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The Mutual Development of Intersubjectivity and Metacognitive Capacity in the Psychotherapy for Persons with Schizophrenia

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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-reflectivity lies in explicitly focusing on a patient’s 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-reflectivity 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-reflection. We discuss when and how the therapist’s 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.

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Notes

  1. All identifying information as well as quoted material has been systematically disguised.

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Authors and Affiliations

  1. Department of Psychiatry, Roudebush VA Medical Center and the Indiana University School of Medicine, 116H 1481 West 10th St, Indianapolis, IN, 46202, USA

    Paul H. Lysaker

  2. Roudebush VA Medical Center, Indianapolis, IN, USA

    Kelly D. Buck & Jamie Ringer

  3. University of Indianapolis, Indianapolis, IN, USA

    Rebecca L. Fogley, Kyle Olesek & Megan L. A. Grant

  4. Department of Psychology, The University Clinic, University of Copenhagen, Copenhagen, Denmark

    Susanne Harder

  5. Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel

    Ilanit Hasson-Ohayon

  6. Centro di Terapia Metacognitiva Interpersonale, Clinical Psychology Specialization Program, University “La Sapienza”, Rome, Italy

    Giancarlo Dimaggio

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  1. Paul H. Lysaker
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  2. Kelly D. Buck
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Correspondence to Paul H. Lysaker.

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Lysaker, P.H., Buck, K.D., Fogley, R.L. et al. The Mutual Development of Intersubjectivity and Metacognitive Capacity in the Psychotherapy for Persons with Schizophrenia. J Contemp Psychother 43, 63–72 (2013). https://doi.org/10.1007/s10879-012-9218-4

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