Abstract
Individuals with personality disorders (PD) demonstrate poor metacognition, here defined as the capacity to use mental state knowledge for regulation of interpersonal relationships. Metacognitive interpersonal therapy (MIT) targets the symptoms of PD via a series of formalized procedures. Its goal is to help individuals improve their metacognitive capacity through developing and enacting more adaptive social behaviors. MIT has been manualized for the treatment of PDs featuring overcontrol, with single case studies providing initial evidence of its effectiveness. Given the need to deliver cost-effective treatments for patients with over-controlled and socially inhibited PDs, we developed MIT in groups (MIT-G), a short-term manualized group treatment with both psychoeducational and experiential aspects (Popolo et al. in Psychol Psychother: Theory Res Pract, 2018. https://doi.org/10.1111/papt.12182). Here we present the case of a young man presenting with Narcissistic PD (vulnerable type) featuring marked avoidant and obsessive-compulsive traits, social inhibition and emotional overcontrol. We describe the therapeutic process and how role-playing significant episodes helped him to improve metacognition, leading to the adoption of more effective social problem solving strategies. Outcomes were positive in terms of increased quality of social relationships, decreased symptoms, better emotion regulation and improved well-being. We conclude by considering how these processes may improve treatment delivery for these types of PD presentations.
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References
Arntz, A., & Jacob, G. A. (2012). Schema therapy in practice. Chichester: Wiley.
Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization based treatment. Oxford: Oxford University Press.
Baumeister, R., & Leary, M. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497–529.
Bowlby, J. (1969). Attachment and loss, Vol. 1: Attachment. New York: Basic Books.
Carcione, A., Semerari, A., Nicolò, G., Pedone, R., Popolo, R., Conti, L., Fiore, D., Procacci, M., & Dimaggio, G. (2011). Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Research, 190, 60–71. https://doi.org/10.1016/j.psychres.2010.12.032.
Dimaggio, G., MacBeth, A., Popolo, R., Salvatore, G., Perrini, F., Raouna, A., Osam, C. S., Buonocore, L., Bandiera, A., & Montano, A. (2018). The problem of overcontrol: Perfectionism and emotional inhibition as predictors of personality disorder. Comprehensive Psychiatry. https://doi.org/10.1016/j.comppsych.2018.03.005.
Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. London: Routledge. ISBN 9781317591184.
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. https://doi.org/10.1007/s10879-016-9342-7.
Dimaggio, G., Semerari, A., Carcione, A., Nicolò, G., & Procacci, M. (2007). Psychotherapy of personality disorders: Metacognition, states of mind and interpersonal cycles. London: Routledge.
Fassbinder, E., & Arntz, A. (2018). Schema therapy with emotionally inhibited and fearful patients. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-018-9396-9.
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington, DC: American Psychiatric Press. [Trad. It. Mazzi F., Morosini P., De Girolamo G., & Guaraldi G. P., (a cura di) (2003). Firenze: Giunti O.S.].
Giromini, L., Velotti, P., de Campora, G., Bonalume, L., & Zavattini, G. C. (2012). Cultural adaptation of the difficulties in emotion regulation scale: Reliability and validity of an Italian version. Journal of Clinical Psychology, 68, 989–1007. https://doi.org/10.1002/jclp.21876.
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. https://doi.org/10.1097/NMD.0000000000000789.
Ivaldi, A. (2016). Treating dissociative and personality disorders: A motivational systems approach to theory and treatment. London: Routledge.
Lichtenberg, J. D., Lachmann, F. M., & Fosshage, J. L. (2016). Self and motivational systems: Towards A theory of psychoanalytic technique. New York: Routledge.
Liotti, G., & Gilbert, P. (2011). Mentalizing, motivation, and social mentalities: Theoretical considerations and implications for psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 84, 9–25. https://doi.org/10.1348/147608310X520094.
Lysaker, P. H., Carcione, A., Dimaggio, G., Johannesen, J. K., Nicolò, G., Procacci, M., et al. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with insight, neurocognition, symptom and function. Acta Psychiatrica Scandinavica, 112, 64–71. https://doi.org/10.1111/j.1600-0447.2005.00514.x.
Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40, 487–491. https://doi.org/10.1093/schbul/sbu038.
Lysaker, P. H., & Klion, R. E. (2017). Recovery, meaning-making, and severe mental illness: A comprehensive guide to metacognitive reflection and insight therapy. New York: Routledge, Taylor & Francis Ltd.
Lysaker, P. H., Olesek, K., Buck, K., Leonhardt, B., Vohs, J., Dimaggio, G., Popolo, R., & Outcalt, J. (2014). Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders. Addictive Behaviors, 39, 558–561. https://doi.org/10.1016/j.addbeh.2013.11.007.
Morley, S., & Dowzer, C. N. (2014). Manual for the leeds reliable change indicator: Simple excel(tm) applications for the analysis of individual patient and group data. Leeds: University of Leeds.
Palmieri, G., Evans, G., Hansen, V., Brancaleoni, G., Ferrari, S., Porcelli, P., Reitano, F., & Rigatelli, M. (2009). Validation of the Italian version of the clinical outcomes in routine evaluation outcome measure (CORE-OM). Clinical Psychology and Psychotherapy, 16(5), 444–449. https://doi.org/10.1002/cpp.646.
Pascual-Leone, A., & Greenberg, L.S. (2007). Emotional processing in experiential therapy: why "the only way out is through.". Journal of Consulting Clinical Psychology, 75(6), 875–887.
Pellecchia, G., Moroni, F., Colle, L., Semerari, A., Carcione, A., Fera, T., Fiore, D., Nicolò, G., Pedone, R., & Procacci, M. (2018). Avoidant personality disorder and social phobia: Does mindreading make the difference? Comprehensive Psychiatry, 80, 163–169. https://doi.org/10.1016/j.comppsych.2017.09.011.
Popolo, R., & Dimaggio, G. (2016). Metacognitive interpersonal therapy in group (MIT-G): A treatment manual. Unpublished, Rome: Centro di Terapia Metacognitiva Interpersonale.
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. https://doi.org/10.1111/papt.12182.
Saggino, A., Balsamo, M., Carlucci, L., Cavalletti, V., Sergi, M. R., da Fermo, G., Dèttore, D., Marsigli, N., Petruccelli, I., Pizzo, S., & Tommasi, M. (2018). Psychometric properties of the Italian version of the Young Schema Questionnaire L-3: Preliminary results. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2018.00312.
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolò, G., Procacci, M., & Alleva, G. (2003). How to evaluate meta-cognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology and Psychotherapy, 10, 238–261. https://doi.org/10.1002/cpp.362.
Semerari, A., Colle, L., Pellecchia, G., Buccione, I., Carcione, A., Dimaggio, G., Nicolò, G., Procacci, M., & Pedone, R. (2014). Metacognitive dysfunctions in personality disorders: Correlations with disorder severity and personality styles. Journal of Personality Disorders, 28, 751–766. https://doi.org/10.1521/pedi_2014_28_137.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.
Tomasello, M., Carpenter, M., Call, J., Behne, T., & Moll, H. (2005). Understanding and sharing intentions: The origin of cultural cognition. Behavioral & Brain Sciences, 28, 675–691. https://doi.org/10.1017/S0140525X05000129.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.
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Popolo, R., MacBeth, A., Canfora, F. et al. Metacognitive Interpersonal Therapy in Groups for Over-Regulated Personality Disorders: A Single Case Study. J Contemp Psychother 49, 49–59 (2019). https://doi.org/10.1007/s10879-018-9401-3
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DOI: https://doi.org/10.1007/s10879-018-9401-3