Deficits in metacognition, that is, in the ability to think about one’s own thinking and the thinking of others, have been identified as a significant barrier to recovery from schizophrenia. While this has raised the possibility that individual psychotherapy might be focused to help persons with schizophrenia improve their capacity for metacognition, little has been written about what that might entail. To explore this issue, a case study is presented in which ongoing assessments of metacognition were used to guide the selection of interventions. Interventions were chosen in particular to match the client’s capacity for metacognition at that time and were conceptualized as offering maximal opportunities for the practice and development of metacognitive capacity. Improvements in function and the development of the ability to perform increasingly complex acts of metacognition are reported over the course of approximately 1.5 years of therapy and implications for research and theory are discussed.
Bateman, A., & Fonagy, P. ( 2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: An 18 month follow up. American Journal of Psychiatry, 158, 36-42.
2.
Bateman, A., & Fonagy, P. ( 2008). Eight year follow up of a patient treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual . American Journal of Psychiatry, 165, 631-638.
3.
Brune, M. ( 2005). Theory of mind in schizophrenia: A review of the literature . Schizophrenia Bulletin, 31, 21-42.
4.
Brüne, M., Abdel-Hamid, M., Lehmkämper, C., & Sonntag, C. ( 2007). Mental state attribution, neurocognitive functioning, and psychopathology: What predicts poor social competence in schizophrenia best?Schizophrenia Research, 92, 151-159.
5.
Choi-Kain, L.W., & Gunderson J.G. (2008). Mentalization: Ontogeny, assessment and application in the treatment of borderline personality disorder . American Journal of Psychiatry, 165, 1127-1135.
6.
Corcoran, R., & Frith, C.D. ( 2003). Autobiographical memory and theory of mind: Evidence of a relationship in schizophrenia. Psychological Medicine , 33, 897-905.
7.
Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A., et al. (2007). Poor Metacognition in narcissistic and avoidant personality disorders: Analysis of four psychotherapy patients. Clinical Psychology and Psychotherapy, 14, 386-401.
8.
Frith, C.D. ( 1992). The cognitive neuropsychology of schizophrenia. Sussex, England: Lawrence Erlbaum.
9.
Karlsson, R., & Kermott, A. ( 2006). Reflective functioning during the process in brief psychotherapies . Psychotherapy Theory, Research, Practice, Training, 43, 65-84.
10.
Laing, R.D. ( 1978). The divided self. New York: Penguin.
11.
Langdon, R., Coltheart, M., Ward, P.B., & Catts, S.V. ( 2002). Disturbed communication in schizophrenia: The role of poor pragmatics and poor mind-reading. Psychological Medicine , 32, 1273-1284.
12.
Lysaker P.H., & Buck, K.D. ( 2007). Illness and the disruption of autobiography: Accounting for the complex effect of awareness in schizophrenia. Journal of Psychosocial Nursing and Mental Health Services, 45, 39-45.
13.
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.
14.
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.
15.
Lysaker, P.H., Dimaggio, G., Buck, K.D., Carcione, A., & Nicolò, G. (2007). Metacognition within narratives of schizophrenia: Associations with multiple domains of neurocognition . Schizophrenia Research, 93, 278-287.
16.
Lysaker, P.H., & Lysaker, J.T. ( 2001). Psychosis and the disintegration of dialogical self-structure: Problems posed by schizophrenia for the maintenance of dialogue. British Journal of Medical Psychology, 74, 23-33.
17.
Lysaker, P.H., & Lysaker, J.T. ( 2008). Schizophrenia and the Fate of the Self. Oxford: Oxford University Press.
18.
Osatuke, K., Mosher, J.K., Goldsmith, J.Z., Stiles, W.B., Shapiro, D.A., Hardy, G.E., et al. (2007). Submissive voices dominate in depression: Assimilation analysis of a helpful session. Journal of Clinical Psychology: In-Session, 63, 153-164.
19.
Roncone, R., Falloon, I.R., Mazza, M., De Risio, A., Necozione, S., Morosini, P., et al. (2002). Is theory of mind in schizophrenia more strongly associated with clinical and social function than with neurocognitive deficit? Psychopathology, 35, 280-288.
20.
Searles, H. ( 1965). Collected papers of schizophrenia and related subjects . New York: International Universities Press.
21.
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procaci, M., et al. (2003). How to evaluate metacognitive function in psychotherapy? The Metacognition Assessment Scale and its applications . Clinical Psychology & Psychotherapy, 10, 238-261.
22.
Stratta, P., Riccardi, I., Mirabilio, D., Di Tommaso, S., Tomassini, A., & Rossi, A. ( 2007). Exploration of irony appreciation in schizophrenia: A replication study on an Italian sample. European Archives of Psychiatry and Clinical Neuroscience, 257, 337-339.
