Metacognitive Interpersonal Therapy

TREATMENT

MIT uses a carefully manualized procedure to foster therapeutic change and include an array of experiential techniques in order to first increase awareness of mental states and then promote cognitive, affective and behavioral change.

The main goals are:

1. Improving knowledge of own inner states, i.e. metacognitive monitoring (Semerari et al., 2003). For example, we use these techniques to increase awareness of affective experiences and then help patients label them.
2. Fostering agency. The goal is helping clients to discard maladaptive self-images such as “I as passively responding to others” and embody more adaptive perspectives, such as: “I have power over my experiences, and am not simply hostage to my thoughts and feelings. I want to act according to my own view and I have the power to do so.” Through both imagery and bodily exercises, patients are guided to discover that they have power and control (agency) over their own mental states.
3. A key step is promoting differentiation, that is discovering that one’s idea about self and others are subjective, bound to one’s own perspective and may therefore be amendable to change. In doing so, the individual realizes that his or her ideas about social relationships do not necessarily mirror reality. Of note, the second step, promoting agency, includes a first element of differentiation, in the process of moving from “I cannot control my reactions” to “I believed that I was a passive recipient of others’ intentions; but now I realize that this is not true as I have power over myself.”
4. Accessing healthy self-positions, relates to helping individuals to gain awareness of self-images imbued with positive qualities such as “I-as-lovable,” “I-as-worthy,” “I-as-strong,” “I-as-energy-driven” and so forth. Usually, the more severe the patients’ difficulties, the poorer their self-awareness of their capacity to use these positions, leading to them under-utilizing such positions in tasks or interactions or even having no recall of the availability of these positions. If the individual is able to access these self-images, they are not sustained within the inner dialogue and are overshadowed by problematic, dominant core self-images.
5. Once persons are connected to healthier views and are aware that suffering was mostly driven by maladaptive schemas, MIT adopts an ongoing combination of behavioural experiments in real-life and experiential techniques in session, ranging from guided imagery and rescripting, two-chairs, role-play and body oriented work in order to promote further change and sustain it.

The experiential shift

In the last few years, as illustrated by the last manual “Metacognitive Interpersonal Therapy: Body, Imagery and Change (2020, Routledge), MIT has more and more included in its procedures a wide array of experiential techniques. They mostly include: guided imagery and rescripting, drama-like techniques such as chair-work or role-play, bodily work and mindfulness/attention regulation. These are delivered according to a fine-grained individualized case-formulation and according to the decision-making procedure described in the manual.

MIT-Related approaches

Beside MIT individual and in groups, two approaches are based on the rationale described in the 2 manuals (Dimaggio et al., 2015; 2020, see references).

Metacognitive-Interpersonal Based Mindfulness Training (Ottavi et al., 2019). It consists of a 9- session program which combines awareness of own maladaptive interpersonal schemas which a unique elaboration of mindfulness practices.

Metacognition Oriented Social Skills Training (Ottavi et al., 2014) has been devised for people with psychosis. It includes some exercises from classic Social Skills Training, but the goal is different. It is not just about teaching skills, but to help patients be aware of the mental states underlying more adaptive social actions, and then acting with more awareness of own goals, intentions, ideas and affects and with some evaluation of the impact of an action on the mind of the others.