrenia. The British Psychological Society.
Cortina, M., & Liotti, G. (2010). The intersubjective and cooperative origins of consciousness: An evolutionary-developmental approach. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 38(2), 291–314. https://doi.org/10.1521/JAAP.2010.38.2.291
Davidson, L. (2003). Living outside mental illness: Qualitative studies of recovery in schizophrenia (pp. 1–240). New York University Press. https://doi.org/10.1176/APPI.PS.55.9.1073-A
de Jong, S., van Donkersgoed, R., Pijnenborg, G. H. M., & Lysaker, P. H. (2016). Metacognitive reflection and insight therapy (MERIT) with a patient with severe symptoms of disorganization. Journal of Clinical Psychology, 72(2), 164–174. https://doi.org/10.1002/JCLP.22249
de Jong, S., van Donkersgoed, R. J. M., Timmerman, M. E., Aan Het Rot, M., Wunderink, L., Arends, J., van der Gaag, M., Aleman, A., Lysaker, P. H., & Pijnenborg, G. H. M. (2019). Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychological Medicine, 49(2), 303–313. https://doi.org/10.1017/S0033291718000855
Dimaggio, G., Ottavi, P., Popolo, R., & Salvatore, G. (2020). Metacognitive interpersonal therapy: Body, imagery and change. Routledge.
Dmitryeva, N., Chernov, N., Kostyuk, G., & Lysaker, P. H. (2021). Utilizing MERIT to promote recovery in schizotypal personality disorder: An illustrative case study. Journal of Clinical Psychology, 77(8), 1798–1806. https://doi.org/10.1002/jclp.23239
Firmin, R. L., Zalzala, A. B., Hamm, J. A., Luther, L., & Lysaker, P. H. (2021). How psychosis interrupts the lives of women and men differently: A qualitative comparison. Psychology and Psychotherapy: Theory, Research and Practice, 94(3), 704–720. https://doi.org/10.1111/PAPT.12317
Fonseca-Pedrero, E. (Ed.). (2019). Tratamientos psicológicos para la psicosis. Pirámide.
Fonseca-Pedrero, E. (Ed.). (2021). Manual de tratamientos psicológicos. Adultos. Pirámide.
Gimeno Peón, A. (2020). Mejorando los resultados en psicoterapia: principios terapéuticos basados en la evidencia. Pirámide.
Hamm, J. A., & Firmin, R. L. (2016). Disorganization and individual psychotherapy for schizophrenia: A case report of metacognitive reflection and insight therapy. Journal of Contemporary Psychotherapy, 46(4), 227–234. https://doi.org/10.1007/S10879-016-9326-7
Hasson-Ohayon, I. (2012). Integrating cognitive behavioural-based therapy with an intersubjective approach: Addressing metacognitive deficits among people with schizophrenia. Journal of Psychotherapy Integration, 22(4), 356–374. https://doi.org/10.1037/A0029576
Hasson-Ohayon, I., & Lysaker, P. H. (2021). The recovery of the self in psychosis: Contributions from metacognitive and mentalization based oriented psychotherapy. Routledge.
Hasson-Ohayon, I., Arnon-Ribenfeld, N., Hamm, J. A., & Lysaker, P. H. (2017). Agency before action: The application of behavioural activation in psychotherapy with persons with psychosis. Psychotherapy, 54(3), 245–251. https://doi.org/10.1037/PST0000114
Hasson-Ohayon, I., Cheli, S., & Lysaker, P. H. (2021). Emerging psychotherapeutic approaches to addressing self-experience in schizophrenia spectrum disorders. Journal of Clinical Psychology, 77(8), 1781–1785. https://doi.org/10.1002/jclp.23223
Hillis, J. D., Leonhardt, B. L., Vohs, J. L., Buck, K. D., Salvatore, G., Popolo, R., Dimaggio, G., & Lysaker, P. H. (2015). Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. Journal of Clinical Psychology, 71(2), 125–135. https://doi.org/10.1002/JCLP.22148
Inchausti, F., García-Poveda, N. V., Ballesteros-Prados, A., Ortuño-Sierra, J., Sánchez-Reales, S., Prado-Abril, J., Aldaz-Armendáriz, J. A., Mole, J., Dimaggio, G., Ottavi, P., & Fonseca-Pedrero, E. (2018). The effects of metacognition-oriented social skills training on psychosocial outcome in schizophrenia-Spectrum disorders: A randomized controlled trial. Schizophrenia Bulletin, 44(6), 1235–1244. https://doi.org/10.1093/SCHBUL/SBX168
Keshavan, M. S., Nasrallah, H. A., & Tandon, R. (2011). Schizophrenia, “just the facts” 6. Moving ahead with the schizophrenia concept: From the elephant to the mouse. Schizophrenia Research, 127(1–3), 3–13. https://doi.org/10.1016/J.SCHRES.2011.01.011
Leichsenring, F., Steinert, C., Rabung, S., & Ioannidis, J. (2022). The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: An umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry, 21(1), 133–145. https://doi.org/10.1002/wps.20941
Leonhardt, B. L., Benson, K., George, S., Buck, K. D., Shaieb, R., & Vohs, J. L. (2016). Targeting insight in first episode psychosis: A case study of metacognitive reflection insight therapy (MERIT). Journal of Contemporary Psychotherapy, 46(4), 207–216. https://doi.org/10.1007/S10879-016-9332-9
Leonhardt, B. L., Ratliff, K., & Vohs, J. L. (2018). Recovery in first-episode psychosis: A case study of metacognitive reflection and insight therapy (MERIT). American Journal of Psychotherapy, 71(4), 128–134. https://doi.org/10.1176/APPI.PSYCHOTHERAPY.20180032
Lysaker, P. H., & Klion, R. E. (2017). Recovery, meaning-making, and severe mental illness: A comprehensive guide to metacognitive reflection and insight therapy. Routledge. https://doi.org/10.4324/9781315447001
Lysaker, P. H., Carcione, A., Dimaggio, G., Johannesen, J. K., Nicolò, G., Procacci, M., & Semerari, A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with neurocognition, symptoms, insight and quality of life. Acta Psychiatrica Scandinavica, 112(1), 64–71. https://doi.org/10.1111/J.1600-0447.2005.00514.X
Lysaker, P. H., Kukla, M., Belanger, E., White, D. A., Buck, K. D., Luther, L., Firmin, R. L., & Leonhardt, B. (2015). Individual psychotherapy and changes in self-experience in schizophrenia: A qualitative comparison of patients in metacognitively focused and supportive psychotherapy. Psychiatry, 78(4), 305–316. https://doi.org/10.1080/00332747.2015.1063916
Lysaker, P. H., Gagen, E., Wright, A., Vohs, J. L., Kukla, M., Yanos, P. T., & Hasson-Ohayon, I. (2019). Metacognitive deficits predict impaired insight in schizophrenia across symptom profiles: A latent class analysis. Schizophrenia Bulletin, 45(1), 48–56. https://doi.org/10.1093/SCHBUL/SBY142
Lysaker, P. H., Gagen, E., Klion, R., Zalzala, A., Vohs, J., Faith, L. A., Leonhardt, B., Hamm, J., & Hasson-Ohayon, I. (2020a). Metacognitive reflection and insight therapy: A recovery-oriented treatment approach for psychosis. Psychology Research and Behavior Management, 13, 331–341. https://doi.org/10.2147/PRBM.S198628
Lysaker, P. H., Kukla, M., Leonhardt, B. L., Hamm, J. A., Schnakenberg Martin, A., Zalzala, A. B., Gagen, E. C., & Hasson-Ohayon, I. (2020b). Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation. Psychiatric Rehabilitation Journal, 43(4), 275–283. https://doi.org/10.1037/PRJ0000436
Lysaker, P. H., Minor, K. S., Lysaker, J. T., Hasson-Ohayon, I., Bonfils, K., Hochheiser, J., & Vohs, J. L. (2020c). Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments. Undefined, 19, 100142. https://doi.org/10.1016/J.SCOG.2019.100142
Moritz, S., & Lysaker, P. H. (2018). Metacognition – What did James H. Flavell really say and the implications for the conceptualization and design of metacognitive interventions. Schizophrenia Research, 201, 20–26. https://doi.org/10.1016/J.SCHRES.2018.06.001
National Collaborating Centre for Mental Health (UK). (2014). Psychosis and Schizophrenia in Adults: Treatment and Management. National Institute for Health and Care Excellence (UK).
Nelson, B., Yung, A. R., Bechdolf, A., & McGorry, P. D. (2008). The phenomenological critique and self-disturbance: Implications for ultra-high risk (“prodrome”) research. Schizophrenia Bulletin, 34(2), 381–392. https://doi.org/10.1093/SCHBUL/SBM094
Nelson, B., Sass, L. A., Thompson, A., Yung, A. R., Francey, S. M., Amminger, G. P., & McGorry, P. D. (2009). Does disturbance of self-underlie social cognition deficits in schizophrenia and other psychotic disorders? Early Intervention in Psychiatry, 3(2), 83–93. https://doi.org/10.1111/J.1751-7893.2009.00112.X
Parnas, J., & Sass, L. A. (2008). Varieties of “phenomenology”: On description, understanding, and explanation in psychiatry. In K. S. Kendler & J. Parnas (Eds.), Philosophical Issues in Psychiatry: Explanation, Phenomenology, and Nosology (p. 239). Johns Hopkins University Press.
Pérez-Álvarez, M., & García-Montes, J. M. (2019). La filosofía de la ciencia aplicada a la psicología clínica: pensando en psicosis. In E. Fonseca-Pedrero (Ed.), Tratamientos psicológicos para la psicosis. Pirámide.
Pérez-Álvarez, M., García-Montes, J. M., Perona-Garcelán, S., & Vallina-Fernández, O. (2008). Changing relationship with voices: New therapeutic perspectives for treating hallucinations. Clinical Psychology & Psychotherapy, 15(2), 75–85. https://doi.org/10.1002/CPP.563
Pérez-Álvarez, M., García-Montes, J. M., Cangas, A. J., & Sass, L. A. (2009). Defending a phenomenological-behavioral perspective: Culture, behavior, and experience. Philosophy, Psychiatry, & Psychology, 15(3), 281–285. https://doi.org/10.1353/PPP.0.0185
Pérez-Álvarez, M., García-Montes, J. M., & Sass, L. (2010). La Hora de la Fenomenología en la Esquizofrenia. Clínica y Salud, 21(3), 221–233.
Pérez-Álvarez, M., García-Montes, J. M., Vallina-Fernández, O., Perona-Garcelán, S., & Cuevas-Yust, C. (2011). New life for schizophrenia psychotherapy in the light of phenomenology. Clinical Psychology and Psychotherapy, 18(3), 187–201. https://doi.org/10.1002/cpp.716
Pérez-Álvarez, M., García-Montes, J. M., Vallina-Fernández, O., & Perona-Garcelán, S. (2016). Rethinking schizophrenia in the context of the person and their circumstances: Seven reasons. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01650
Prado-Abril, J., Sánchez-Reales, S., & Inchausti, F. (2017). En busca de nuestra mejor versión: pericia y excelencia en Psicología Clínica. Ansiedad y Estrés, 23(2), 110–117. https://doi.org/10.1016/J.ANYES.2017.06.001
Ritunnano, R., & Bortolotti, L. (2021). Do delusions have and give meaning? Phenomenology and the Cognitive Sciences., 21, 949. https://doi.org/10.1007/s11097-021-09764-9
Salvatore, G., Buonocore, L., Ottavi, P., Popolo, R., & Dimaggio, G. (2018). Metacognitive interpersonal therapy for treating persecutory delusions in schizophrenia. American Journal of Psychotherapy, 71(4), 164–174. https://doi.org/10.1176/APPI.PSYCHOTHERAPY.20180039
Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29(3), 427–444. https://doi.org/10.1093/OXFORDJOURNALS.SCHBUL.A007017
Stanghellini, G. (2010). A hermeneutic framework for psychopathology. Psychopathology, 43(5), 319–326. https://doi.org/10.1159/000319401
Stanghellini, G., & Lysaker, P. H. (2007). The psychotherapy of schizophrenia through the lens of phenomenology: Intersubjectivity and the search for the recovery of first- and second-person awareness. American Journal of Psychotherapy, 61(2), 163–179. https://doi.org/10.1176/APPI.PSYCHOTHERAPY.2007.61.2.163
Stanghellini, G., & Mancini, M. (2017). The therapeutic interview in mental health. Cambridge University Press. https://doi.org/10.1017/9781316181973
Tandon, R., Keshavan, M. S., & Nasrallah, H. A. (2008). Schizophrenia, “just the facts” what we know in 2008. 2. Epidemiology and etiology. Schizophrenia Research, 102(1–3), 1–18. https://doi.org/10.1016/j.schres.2008.04.011
The Lancet Psychiatry. (2021). The things themselves. The Lancet Psychiatry, 8(3), 169. https://doi.org/10.1016/S2215-0366(21)00033-X
Tomasello, M., Carpenter, M., Call, J., Behne, T., & Moll, H. (2005). Understanding and sharing intentions: The origins of cultural cognition. Behavioral and Brain Sciences, 28(5), 675–691. https://doi.org/10.1017/S0140525X05000129
van Donkersgoed, R. J. M., de Jong, S., & Pijnenborg, G. H. M. (2016). Metacognitive reflection and insight therapy (MERIT) with a patient with persistent negative symptoms. Journal of Contemporary Psychotherapy, 46(4), 245–253. https://doi.org/10.1007/S10879-016-9333-8
Vitzthum, F. B., Veckenstedt, R., & Moritz, S. (2014). Individualized metacognitive therapy program for patients with psychosis (MCT+): Introduction of a novel approach for psychotic symptoms. Behavioural and Cognitive Psychotherapy, 42(1), 105–110. https://doi.org/10.1017/S1352465813000246
Vohs, J. L., Lysaker, P. H., Liffick, E., Francis, M. M., Leonhardt, B. L., James, A., Buck, K. D., Hamm, J. A., Minor, K. S., Mehdiyoun, N., & Breier, A. (2015). Metacognitive capacity as a predictor of insight in first-episode psychosis. The Journal of Nervous and Mental Disease, 203(5), 372–378. https://doi.org/10.1097/NMD.0000000000000291
Vohs, J. L., Leonhardt, B. L., James, A. V., Francis, M. M., Breier, A., Mehdiyoun, N., Visco, A. C., & Lysaker, P. H. (2018). Metacognitive reflection and insight therapy for early psychosis: A preliminary study of a novel integrative psychotherapy. Schizophrenia Research, 195, 428–433. https://doi.org/10.1016/J.SCHRES.2017.10.041
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This study was conducted in accordance with the Declaration of Helsinki. We obtained the patient’s informed consent before publication. The patient grants his permission for his information to be published in this case report.
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Ródenas-Perea, G., Al-Halabí, S., Inchausti, F., Fonseca-Pedrero, E. (2023). The Phenomenological Perspective and Metacognitive Psychotherapy in Addressing Psychosis. In: Díaz-Garrido, J.A., Zúñiga, R., Laffite, H., Morris, E. (eds) Psychological Interventions for Psychosis. Springer, Cham. https://doi.org/10.1007/978-3-031-27003-1_11
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