Metacognitive reflection and insight therapy in an inpatient setting: Transforming messianism to a coherent mission

Abstract

Metacognitive reflection and insight therapy (MERIT) is an integrative form of psychotherapy which seeks to help adults with serious mental illness make sense of the psychosocial challenges and possibilities they face and decide how to respond to them and direct their own recovery. In this article, we present an adaptation of MERIT to the context of an inpatient ward with an accompanied case illustration. Specifically, we describe how this approach is supported by a broad intersubjective framework, followed by a presentation of processes and contents of the treatment. Special attention is given to the concurrent improvements in reflective abilities and overall well‐being of the patient. The unique role that psychotherapy in general, and approaches that emphasize reflective processes in particular, play during acute crises in an inpatient setting is discussed.

Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy

“…Of note, various life events of individuals with schizophrenia, such as psychiatric hospitalization, receiving a schizophrenia diagnosis, and disclosing their mental condition to others may give rise to intense conflicting emotions that are hard to experience, express, and regulate (Berna et al, 2011). Previous case reports have shown the benefits of emotional processing and meaning-making of illness perception and psychotic experiences within MERIT (Igra et al, 2020;Cohen-Chazani et al, 2021).…”

“…Evidence supporting the clinical importance of metacognition in psychosis can be found in a metanalysis that showed metacognitive abilities were associated negatively with levels of psychiatric symptoms and positively with psychosocial functioning measures (Arnon-Ribenfeld et al, 2017). Research supporting MERIT's effectiveness in improving different dimensions of metacognition such as mastery and self-reflection includes randomized controlled trails (Vohs et al, 2018;de Jong et al, 2019), open trails (Bargenquast and Schweitzer, 2014;de Jong et al, 2016) and a series of case studies (e.g., Cohen-Chazani et al, 2021;Arnon-Ribenfeld et al, 2018;Igra et al, 2020).…”

Psychotherapy on an Acute Psychiatric Ward: Preliminary Findings From a Controlled Study

“…Importantly, MERIT seems to have been received in a positive and hopeful way by patients as reflected in their adherence to treatment and subjective reports of its benefits contributing (see two case studies reported from this trial: Cohen‐Chazani et al. 2021; Cohen‐Chazani, Roe, and Hasson‐Ohayon 2023).…”

“…While there has yet to be a trial conducted in inpatient setting, two case‐studies of inpatients suggest MERIT can be feasible and effective in inpatient setting (Cohen‐Chazani et al. 20212022). The current study aims to (1) assess the feasibility and acceptability of MERIT in an inpatient setting in terms of engagement, dropout and safety and (2) pilot test the efficacy of MERIT for inpatients in terms of impact upon both metacognitive abilities and symptoms severity.…”

Psychotherapy to emphasize self-directed recovery for persons with serious mental illness: Contributions from metacognitive reflection and insight therapy (MERIT).

“…In a community clinic setting, a randomized trial similarly showed increased metacognition and decreased symptoms after completion of a course of MERIT (Hasson-Ohayon et al, 2023). Finally, in a recently completed randomized controlled trial in an inpatient unit, participants showed improvements in both metacognition and symptomology (Cohen-Chazani et al, 2021). Recent work also has shown MERITg, the group format of MERIT, to be feasible and acceptable to individuals with SMI in both inpatient and outpatient psychiatric settings (Schnakenberg Martin et al, 2024).…”