Metacognition and Intersubjectivity: Reconsidering Their Relationship Following Advances From the Study of Persons With Psychosis

Abstract

As research on metacognition has progressed a significant array of definitions, methodologies and therapeutic applications have emerged. Some of this work has primarily framed metacognition as an activity carried out by one person in order to know, monitor, and adjust their beliefs, memories, and behaviors. Accordingly, problems with metacognition have often been characterized as issues related to cognition. This, however, risks neglecting how metacognition is also a fundamentally intersubjective act, one in which human beings know and reflect upon themselves and others primarily with and through connections with other people. In this paper, we review research on metacognition in schizophrenia using the integrative model of metacognition and a research paradigm in which metacognition is assessed within personal narratives. Stimulated by this work, we discuss how disturbances in intersubjective experience and metacognitive capacity mutually influence one another, with disruptions in metacognition perhaps more deeply understood as disruptions in relatedness with others. We then discuss how metacognition and intersubjectivity each affect mental health. We finally focus on the implications of this for treatments that target metacognition as well as future directions for research.

Special challenges in psychotherapy continuation and adaption for persons with schizophrenia in the age of coronavirus (COVID-19)

“…MERIT, we suggest that implications are beyond any specific approach. As people with schizophrenia often cope with challenges to their sense of agency and subjectivity (Hasson-Ohayon et al, 2020) and as many integrative approaches share narration, metacognition and interpersonal components (Hamm, Hasson-Ohayon, Kukla, & Lysaker, 2013;Lysaker, Gagen, Moritz, & Schweitzer, 2018;Philipp et al, 2019) the observations made here seem to be applicable to psychotherapists working with people with schizophrenia in general. Thus, psychotherapy via video or telephone at the time of pandemic is possible, and the adaptions outlined in this paper can assist in maintaining a good therapeutic alliance and enhancing recovery.…”

“…Intersubjectivity refers to a range of processes that occur between people rather than in one's isolated mind (Beebe et al, 2003). All metacognitive acts or thoughts people form about themselves require someone else who does or could recognize, understand or respond to them (Hasson-Ohayon, Gumley, McLeod, & Lysaker, 2020). In MERIT, then, client's experiences are jointly understood by the therapeutic dyad.…”

Disturbances in dialogue and metacognition: A renewed way to understand and respond to alterations in self-experience in psychosis

“…Concerning interpersonal relationships, these alterations in self-experience might have more pointed effects. Intersubjectivity involves persons jointly forming a sense of each other and themselves in the company of each other (Hasson-Ohayon et al, 2020). It therefore involves an exchange in which one has to both sort out one's reaction to the other and deal with how the other sees and thinks about one.…”

“…The information it gathers and organizes belongs to the larger activities through which persons respond to emergent challenges and opportunities (Semerari et al, 2003). Finally, metacognition also specifies processes bound to intersubjective contexts (Hasson-Ohayon et al, 2020), which indicates that metacognition is always socially situated and inflected.…”

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

“…It has been noted that there is more than one way to understand metacognition in psychosis [ 18 ]. To avoid confusion, we are therefore using the term metacognition to refer to a spectrum of activities that are integrative in nature and intersubjectively rooted [ 7 , 19 , 20 ]. Metacognition is integrative which is to say that it enables persons to synthesize or piece together information into a larger whole of themselves or others as unique people.…”