Abstract
Metacognition refers to the set of activities which allow persons to have a sense of oneself and of others available to them within the flow of daily experience. These activities range from awareness of discrete aspects of experience to their synthesis into larger, more complex ideas. Following research documenting the existence and influence of metacognitive deficits in schizophrenia, psychotherapeutic frameworks have emerged aiming to improve metacognition in this group. Metacognitive Reflection and Insight Therapy (MERIT) is one such integrative psychotherapy framework. Therapeutic targets and principles of MERIT are intended to be integrative but share common characteristics with psychoanalytical tradition in the treatment of schizophrenia. This paper accordingly explores how psychoanalytic theory can help explain how the effects of MERIT upon metacognition and self-experience in schizophrenia may reflect its effects on repairing the collapse of the boundary/connection between self and the world, mental fragmentation, and the lack of symbolization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anzieu, D. (2016). The skin-ego: A new translation by Naomi Segal. London: Routledge.
Beebe, B. (2014). My journey in infant research and psychoanalysis: Microanalysis, a social microscope. Psychoanalytic Psychology,31(1), 4–25. https://doi.org/10.1037/a0035575.
Brown, K. (2017). Psychosis from an attachment perspective. British Journal of Psychotherapy,33(3), 365–387. https://doi.org/10.1111/bjp.12306.
Busch, F. (2015). Our vital profession. International Journal of Psychoanalysis,96, 553–568. https://doi.org/10.1111/1745-8315.12349.
Carsky, M., & Rand, S. N. (2018). Conflict between fantasy and reality: A patient and therapist talk about psychotherapy and schizophrenia. Psychoanalytic Psychology,35(4), 401–409. https://doi.org/10.1037/pap0000178.
Coelho, N. E. (2016). The origins and destinies of the idea of thirdness in contemporary psychoanalysis. International Journal of Psychoanalysis,97, 1105–1127. https://doi.org/10.1111/1745-8315.12433.
Curtis, H. (2014). The development of a psychotic countertransference in work with two severely disturbed patients. British Journal of Psychotherapy,30(2), 197–211. https://doi.org/10.1111/bjp.12082.
Cutler, S. E., & Brakel, L. A. W. (2014). The primary processes: A preliminary exploration of A-Rational mentation from an evolutionary viewpoint. Psychoanalytic Inquiry,34, 792–809. https://doi.org/10.1080/07351690.2014.968022.
De Masi, F. (2016). Herbert Rosenfeld in Italy, 1978–1985. International Forum of Psychoanalysis,25(4), 241–248. https://doi.org/10.1080/0803706X.2015.1127423.
De Masi, F. (2017). Some paths towards psychotic alienation. American Journal of Psychoanalysis,77(4), 347–358. https://doi.org/10.1057/s11231-017-9111-8.
De Jong, S., Van Donkersgoed, R., Pijnenborg, G. H., & Lysaker, P. H. (2016). Metacognitive reflection and insight therapy (MERIT) with a patient with severe symptoms of disorganization. Journal of Clinical Psychology: In Session,72(2), 164–174. https://doi.org/10.1002/jclp.22249.
Frosch, J. P. (2014). From grievance to grief: Narcissism and the inability to mourn. Canadian Journal of Psychoanalysis,22(2), 259–275.
Hamm, J. A., & Lysaker, P. H. (2016). Psychoanalytic phenomenology of schizophrenia: Synthetic metacognition as a construct for guiding investigation. Psychoanalytic Psychology,33(1), 147–160. https://doi.org/10.1037/a0038949.
Hinshelwood, R. D. (2018). Symbolic equation and symbolic representation: An appraisal of Hanna Segal´s work. British Journal of Psychotherapy,34(3), 342–357. https://doi.org/10.1111/bjp.12376.
House, J., & Slotnick, J. (2015). Après-Coup in French Psychoanalysis: The Long Afterlife of Nachträglichkeit. The First Hundred Years, 1893 to 1993. Psychoanalytic Review,102(5), 683–708. https://doi.org/10.1521/prev.2015.102.5.683.
Joannidis, C. (2018). Binocular vision in the total situation. The American Journal of Psychoanalysis,78(1), 74–88. https://doi.org/10.1057/S11231-017-9124-3.
Kuchenhoff, J. (2018). Understanding psychosis: A psychoanalytic approach. Abingdon: Routledge.
Leonhardt, B. L., Huling, K., Hamm, J. A., Roe, D., Hasson-Ohayon, I., McLeod, H., et al. (2017). Recovery and serious mental illness: A review of current clinical and research paradigms and future directions. Expert Review of Neurotherapeutics,17(11), 1117–1130. https://doi.org/10.1080/14737175.2017.1378099.
Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin,40(3), 487–491. https://doi.org/10.1093/schbul/sbu038.
Lysaker, P. H., Dimaggio, G., Hamm, J. A., Leonhardt, B. L., Hochheiser, J., & Lysaker, J. T. (2018). Disturbances in self-experience in schizophrenia: Metacognition and the development of an integrative recovery-oriented individual psychotherapy. Psychopathology,52(2), 135–142. https://doi.org/10.1159/00049529.
Lysaker, P. H., & Klion, R. E. (2017). Recovery, meaning-making, and severe mental illness. New York (NY): Routledge.
Lysaker, P. H., Kukla, M., Vohs, J., Schnackenberg Martin, A., Buck, K. D., & Hasson-Ohayon, I. (2019). Metacognition and recovery in schizophrenia: From research to the development of Metacognitive Reflection and Insight Therapy. Journal of Experimental Psychopathology,10(1), 2043808718814992. https://doi.org/10.1177/2043808718814992.
Martens, W. H. (2012). Healing dynamics of psychosis. International Forum of Psychoanalysis,21, 68–81. https://doi.org/10.1080/0803706X.2011.592509.
Mawson, C. (2017). Interpretation as Freud's specific action, and Bion's container-contained. The International Journal of Psychoanalysis,98(6), 1519–1532. https://doi.org/10.1111/1745-8315.12668.
Mentzos, S. (2015). Dilemmatische Gegensätze im Zentrum der Psychodynamik der Psychosen [Dilemmatic conflicts at the center of the psychodynamics of psychoses]. Forum der Psychoanalyse,31, 341–352.
Michels, R. (2017). Stern on “Self”. Psychoanalytic Inquiry,37(4), 265–269. https://doi.org/10.1080/07351690.2017.1299502.
Modell, A. H. (2014). The evolutionary significance of the primary process—The Freudian concept and its revision. Psychoanalytic Inquiry,34, 810–816. https://doi.org/10.1080/07351690.2014.968023.
Ogden, T. H. (2018). The nature of schizophrenic conflict. Projective Identification and Psychotherapeutic Technique (pp. 135–172). London: Routledge.
Robbins, M. (2018). The primary process: Freud’s profound yet neglected contribution to the psychology of consciousness. Psychoanalytic Inquiry,38(3), 186–197. https://doi.org/10.1080/07351690.2018.1430965.
Rosenbaum, B. (2015). Psychodynamic psychotherapy for persons in states of psychosis: Some research perspectives. British Journal of Psychotherapy,31(4), 476–491. https://doi.org/10.1111/bjp.12187.
Searles, H. F. (2018). Phases of patient-therapist interaction in the psychotherapy of chronic schizophrenia. In H. F. Searles (Ed.), Collected papers on schizophrenia and related subjects (pp. 521–559). Abingdon: Routledge.
Shaw, J. (2014). Psychotic and non-psychotic perceptions of reality. Journal of Child Psychotherapy,40(1), 73–89. https://doi.org/10.1080/0075417X.2014.883139.
Treurniet, N. (2018). Introduction to “On Narcissísm”. In P. Fonagy, E. Person, & J. Sandler (Eds.), Freud's "On Narcissism: An introduction" (pp. 75–94). Abingdon: Routledge.
Von Haebler, D. (2015). Modifizierte, psychodynamische Behandlungstechnik und therapeutische Haltung in der Psychotherapie von Menschen mit Psychosen [Modified psychodynamic treatment technique and therapeutic attitude in psychotherapy of people with psychoses]. Forum der Psychoanalyse,31, 395–413. https://doi.org/10.1007/s00451-015-0218-3.
Werbart, A. (2019). “The skin is the cradle of the soul”: Didier Anzieu on the skin-ego, boundaries, and boundlessness. Journal of the American Psychoanalytic Association,67(1), 37–58. https://doi.org/10.1177/0003065119829701.
Yerushalmi, H. (2017). On regressive and progressive forces in therapy. British Journal of Psychotherapy,33(3), 346–364. https://doi.org/10.1111/bjp.12280.
Author information
Authors and Affiliations
Contributions
OP and PHL had the idea for the article and drafted the article. VP, BLL, JAH, and PB critically revised the work.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Research Involving Human Participants and/or Animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pec, O., Lysaker, P.H., Probstova, V. et al. The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement. J Contemp Psychother 50, 205–212 (2020). https://doi.org/10.1007/s10879-020-09452-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-020-09452-w