Recovery, meaning-making, and severe mental illness : a comprehensive guide to metacognitive reflection and insight therapy

192 Pages·2017·0.771 MB·English

by  Klion, Reid E., Lysaker, Paul H.

Recovery, Meaning-Making,
and Severe Mental Illness
Recovery, Meaning-Making, and Severe Mental Illness offers practitioners an
integrative treatment model that will stimulate and harness their creativity,
allowing for the formation of new ideas about wellness in the face of pro-
found suffering. The model, Metacognitive Refl ection and Insight Therapy
(MERIT), complements current treatment modalities and can be used by prac-
titioners from a broad range of theoretical backgrounds. By using metacog-
nitive capacity as a guide to intervention, MERIT stretches and strengthens
practitioners’ capacity for refl ection and allows them to better use their unique
knowledge to help people who are confronting the suffering and chaos that
often comes from psychosis. Clinicians will come away from this book with a
variety of tools for helping clients manage their own recovery and confront the
issues that accompany an illness-based identity.
Paul H. Lysaker, PhD, is a clinical psychologist and professor of clinical psy-
chology in the Department of Psychiatry at the Indiana University School of
Medicine. He has studied and provided psychotherapy to adults with serious
mental illness for over 30 years. Dr. Lysaker is an author of over 400 peer-
reviewed articles and is a member of the editorial boards of multiple profes-
sional journals.
Reid E. Klion, PhD, is a clinical psychologist and the chief operating offi -
cer of the MERIT Institute. His previous positions include assistant professor
of psychiatry at the Indiana University School of Medicine and chief science
offi cer at Performance Assessment Network, Inc. Dr. Klion has done work in
areas ranging from psychotherapy to industrial-organizational psychology and
test publishing.

Recovery, Meaning-Making,
and Severe Mental Illness
A Comprehensive Guide to
Metacognitive Refl ection
and Insight Therapy
Paul H. Lysaker and
Reid E. Klion
First edition published 2018
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2018 Paul H. Lysaker and Reid E. Klion
The rights of Paul H. Lysaker and Reid E. Klion to be identifi ed as
the authors of this work has been asserted by them in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identifi cation and
explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Names: Lysaker, Paul H., author. | Klion, Reid E., author.
Title: Recovery, meaning-making, and severe mental
illness : a comprehensive guide to metacognitive refl ection
and insight therapy / Paul H. Lysaker and Reid E. Klion.
Description: First edition. | New York : Routledge, 2017. |
Includes bibliographical references.
Identifi ers: LCCN 2017030545 | ISBN 9781138208384
(hardcover : alk. paper) | ISBN 9781138208407
(pbk. : alk. paper) | ISBN 9781315447001 (e-book)
Subjects: | MESH: Mental Disorders—therapy | Cognitive
Therapy—methods | Metacognition | Psychotherapeutic
Processes | Models, Psychological
Classifi cation: LCC RC467 | NLM WM 425.5.C6 |
DDC 616.89—dc23
LC record available at https://lccn.loc.gov/2017030545
ISBN: 978-1-138-20838-4 (hbk)
ISBN: 978-1-138-20840-7 (pbk)
ISBN: 978-1-315-44700-1 (ebk)
Typeset in Galliard
by Apex CoVantage, LLC
Contents
List of Tables vii
Preface ix
About the Authors xi
SECTION I
Theoretical, Empirical, and Clinical Framework
of MERIT 1
1 Introduction 3
2 Metacognitive Impairment and Serious
Mental Illness 9
3 Understanding the Process of Metacognition 17
4 Assessing Metacognition and Its Role in
Severe Mental Illness 25
SECTION II
MERIT’s Preconditions and Eight Core Elements 31
5 Preconditions for Implementing MERIT 33
6 Overview of MERIT’s Elements and Element 1:
The Agenda 43
7 Element 2: Insertion of the Therapist’s Mind 53
8 Element 3: Eliciting the Narrative Episode 61
9 Element 4: Defi ning the Psychological Problem 69
vi Contents
10 Element 5: Refl ecting on the Therapeutic
Relationship 79
11 Element 6: Refl ecting on Progress 85
12 The MERIT-IF and Assessment of
Metacognition During Sessions 91
13 Element 7: Stimulating Self-Refl ection (S)
and Awareness of the Other (O) 105
14 Element 8: Stimulating Mastery (M) 121
SECTION III
Implementation, Clinical, and Technical Issues 129
15 Practical Treatment Considerations
and Learning MERIT 131
16 Common Clinical Issues 141
17 MERIT: Past and Future 149
Appendix I: MERIT Intervention Framework
(MERIT-IF) 157
Appendix II: The MERIT Therapist Adherence Scale
(MERIT-TAS) 159
References 163
Index 173
Tables
4.1 MAS-A Scales and Anchors 26
5.1 Preconditions for MERIT 41
6.1 MERIT Elements 43
6.2 Potential Agendas Expressed by a Simple Utterance 46
6.3 MERIT-TAS Element 1 Scale 52
7.1 Interventions to Sustain Dialogue 59
7.2 MERIT-TAS Element 2 Scale 60
8.1 MERIT-TAS Element 3 Scale 67
9.1 MERIT-TAS Element 4 Scale 76
10.1 MERIT-TAS Element 5 Scale 83
11.1 MERIT-TAS Element 6 Scale 89
12.1 Self-Refl ectivity (S) Scale 93
12.2 Understanding Others’ Minds (O) Scale 94
12.3 Mastery (M) Scale 95
12.4 Decentration (D) Scale 96
13.1 Characteristic Outcomes and Interventions for
Self-Refl ection (S) 106
13.2 Characteristic Outcomes and Interventions for
Awareness of Others (O) 114
13.3 MERIT-TAS Element 7 119
14.1 MERIT-TAS Element 8 127
17.1 MERIT Psychotherapy Case Studies 151

Preface
MERIT is an integrative system of psychotherapy for adults with serious men-
tal illness. It was not created in isolation. Key initial contributions came from
Giancarlo Dimaggio, Susanne Harder, Ilanit Hasson-Ohayon, Andrew Gum-
ley, and Kelly Buck. Two others, Jay Hamm and Bethany Leonhardt, joined
this dialogue shortly after, and the name of MERIT was developed by Steven
de Jong, Rozanne van Donkersgoed, and G. H. M. Pijnenborg. Others from
our Indianapolis study group have contributed signifi cantly to the develop-
ment of this method including Jenifer Vohs, Marina Kukla, Kyle Minor, Sally
Wasmuth, Elizabeth Belanger, Lauren Luther, Alison James, Benjamin Buck,
Kelsey Bonfi ls, and Ruthie Firmin. The list of contributors also includes clinical
colleagues Christina Silas, Jackie Hillis, Alysia Siegel, Sunita George, Ashley
Schnackenberg, E lizabeth Smith, and Rebecca Fogley. Core support in India-
napolis has also come from Amy Strausberger and Nicole Beattie. Other sup-
port, from both North America and internationally, has come from Hamish
McLeod, Robert Schweitzer, Ondrej Pec, Cumhur Taş, Leonor Irarrazaval,
Jens Jensen, Nicolai Ladegaard, Sune Bo Hansen, Raffaele Popolo, and Giam-
paolo Salvatore. Others have provided considerable forms of support and these
include David Pfenninger, David Roe, Philip Yanos, Antonio Semerari, and
Martin Brüne.