Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation

Lysaker, Paul H.; Buck, Kelly D.; Pattison, Michelle L.; Beasley, Rhianna E.; Hillis, Jaclyn D.; Hamm, Jay A.

doi:10.1057/s11231-019-09198-y

Cited by 11 publications

(5 citation statements)

References 33 publications

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“…Current metacognitive approaches, like MERIT (Lysaker and Klion, 2017), already include facets of implicit work without fully conceptualizing it. A recent publication is compatible with psychodynamic practice as it pointed out the need to supervise (co)transference phenomena in response to fragmentation (Lysaker et al, 2019a). Working with co-and counter-transference has a long psychoanalytic tradition and particularities in response to psychotic states were elaborated and emphasized in modern approaches (Mentzos, 2015;Lempa et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

et al. 2020

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Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures

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Section: Discussionmentioning

confidence: 99%

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

et al. 2020

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“…A second aspect of MERIT supervision is that it should help therapists to join or share in the patient's experience of fragmentation before attempting to jointly make meaning of it. 30 This may call for supervisors to help therapists examine their basic experience of, automatic and visceral responses to, and fundamental beliefs about fragmentation. It has also been suggested that supervision should involve the identification and examination of counterproductive approaches that therapists may commonly take with individuals with psychosis, including declaring what is real and what is not, seeking to bestow knowledge or "facts" upon the patient, or seeking to reduce a patient's pain, this later stance often stemming from a therapist feeling overwhelmed.…”

Section: Metacognitive Reflection Insight Therapy (Merit): Tools and mentioning

confidence: 99%

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

Lysaker¹,

Gagen²,

Klion

et al. 2020

PRBM

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Recent research has suggested that recovery from psychosis is a complex process that involves recapturing a coherent sense of self and personal agency. This poses important challenges to existing treatment models. While current evidence-based practices are designed to ameliorate symptoms and skill deficits, they are less able to address issues of subjectivity and self-experience. In this paper, we present Metacognitive Insight and Reflection Therapy (MERIT), a treatment approach that is explicitly concerned with self-experience in psychosis. This approach uses the term metacognition to describe those cognitive processes that underpin self-experience and posits that addressing metacognitive deficits will aid persons diagnosed with psychosis in making sense of the challenges they face and deciding how to effectively manage them. This review will first explore the conceptualization of psychosis as the interruption of a life and how persons experience themselves, and then discuss in more depth the construct of metacognition. We will next examine the background, practices and evidence supporting MERIT. This will be followed by a discussion of how MERIT overlaps with other emerging treatments as well as how it differs. MERIT's capacity to engage patients who reject the idea that they have mental illness as well as cope with entrenched illness identities is highlighted. Finally, limitations and directions for future research are discussed.

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“…The process of internal state reflection can be influenced by various factors, from evaluation and supervision processes (Mažgon et al, 2018;Schofield & Grant, 2013) to research activities on the counseling process and itself to improve internally. In particular, supervision activities provide the chance for thorough reflection (Kernberg, 2019;Lysaker et al, 2019). Thus, the supervision activities need to add focus on assessing the counselor's internal competence.…”

Section: Discussionmentioning

confidence: 99%

Cognitive fusion on counselor performance : A comparative study of the experienced and novice counselor

2022

pegegog

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The counselor's internal competence has an impact on the counselor's self-management, primarily the cognitive domain. Failure to manage thoughts will cause cognitive distortions, even to identify biases in mental experiences. This condition is cognitive fusion. Cognitive fusion causes the counselor to be trapped in his mind, unable to discern the effects of his mind's external assumptions on conditions. The experienced counselor can predict the counselor's cognitive fusion condition. This study aims to identify and describe the cognitive fusion condition data for counselors. The research method uses a comparative study design through the Cognitive Fusion Questionnaire instrument. Respondents in this study totaled 170 divided into two groups, experienced counselors and novice counselors. The moderate form of counselors' cognitive fusion condition was found as the research results. In particular, some counselors have high cognitive fusion conditions. The counselor's experience in counseling, evaluation, supervision, and action research makes them train their minds to think at a high level. Thus, the counselor has many historical events as their reflection and internalization in their mind. Based on the research results, Mind-skills training could be given as one of recommendation to improve the metacognitive skills of novice counselors so that they can match the performance of experienced counselors.

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Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation

Cited by 11 publications

References 33 publications

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

<p>Metacognitive Reflection and Insight Therapy: A Recovery-Oriented Treatment Approach for Psychosis</p>

Cognitive fusion on counselor performance : A comparative study of the experienced and novice counselor

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