Metacognitive Interpersonal Therapy (MIT) for personality disorders has been formulated in Dimaggio, Semerari et al., 2007. Then Dimaggio and colleagues (2015; 2020) devised a structured and manualized set of procedures aimed at guiding the clinicians’ therapeutic engagement and treatment from the very first session to the conclusion of treatment.
MIT adopts a series of techniques in order to deal with symptoms, promote awareness of mental states and in particular of maladaptive interpersonal schemas. Then the goal is to take critical distance from the schemas, access healthier and more benevolent view of the self and of the others. Individuals are helped to contact their own healthy wishes and preferences and try to let them guide their actions. MIT is unique, in that it focuses on an individualized, fine-grained case-formulation so to meet the needs of the specific person, while still remaining highly formalized.
MIT is delivered both individually and in group. As regard, group, Popolo and Dimaggio devised a 16 sessions program which combines psychoeducation about human motives and interpersonal schemas, with an experiential part, which role-play coming from patients’ autobiographical episodes.
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:
- 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.
- 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.
- 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.”
- 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.
- 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.
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.
Certification in Italy has 3 levels.
Level 1, basic, is achieved by a 4-days training, 8 hours each.
Level 2, intermediate is achieved by another 4-days training, 8 hours each.
Level 3 requires participation to either another 4-days training, 8 hours each, or a residential training. Then supervision is necessary. Visit the Italian website for information.
As regard Certification outside of Italy, Level 1, basic is achieved following this webinar.
In general, a 3-days, 6 to 8 hours each, training would confer
Level 1, basic: Information for getting the next certificates will be provided later on.
- Dimaggio. G., Ottavi, P., Popolo, R. & Salvatore, G. (2020). Metacognitive Interpersonal Therapy Body, imagery and change. Routledge.
- Dimaggio, G., Montano, A., Popolo, R. & Salvatore, G. (2015). Metacognitive Interpersonal Therapy for Personality Disorders: A treatment manual. Routledge
Papers on MIT and MIT-related approaches outcomes
- Dimaggio, G., Salvatore, G., MacBeth, A., Ottavi, P., Buonocore, L. & Popolo, R. (2017). Metacognitive Interpersonal Therapy for personality disorders: A case study series. Journal of Contemporary Psychotherapy, 47, 11-21.DOI: 10.1007/s10879-016-9342-7
- Gordon-King, K., Schweitzer, R.D. & Dimaggio, G. (2018). Metacognitive Interpersonal Therapy for Personality Disorders Featuring Emotional Inhibition: A Multiple baseline Case Series. Journal of Nervous and Mental Disease, 206(4), 263-269. doi: 10.1097/NMD.0000000000000789
- Popolo, R., MacBeth, A., Brunello, S., Canfora, F., Ozdemir, E., Rebecchi, D., Toselli, C., Venturelle, G., Salvatore, G. & Dimaggio, G. (2018). Metacognitive Interpersonal Therapy in Group (MIT-G): A pilot noncontrolled effectiveness study. Research in Psychotherapy: Psychopathology, Process and Outcome, 21, 155-163. doi:10.4081/ripppo.2018.338
- Popolo, R., MacBeth, A., Canfora, F., Rebecchi, D., Toselli, C., Salvatore, G. & Dimaggio, G. (2018). Metacognitive Interpersonal Therapy in group (MIT-G) for young adults personality disorders. A pilot randomized controlled trial. Psychology and Psychotherapy: Theory, Research & Practice DOI:1111/papt.12182
- Cheli, S., Lysaker, P.H., & Dimaggio, G. (2019). Metacognitively oriented psychotherapy for Schizotypal Personality Disorder: A two cases series. Personality and mental health, 13, 155-167. https://doi.org/10.1002/pmh.1447
- Ottavi, P., Passarella, T., Pasinetti, M., MacBeth, A., Velotti, P., Buonocore, L, Popolo, R., Salvatore, G., Velotti, A. & Dimaggio, G. (2019). Metacognitive Interpersonal Mindfulness-Based Training For Worry About Interpersonal Events: A Pilot Feasibility And Acceptability Study. Journal of Nervous and Mental Disease, 207, 944-950. DOI: 10.1097/NMD.0000000000001054
- Inchausti, F., García-Poveda, N.V, Ballesteros-Prados, A., Ortuño-Sierra, J., Sánchez-Reales, S., Prado-Abril, J., Aldaz-Armendáriz, J.A., Mole, J., Dimaggio, G., Ottavi, P. & Fonseca-Pedrero, E. (2018). The effects of Metacognition-Oriented Social Skills Training (MOSST) on Psychosocial Outcomes in Schizophrenia-Spectrum Disorders: A Randomized Controlled Trial. Schizophrenia Bulletin, 44, 1235–1244. https://doi.org/10.1093/schbul/sbx168