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According to proponents of Dialogical Self Theory (DST), the self is made up of a series of I-positions, which continuously interact, negotiating potential courses of action, and attributing meaning to events. Individuals with personality disorders tend to attribute meaning according to stereotyped dialogical relationship patterns which prevent them from achieving social adaptation and fulfillment. Of note, in our perspective, we do not necessarily take dialogical relationship as healthy. We refer to dialogical thinking as a form of thoughts about interpersonal interactions, but the very dialogue may itself be stuck and repetitive as in the case of patients with personality disorders (Dimaggio et al., 2003, 2010; Schacter et al., 2012). These patterns do not just take the form of verbal discourse, but are instead embodied and rooted within internalized processes; which are themselves laden with affect, behavioral dispositions and somatic experiences. Using a case study we demonstrate how Metacognitive Interpersonal Therapy (MIT) provides a platform for changing embodied dialogical patterns, via imagery and body work. These techniques enable revision of the embodied component of the dialogical pattern, promoting the emergence of new I-positions. These new patterns comprise more adaptive aspects and correspondingly impede the enactment of previous maladaptive coping strategies, that were driven by pathological I-positions. Finally, we discuss the implications of experiential work in this context, as a crucial component of dialogical oriented therapies for people experiencing severe interpersonal problems such as personality disorders. [ABSTRACT FROM AUTHOR]

Objective: The therapeutic alliance is possibly a crucial factor in treatment for borderline personality disorder (BPD). Among predictors of therapeutic alliance, aspects that have not yet been considered are metacognition or the patient's capacity to be aware of mental states. We therefore explored whether metacognition predicted alliance and if metacognition and therapeutic alliance together predicted outcome in brief treatment for BPD. Method: In a secondary analysis of a randomized controlled trial, we included N = 36 patients with BPD in the current study. The original trial assessed the effects of a 10 session psychiatric standard treatment with or without the added the Plan Analysis and the Motive Oriented Therapeutic Relationship. We assessed the therapeutic alliance session by session (Working Alliance Inventory), metacognition at session 1 (using the Metacognitive Assessment Scale-Revised) and outcome (using residual gains on the Outcome Questionnaire-45.2 between sessions 1 and 10). Results: A more differentiated capacity to understand the mind of the others at treatment onset predicted an increase of therapist-rated alliance over time. Therapist rated alliance was the only significant outcome predictor (B = −0.85, R Squared =.12). Conclusions: More differentiated metacognition predicted therapeutic alliance which in turn affected outcome, thus making metacognition a relevant therapy target early in therapy for BPD. Future studies should expand this investigation to patients with better functioning, treated with different modalities and with longer treatments. [ABSTRACT FROM AUTHOR]

We describe here a narrative-based psychotherapy for a woman in her 40s who had been HIV+ since the age of 21 and who suffered from posttraumatic symptoms related to having received the diagnosis. She had also suffered from self-stigma and had lost the capacity to envision a future filled with hope. Treating individuals with HIV who face posttraumatic symptoms and stigma can be challenging for the clinician. A narrative approach to therapy can be helpful for these persons, in order to overcome symptoms, build a more benevolent self-image, feel accepted by society, and promote posttraumatic growth. Current evidence indicates that such an approach is mostly lacking. We describe how we applied metacognitive interpersonal therapy—an approach rooted in narrative constructivism. By using this treatment, the patient could overcome posttraumatic symptoms, participate in social activities after years of avoidance and isolation, and recover her sense of being a person able to make plans for the future with strength and dignity. Discussion includes ideas of how to generalize some of the mechanisms that have likely been effective in this therapy to other individuals with HIV. [ABSTRACT FROM AUTHOR]

Among persons with posttraumatic stress disorder (PTSD), the severity of symptoms and concurrent distress are not fully explained by trauma severity. Interest has consequently arisen in the psychological processes that cause distress and heighten PTSD symptoms. This study accordingly sought to examine whether differences in metacognitive capacity are related to levels of emotional distress, avoidance/numbing, and hyperarousal. Participants were 48 adults with a confirmed diagnosis of PTSD. Comparison groups included 51 adults with HIV and 183 with schizophrenia. Metacognition, emotion recognition, depression, and emotional distress and levels of avoidance/numbing and hyperarousal were assessed concurrently using the Metacognition Assessment Scale–Abbreviated, the Bell Lysaker Emotion Recognition Test, the Beck Depression Inventory, and the Clinician-Administered PTSD Scale. Results revealed that the PTSD group had better ratings of overall metacognitive capacity than the schizophrenia group and specifically poorer levels of metacognitive mastery, or the ability to use metacognitive knowledge to respond to challenges, than the HIV group. Within the PTSD group, poorer metacognitive mastery was linked with greater distress and higher hyperarousal when depression was controlled for statistically. Emotion recognition was not linked with distress or symptom severity. Results are consistent with models in which symptom severity in PTSD is related to the extent to which persons can use knowledge of themselves and others to find ways to respond to distress that match their own unique needs. [ABSTRACT FROM PUBLISHER]

Personality Disorders (PDs) can reasonably hope to gain benefit from psychotherapy. Nevertheless many patients do not fully respond. Research therefore has to be done into which variables need to be targeted in psychotherapy, in order to tailor treatment to the needs of the majority of PD patients. These have to date been understudied, in particular where patients have PD other than borderline and where they obtain no or limited benefits from available treatments. Many elements of the therapy process, such as therapy alliance, can be investigated. We outline here some personality pathology core issues and then describe how the authors involved in this special issue investigated the roles of symptoms, emotional experience and regulation, interpersonal patterns and mentalizing in PD psychotherapy. [ABSTRACT FROM AUTHOR]

Metacognition has been shown to be impaired in people diagnosed with schizophrenia, and related to poorer social functioning. To date, no research has looked at the relationship between a particularly rare – but problematic – social functioning outcome (violence) and metacognition. The present study explored patterns of metacognition in people diagnosed with schizophrenia and a history of interpersonal violence, and comparing them to a group with schizophrenia and no history of violence. Participants took part in an interview which explored stress and coping, which was subsequently coded for metacognitive ability. There were no differences between the two groups. Metacognition was significantly correlated with negative symptoms. The limitations of the study and implications for clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Introduction. Deficits in the ability to think about thinking have been widely observed in persons with schizophrenia and linked with concurrent assessments of various forms of function. Less is known though about their links to outcome over time. To address this issue, the current study explores whether Mastery, a domain of metacognition that reflects the ability to use knowledge about one's own mental states and those of others to respond to psychological challenges, is related to the frequency of social contact and persons' capacity for social relatedness. Methods. Participants were 72 adults with schizophrenia spectrum disorders enrolled in vocational rehabilitation; these patients completed a baseline assessment as well as a follow-up assessment 5 months later. Mastery was assessed using the Metacognitive Assessment Scale and social functioning by the Quality of Life Scale. Results. Using structural equation modelling, the proposed model demonstrated acceptable fit even when a range of possible confounding variables were entered as covariates. Conclusions. Results are consistent with the possibility that certain forms of metacognition affect social function among persons with schizophrenia, both concurrently and over time. [ABSTRACT FROM AUTHOR]

Patients with borderline personality disorder (BPD) are thought to be impaired in their ability to reflect on others' mental states. Only a few empirical studies have explored the idea that impaired mentalizing in BPD is associated with poor quality of parental care or parental separation during early childhood. Fifty patients diagnosed with BPD were examined using a cartoon task. Quality of parental care was assessed using a self-report measure for recalled parental child-rearing style. Patients with BPD did not differ from controls in their mentalizing abilities. In BPD, however, mentalizing correlated inversely with maternal overprotection, lack of emotional availability, and rejection. Moreover, maternal punishment and rejection and parental separation at an early developmental age were significant predictors of poor mentalizing skills in BPD. These findings suggest that the quality of parental care during early childhood plays a role in the development of mentalizing skills in BPD. [ABSTRACT FROM AUTHOR]

This study uses the Grid of Problematic States (GPS) to examine Lisa's case, one of the most successful in the York Psychotherapy Depression Project. This study tried to assess whether the contents of mental experience form stable clusters consistent with a diagnosis of depression. It was possible with the GPS to pinpoint problematic states typical of depression and trace the transitional states occurring in Lisa between two different mental states: depressive and well-being. The GPS analysis suggested that the treatment successfully managed to deal with symptoms and to change the patient's thought themes and emotions. At the end of treatment, Lisa was less sad and displayed some anger, and a state of being nurtured emerged. [ABSTRACT FROM AUTHOR]

The authors analyzed the successful case of Lisa, a client with major depression, using the Metacognitive Assessment Scale (MAS). Consistently with the literature on depression, the authors hypothesize that Lisa's ability to reflect on mental states—here metacognition—is marginally affected. The authors found that Lisa was better at describing her own mind rather than understanding the mind of the others. Furthermore, the most severe impairment was in using metacognition to cope with mental state source of distress and to enact strategies to solve interpersonal problems. During the therapy such difficulties improved progressively. Limitations and implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

The subjective experience of patients suffering from narcissistic personality disorder (NPD) has been studied using various methods. However, there has not been an analysis of psychotherapy session transcripts. It is much more likely that the facets of experience surface in this context than during a single interview or in a self-administered questionnaire. Using the Grid of Problematic States, designed to assess contents emerging in patients' transcripts, the authors analyzed the first 18 psychotherapy sessions with three female patients suffering from NPD and treated by therapists of the cognitive-constructivist school specializing in personality disorders. The three patients' dominant states of mind were characterized by anger, feeling excluded from groups, feelings of being harmed, and distrust toward others. The authors discuss the results and their implications for future research and for the definition of NPD in future editions of the Diagnostic and Statistical Manual of Mental Disorders. [ABSTRACT FROM AUTHOR]

The majority of neurocognitive models of negative symptoms in schizophrenia focus on failures to construct and sustain accurate representations of others and the world. Rarely considered are the intersubjective dimensions of negative symptoms as well as the mechanisms that sustain such symptoms. This paper critically analyses neurocognitive models of schizophrenia based on Theory of Mind (TOM) deficits and describes an alternative model of negative symptoms of schizophrenia based on Simulation Theory. We assert that several forms of negative symptoms of schizophrenia can be explained by an inability to express oneself, participate in, or be attuned to the context of social interactions. We label this deficit disadherence and suggest it may result from dysfunctions in "mirror" neurons. In particular, we suggest that patients with schizophrenia are unable to construct an inner model of the mind of another person and "select", from among various hypotheses, the one most suited to immediately understand the meanings and goals of interpersonal interactions. Moreover dysfunction in both "canonical" and "mirror" neurons, situated for the most part in the premotor and parietal cortex, could cause psychomotor negative symptoms. These hypotheses are explored in the context of a single case study. [ABSTRACT FROM AUTHOR]

Patients with narcissistic features are difficult to treat in psychotherapy, in particular because of problems in building sound therapeutic relationships with them. Therapists can get easily involved in dysfunctional relationship patterns that have a negative impact on the therapeutic alliance. Tracing the typical patterns that can recur in persons with narcissistic features should, therefore, prove useful in helping therapists to recognize their involvement in them at an early treatment stage and to deal with them effectively. A dialogical theory of the self offers a promising perspective from which to recognize and describe these patterns. From this vantage point, we discuss the treatment of a client diagnosed as having a narcissistic personality. What occurred during this therapy lends support to the idea that there are typical dialogical relationship patterns in patients with narcissistic features and that knowing them might help therapists to make treatment effective, avoid early dropouts, and successfully manage the therapeutic relationship. In addition, we put forward the hypothesis that some of the therapeutic techniques described here also can be applied to other patients displaying similar narcissistic features. [ABSTRACT FROM AUTHOR]

Disorders in the ability to understand mental states (metacognition) have an important role in psychopathology. Some clinicians talk of a generalised impairment of metacognition and others of malfunctioning of specific aspects. We compare two contrasting hypotheses. We call the first one ‘fast running’ hypothesis according to which metacognition is a single function, like speed in running. The second one is the ‘tennis playing’ hypothesis according to which metacognition is composed, like the ability to play tennis, of various, relatively independent skills, which can get impaired selectively. We reviewed the main theories and researches on metacognition and, therefore, we outlined a research programme based on them, describing the contribution made by the research on the psychotherapeutic process to this programme. [ABSTRACT FROM AUTHOR]

The self-narratives used by individuals to give meaning to their experience need a certain degree of clarity and consistency if they are to promote adaptation and be effective at guiding behavior. Various authors have noted how some patients are unable to put together well-organized stories. The individuals in question have often been diagnosed with schizophrenia or personality disorders, or have suffered serious traumas. The purpose of this special issue is, on the one hand, to compare a number of descriptions of disorganized narrative phenomena with each other and, on the other, to show how a therapeutic intervention can be tailored to giving consistency to stories. [ABSTRACT FROM AUTHOR]

The way in which patients tell therapists their stories has an impact on treatment. They try to put their emotions and the events generating them, their goals and the behavior they adopt to achieve them, and so on, together in a coherent discourse. But some patients fail in organizing their narratives. They might describe a diffuse arousal without letting the reasons for their discomfort be known, switch from one subject to another without any apparent connection, or pile up one topic after another, thus overwhelming a listener, who is unable to see which is the main one. We call such narratives disorganized. They do not help a patient to make sense of experience or achieve consistency in behavior. A therapist listening has difficulty in planning treatment and often reacts negatively to such patients. Here we propose a series of interventions aimed at improving narrative coherence, creating a sound therapeutic relationship and making treatment effective. We will describe the therapy with a seriously dissociated patient in which this intervention has proven useful. [ABSTRACT FROM AUTHOR]

According to Dialogical Self Theory (DST), persons give meaning to their relationships through an ongoing dialogue taking place between different parts of the self, termed characters, voices or positions. Following a brief introduction to DST, the authors present a case study in order to illustrate how a young woman diagnosed with Paranoid Personality Disorder (PPD) transformed self-other internal dialogues into (a) selves characterized by inadequacy and mistrust, and (b) others who express hostility, humiliation, and threats. The role of the therapist in this client's transformation toward healthier self-other dialogues is also highlighted. [ABSTRACT FROM AUTHOR]

Narrative constructivism places emphasis on how therapy can be used for rewriting patients' stories through the construction of more adaptive narratives, assisting patients in overcoming their conflicts and tackling the world's complexities. In this article, we shall use the analysis of a clinical case to show how a patient put together her set of narratives using the tool of Self-Investigation. We shall then show how the set changed after six months, as expressed in a second Self-Investigation. Finally, we shall describe the process by which this change took place, through the qualitative microanalysis of the diaries written by the patient during psychotherapy and the description of what was happening at the same time to the therapeutic relationship. It emerges that the patient's negative emotions diminished in intensity, and dependent characters, suffering from guilt feelings, gave way in the texts to narratives in which the self acts independently and without feeling it is harming others if it accomplishes its own objectives. [ABSTRACT FROM AUTHOR]

During psychotherapy, patients describe their experiences in the form of storytelling. Our goal here is to define the criteria that will allow a therapist to distinguish an effective narrative from a dysfunctional one. On the basis of a number of criteria, we provide a classification of the psychopathological forms that can be taken by the discourse of patients observed during psychotherapy. Two main categories are described: (a) Impoverished narratives, which are divided into the subcategories, Deficit in Narrative Production and Alexithymical Narratives; and (b) Integration deficit which is subdivided into Basic integration deficit, Deficit in integration between multiple representations of self and of others, Overproduction of narratives and deficit in hierarchization, and lastly Deficit in attribution to the correct mental function and deficit in distinction between reality and fantasy (between primary and disconnected representations). [ABSTRACT FROM AUTHOR]