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Journal of Contemporary Psychotherapy

, Volume 49, Issue 1, pp 49–59 | Cite as

Metacognitive Interpersonal Therapy in Groups for Over-Regulated Personality Disorders: A Single Case Study

  • Raffaele PopoloEmail author
  • Angus MacBeth
  • Flaviano Canfora
  • Daniela Rebecchi
  • Cecilia Toselli
  • Giampaolo Salvatore
  • Giancarlo Dimaggio
Original Paper

Abstract

Individuals with personality disorders (PD) demonstrate poor metacognition, here defined as the capacity to use mental state knowledge for regulation of interpersonal relationships. Metacognitive interpersonal therapy (MIT) targets the symptoms of PD via a series of formalized procedures. Its goal is to help individuals improve their metacognitive capacity through developing and enacting more adaptive social behaviors. MIT has been manualized for the treatment of PDs featuring overcontrol, with single case studies providing initial evidence of its effectiveness. Given the need to deliver cost-effective treatments for patients with over-controlled and socially inhibited PDs, we developed MIT in groups (MIT-G), a short-term manualized group treatment with both psychoeducational and experiential aspects (Popolo et al. in Psychol Psychother: Theory Res Pract, 2018.  https://doi.org/10.1111/papt.12182). Here we present the case of a young man presenting with Narcissistic PD (vulnerable type) featuring marked avoidant and obsessive-compulsive traits, social inhibition and emotional overcontrol. We describe the therapeutic process and how role-playing significant episodes helped him to improve metacognition, leading to the adoption of more effective social problem solving strategies. Outcomes were positive in terms of increased quality of social relationships, decreased symptoms, better emotion regulation and improved well-being. We conclude by considering how these processes may improve treatment delivery for these types of PD presentations.

Keywords

Personality disorder Metacognition Motives Metacognitive interpersonal therapy Emotion regulation 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standard of the local ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from the individual participant included in the study.

References

  1. Arntz, A., & Jacob, G. A. (2012). Schema therapy in practice. Chichester: Wiley.Google Scholar
  2. Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization based treatment. Oxford: Oxford University Press.CrossRefGoogle Scholar
  3. Baumeister, R., & Leary, M. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497–529.CrossRefGoogle Scholar
  4. Bowlby, J. (1969). Attachment and loss, Vol. 1: Attachment. New York: Basic Books.Google Scholar
  5. Carcione, A., Semerari, A., Nicolò, G., Pedone, R., Popolo, R., Conti, L., Fiore, D., Procacci, M., & Dimaggio, G. (2011). Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Research, 190, 60–71.  https://doi.org/10.1016/j.psychres.2010.12.032.CrossRefGoogle Scholar
  6. Dimaggio, G., MacBeth, A., Popolo, R., Salvatore, G., Perrini, F., Raouna, A., Osam, C. S., Buonocore, L., Bandiera, A., & Montano, A. (2018). The problem of overcontrol: Perfectionism and emotional inhibition as predictors of personality disorder. Comprehensive Psychiatry.  https://doi.org/10.1016/j.comppsych.2018.03.005.Google Scholar
  7. Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. London: Routledge. ISBN 9781317591184.CrossRefGoogle Scholar
  8. Dimaggio, G., Salvatore, G., MacBeth, A., Ottavi, P., Buonocore, L., & Popolo, R. (2017). Metacognitive interpersonal therapy for personality disorders: A case study series. Journal of Contemporary Psychotherapy, 47, 11–21.  https://doi.org/10.1007/s10879-016-9342-7.CrossRefGoogle Scholar
  9. Dimaggio, G., Semerari, A., Carcione, A., Nicolò, G., & Procacci, M. (2007). Psychotherapy of personality disorders: Metacognition, states of mind and interpersonal cycles. London: Routledge.CrossRefGoogle Scholar
  10. Fassbinder, E., & Arntz, A. (2018). Schema therapy with emotionally inhibited and fearful patients. Journal of Contemporary Psychotherapy.  https://doi.org/10.1007/s10879-018-9396-9.Google Scholar
  11. First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington, DC: American Psychiatric Press. [Trad. It. Mazzi F., Morosini P., De Girolamo G., & Guaraldi G. P., (a cura di) (2003). Firenze: Giunti O.S.].Google Scholar
  12. Giromini, L., Velotti, P., de Campora, G., Bonalume, L., & Zavattini, G. C. (2012). Cultural adaptation of the difficulties in emotion regulation scale: Reliability and validity of an Italian version. Journal of Clinical Psychology, 68, 989–1007.  https://doi.org/10.1002/jclp.21876.CrossRefGoogle Scholar
  13. Gordon-King, K., Schweitzer, R. D., & Dimaggio, G. (2018). Metacognitive interpersonal therapy for personality disorders featuring emotional inhibition: A multiple baseline case series. Journal of Nervous and Mental Disease.  https://doi.org/10.1097/NMD.0000000000000789.Google Scholar
  14. Ivaldi, A. (2016). Treating dissociative and personality disorders: A motivational systems approach to theory and treatment. London: Routledge.Google Scholar
  15. Lichtenberg, J. D., Lachmann, F. M., & Fosshage, J. L. (2016). Self and motivational systems: Towards A theory of psychoanalytic technique. New York: Routledge.CrossRefGoogle Scholar
  16. Liotti, G., & Gilbert, P. (2011). Mentalizing, motivation, and social mentalities: Theoretical considerations and implications for psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 84, 9–25.  https://doi.org/10.1348/147608310X520094.Google Scholar
  17. Lysaker, P. H., Carcione, A., Dimaggio, G., Johannesen, J. K., Nicolò, G., Procacci, M., et al. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with insight, neurocognition, symptom and function. Acta Psychiatrica Scandinavica, 112, 64–71.  https://doi.org/10.1111/j.1600-0447.2005.00514.x.CrossRefGoogle Scholar
  18. Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40, 487–491.  https://doi.org/10.1093/schbul/sbu038.CrossRefGoogle Scholar
  19. Lysaker, P. H., & Klion, R. E. (2017). Recovery, meaning-making, and severe mental illness: A comprehensive guide to metacognitive reflection and insight therapy. New York: Routledge, Taylor & Francis Ltd.CrossRefGoogle Scholar
  20. Lysaker, P. H., Olesek, K., Buck, K., Leonhardt, B., Vohs, J., Dimaggio, G., Popolo, R., & Outcalt, J. (2014). Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders. Addictive Behaviors, 39, 558–561.  https://doi.org/10.1016/j.addbeh.2013.11.007.CrossRefGoogle Scholar
  21. Morley, S., & Dowzer, C. N. (2014). Manual for the leeds reliable change indicator: Simple excel(tm) applications for the analysis of individual patient and group data. Leeds: University of Leeds.Google Scholar
  22. Palmieri, G., Evans, G., Hansen, V., Brancaleoni, G., Ferrari, S., Porcelli, P., Reitano, F., & Rigatelli, M. (2009). Validation of the Italian version of the clinical outcomes in routine evaluation outcome measure (CORE-OM). Clinical Psychology and Psychotherapy, 16(5), 444–449.  https://doi.org/10.1002/cpp.646.CrossRefGoogle Scholar
  23. Pascual-Leone, A., & Greenberg, L.S. (2007). Emotional processing in experiential therapy: why "the only way out is through.". Journal of Consulting Clinical Psychology, 75(6), 875–887.Google Scholar
  24. Pellecchia, G., Moroni, F., Colle, L., Semerari, A., Carcione, A., Fera, T., Fiore, D., Nicolò, G., Pedone, R., & Procacci, M. (2018). Avoidant personality disorder and social phobia: Does mindreading make the difference? Comprehensive Psychiatry, 80, 163–169.  https://doi.org/10.1016/j.comppsych.2017.09.011.CrossRefGoogle Scholar
  25. Popolo, R., & Dimaggio, G. (2016). Metacognitive interpersonal therapy in group (MIT-G): A treatment manual. Unpublished, Rome: Centro di Terapia Metacognitiva Interpersonale.Google Scholar
  26. Popolo, R., MacBeth, A., Canfora, F., Rebecchi, D., Toselli, C., Salvatore, G., & Dimaggio, G. (2018). Metacognitive interpersonal therapy in group (MIT-G) for young adults personality disorders. A pilot randomized controlled trial. Psychology and Psychotherapy: Theory, Research & Practice.  https://doi.org/10.1111/papt.12182.Google Scholar
  27. Saggino, A., Balsamo, M., Carlucci, L., Cavalletti, V., Sergi, M. R., da Fermo, G., Dèttore, D., Marsigli, N., Petruccelli, I., Pizzo, S., & Tommasi, M. (2018). Psychometric properties of the Italian version of the Young Schema Questionnaire L-3: Preliminary results. Frontiers in Psychology.  https://doi.org/10.3389/fpsyg.2018.00312.Google Scholar
  28. Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolò, G., Procacci, M., & Alleva, G. (2003). How to evaluate meta-cognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology and Psychotherapy, 10, 238–261.  https://doi.org/10.1002/cpp.362.CrossRefGoogle Scholar
  29. Semerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G., Nicolò, G., Procacci, M., & Pedone, R. (2014). Metacognitive dysfunctions in personality disorders: Correlations with disorder severity and personality styles. Journal of Personality Disorders, 28, 751–766.  https://doi.org/10.1521/pedi_2014_28_137.CrossRefGoogle Scholar
  30. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.Google Scholar
  31. Tomasello, M., Carpenter, M., Call, J., Behne, T., & Moll, H. (2005). Understanding and sharing intentions: The origin of cultural cognition. Behavioral & Brain Sciences, 28, 675–691.  https://doi.org/10.1017/S0140525X05000129.Google Scholar
  32. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Raffaele Popolo
    • 1
    Email author
  • Angus MacBeth
    • 2
  • Flaviano Canfora
    • 3
  • Daniela Rebecchi
    • 4
  • Cecilia Toselli
    • 5
  • Giampaolo Salvatore
    • 1
  • Giancarlo Dimaggio
    • 1
  1. 1.Centro di Terapia Metacognitiva InterpersonaleRomeItaly
  2. 2.University of EdinburghEdinburghUK
  3. 3.Servizio Adolescenti CeisModenaItaly
  4. 4.Studi Cognitivi ModenaModenaItaly
  5. 5.Villa IgeaModenaItaly

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