Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder

J Clin Psychol. 2015 Feb;71(2):125-35. doi: 10.1002/jclp.22148. Epub 2014 Dec 31.


Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal-directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.

Keywords: Schizophrenia; cognition; first episode psychosis; metacognition; psychotherapy; recovery.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Awareness / physiology*
  • Humans
  • Male
  • Psychotherapy / methods*
  • Psychotic Disorders / therapy*
  • Schizophrenia / therapy*
  • Theory of Mind / physiology*
  • Treatment Outcome
  • Young Adult