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J Contemp Psychother (2013) 43:6372 DOI 10.1007/s10879-012-9218-4
ORIGINAL PAPER
The Mutual Development of Intersubjectivity and Metacognitive Capacity in the Psychotherapy for Persons with Schizophrenia
Paul H. Lysaker Kelly D. Buck Rebecca L. Fogley
Jamie Ringer Susanne Harder Ilanit Hasson-Ohayon
Kyle Olesek Megan L. A. Grant Giancarlo Dimaggio
Published online: 31 August 2012 Springer Science+Business Media, LLC (outside the USA) 2012
Abstract While cognitive behavioral approaches have been shown to help some individuals with schizophrenia, these approaches may be limited when working with patients with impairments in the metacognitive abilities required to form complex and integrated representations of themselves and others. In response, this paper explores the possibility that a key to working with patients with relatively impaired self-reectivity lies in explicitly focusing on a patients intersubjective experience within psychotherapy. We offer theoretical and empirical support for the assertion that the tolerance and capacity for intersubjectivity is a basis for the development of self-reectivity in general. We also explore how the fostering of intersubjective processes in psychotherapy might enable some
patients to form more complex ideas about themselves and so better ward off delusions in the face of the challenges of daily life. To illustrate these principles we present the case of a patient with tenaciously held delusions and limited capacity for self-reection. We discuss when and how the therapists awareness and verbalization of intersubjective processes within session allowed her and the patient to develop more complex and consensually valid ideas about him as a being in the world, which then assisted the patient to achieve improvements in a number of domains in his life.
Keywords Metacognition Intersubjectivity Delusions
Narrative Schizophrenia Recovery Psychotherapy
Recent emphasis on recovery as an achievable outcome from schizophrenia (Lysaker et al. 2009; Roe 2001; Silverstein and Bellack 2008) has led to renewed interest in integrating non-pharmacological interventions such as psychotherapy into routine treatment. To date, the most commonly reported form of psychotherapy that has been empirically studied with patients with schizophrenia is cognitive behavioral therapy (CBT). As detailed in a range of sources, these interventions seek to assist patients to recognize and correct dysfunctional thoughts and behaviors (Kingdon and Turkington 2004; Rector and Beck 2002). Furthermore, they have been found to be effective, particularly with regard to reducing positive (e.g. Sensky...