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Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy

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Abstract

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.

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References

  • Bargenquast, R., & Schweitzer, R. D. (2013). Enhancing sense of recovery and self-reflectivity in people with schizophrenia: A pilot study of metacognitive narrative psychotherapy. Psychology and Psychotherapy Theory Research and Practice, 87, 338–356.

    Article  Google Scholar 

  • Bargenquast, R., Schweitzer, R. D., & Drake, S. (2015). Reawakening reflective capacity in the psychotherapy of schizophrenia: A case study. Journal of Clinical Psychology, 71(2), 136–145.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Rector, N. A., Stolar, N., & Grant, P. (2009). Schizophrenia: Cognitive theory, research, and therapy. New York: The Guilford Press.

    Google Scholar 

  • Bleuler, E. (1911/1950) Dementia praecox or the group of schizophrenias. New York: International Universities Press.

  • de Jong, S., Donkersgoed, R. J. M., Aleman, A., van der Gaag, M., Wunderink, L., Arends, J., Lysaker, P. H., & Pijnenborg, G. H. M. (2010) ***The practical implications of Metacognitive psychotherapy in psychosis: Findings from a pilot study (submitted for publication).

  • Greben, M., Schweitzer, R. D., & Bargenquast, R. (2014). Mechanisms of change in psychotherapy for people diagnosed with schizophrenia: The role of narrative reflexivity in promoting recovery. Australian Journal of Rehabilitation Counseling, 20, 1–14.

    Article  Google Scholar 

  • Hillis, J. D., Leonhardt, B. L., Vohs, J. L., Buck, K. D., Salvatore, G., Popolo, R., et al. (2015). Metacognitive reflective and insight therapy for persons in early phase of a schizophrenia spectrum disorder. Journal of Clinical Psychology, 71(2), 125–135.

    Article  PubMed  Google Scholar 

  • Lysaker, P. H., Buck, K. D., Carcione, A., Procacci, M., Salvatore, G., Nicolo, G., & Dimaggio, G. (2011). Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes. Psychology and Psychotherapy: Theory, Research and Practice, 84, 58–69.

    Article  Google Scholar 

  • Lysaker, P. H., Buck, K. D., Leonhardt, B., Buck, B. E., Hamm, J. A., Vohs, J., et al. (2014). Metacognitively focused psychotherapy for persons with schizophrenia: Eight core elements that define practice. In P. H. Lysaker, G. Dimaggio, & M. Brüne (Eds.), Metacognition and social cognition in schizophrenia. New York: Elsevier Press.

    Chapter  Google Scholar 

  • Lysaker, P. H., Buck, K. D., & Ringer, J. (2007). The recovery of metacognitive capacity in schizophrenia across thirty two months of individual psychotherapy: A case study. Psychotherapy Research, 17, 713–720.

    Article  Google Scholar 

  • Lysaker, P. H., Davis, L. D., Eckert, G. J., Strasburger, A., Hunter, N., & Buck, K. D. (2005). Changes in narrative structure and content in schizophrenia in long-term individual psychotherapy: A single case study. Clinical Psychology and Psychotherapy, 12, 406–416.

    Article  Google Scholar 

  • Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40(3), 487–491.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lysaker, P. H., Glynn, S. M., Wilkniss, S. M., & Silverstein, S. M. (2010). Psychotherapy and recovery from schizophrenia: A review of potential applications and need for future study. Psychological Services, 7(2), 75–91. doi:10.1037/a0019115.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lysaker, P. H., & Lysaker, J. T. (2006). Psychotherapy and schizophrenia: An analysis of requirements of an individual psychotherapy for persons with profoundly disorganized selves. Journal of Constructivist Psychology, 19, 171–189.

    Article  Google Scholar 

  • Salvatore, G., Lysaker, P. H., Gumley, A., Popolo, R., Mari, J., & Dimaggio, G. (2012). Out of illness experience: Metacognition-oriented therapy for promoting self-awareness in individuals with psychosis. American Journal of Psychotherapy, 66(1), 85–106.

    PubMed  Google Scholar 

  • Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procacci, M., & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The Metacognition Assessment Scale and its applications. Clinical Psychology and Psychotherapy, 10(4), 238–261.

    Article  Google Scholar 

  • Van Donkersgoed, R. J. M., De Jong, S., Van der Gaag, M., Aleman, A., Lysaker, P. H., & Pijnenborg, G. H. M. (2014). A manual-based individual therapy to improve metacognition: Protocol of a multi-center RCT. BMC Psychiatry, 14, 27.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Jay A. Hamm.

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Hamm, J.A., Firmin, R.L. Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy. J Contemp Psychother 46, 227–234 (2016). https://doi.org/10.1007/s10879-016-9326-7

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  • DOI: https://doi.org/10.1007/s10879-016-9326-7

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