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Meaning Making and Recovery in Psychosis and Intellectual Disability: Application of Metacognitive Reflection and Insight Therapy


Despite a substantial literature demonstrating effectiveness of psychotherapy for people experiencing psychosis, and a small body of work advocating for increased availability of psychotherapy for individuals with intellectual disability (ID), the intersection of psychosis and ID has been almost entirely neglected in the professional literature. In this article, the authors posit that an integrative psychotherapy approach, Metacognitive Reflection and Insight Therapy (MERIT), may be a feasible and effective approach for promoting recovery for individuals experiencing both psychosis and ID. The authors review the conceptual considerations for MERIT’s use with individuals with ID, highlighting the value of offering a treatment that recognizes the possibilities and importance of shared meaning making. Following this the authors present a case illustration of MERIT with a man diagnosed with schizophrenia and ID.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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All authors contributed to the manuscript conception. The first draft was prepared by JH and KH and all authors substantively contributed to edits. All authors read and approved the final manuscript.

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Correspondence to Jay A Hamm.

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Informed consent was obtained from the client in the clinical vignette, who gave full permission to use his clinical material for the purposes of this manuscript. Additional efforts were taken to disguise any potentially identifiable details.

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Hamm, J.A., Huling, K., Ridenour, J.M. et al. Meaning Making and Recovery in Psychosis and Intellectual Disability: Application of Metacognitive Reflection and Insight Therapy. J Contemp Psychother (2022).

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  • Psychosis
  • Metacognition
  • Intellectual disability
  • Psychotherapy
  • Recovery