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Published in: Journal of Contemporary Psychotherapy 4/2016

01-12-2016 | Original Paper

Metacognitive Reflection and Insight Therapy for Borderline Personality Disorder: A Case Illustration of an Individual in a Long Term Institutional Setting

Authors: Jenifer L. Vohs, Bethany L. Leonhardt

Published in: Journal of Contemporary Psychotherapy | Issue 4/2016

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Abstract

Impairments in metacognitive capacity are a core barrier to recovery for many with borderline personality disorder. Metacognition refers to the processes which enable individuals to access, understand, and integrate their ideas about the mental states of themselves and others, and then use that information to recognize and respond adaptively to psychological challenges. Borderline personality disorder is believed to be amenable to psychotherapy, but few of the established treatment protocols specifically target metacognitive capacity. This case illustration provides a descriptive account of an individual with borderline personality disorder in a long term institutional setting who participated in 14 months of a novel psychotherapy that specifically targeted metacognitive processes: Metacognitive Reflection and Insight Therapy. The vital elements of the intervention are elaborated with examples from the case illustration. Case conceptualization, outcomes, and potential prognosis are also presented and discussed.
Literature
go back to reference Bateman, A. W., & Fonagy, P. (2009). Randomly controlled trial of outpatient mentalizing-based therapy versus structured clinical management for borderline personality disorder. American Journal of Psychiatry, 166, 1355–1364.CrossRefPubMed Bateman, A. W., & Fonagy, P. (2009). Randomly controlled trial of outpatient mentalizing-based therapy versus structured clinical management for borderline personality disorder. American Journal of Psychiatry, 166, 1355–1364.CrossRefPubMed
go back to reference Bateman, A. W., & Fonagy, P. (2012). Borderline personality disorder. In A. W. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 273–288). Washington, DC: American Psychiatric Publishing Inc. Bateman, A. W., & Fonagy, P. (2012). Borderline personality disorder. In A. W. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 273–288). Washington, DC: American Psychiatric Publishing Inc.
go back to reference Buck, K. D., & George, S. E. (2016). Metacognitive reflective and insight therapy for a person who gained maximal levels of metacognitive capacity and was able to terminate therapy. Journal of Contemporary Psychotherapy. doi:10.1007/s10879-016-9322-y Buck, K. D., & George, S. E. (2016). Metacognitive reflective and insight therapy for a person who gained maximal levels of metacognitive capacity and was able to terminate therapy. Journal of Contemporary Psychotherapy. doi:10.​1007/​s10879-016-9322-y
go back to reference De Bolle, M., De Fruyt, F., Quilty, L. C., Rolland, J.-P., Decuyper, M., & Bagby, R. M. (2011). Does personality disorder co-morbidity impact treatment outcome for patients with major depression? A multi-level analysis. Journal of Personality Disorders, 25, 1–15.CrossRefPubMed De Bolle, M., De Fruyt, F., Quilty, L. C., Rolland, J.-P., Decuyper, M., & Bagby, R. M. (2011). Does personality disorder co-morbidity impact treatment outcome for patients with major depression? A multi-level analysis. Journal of Personality Disorders, 25, 1–15.CrossRefPubMed
go back to reference Dimaggio, G., Carcione, A., Conti, M. L., Nicolò, G., Fiore, D., & Pedone, R. (2009). Impaired decentration in personality disorder: An analysis with the Metacognition Assessment Scale. Clinical Psychology and Psychotherapy., 16, 450–462.CrossRefPubMed Dimaggio, G., Carcione, A., Conti, M. L., Nicolò, G., Fiore, D., & Pedone, R. (2009). Impaired decentration in personality disorder: An analysis with the Metacognition Assessment Scale. Clinical Psychology and Psychotherapy., 16, 450–462.CrossRefPubMed
go back to reference Dimaggio, G., & Lysaker, P. H. (2015). Metacognition and mentalizing in the psychotherapy of patients with psychosis and personality disorders. Journal of Clinical Psychology, 71(2), 117–125.CrossRefPubMed Dimaggio, G., & Lysaker, P. H. (2015). Metacognition and mentalizing in the psychotherapy of patients with psychosis and personality disorders. Journal of Clinical Psychology, 71(2), 117–125.CrossRefPubMed
go back to reference Dimaggio, G., Lysaker, P. H., Carcione, A., Nicolό, G., & Semerari, A. (2008). Know yourself and you shall know the other… to a certain extent: Multiple paths of influence of self- reflection on mindreading. Consciousness and Cognition, 17, 778–789.CrossRefPubMed Dimaggio, G., Lysaker, P. H., Carcione, A., Nicolό, G., & Semerari, A. (2008). Know yourself and you shall know the other… to a certain extent: Multiple paths of influence of self- reflection on mindreading. Consciousness and Cognition, 17, 778–789.CrossRefPubMed
go back to reference Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. New York, NY: Routledge. Dimaggio, G., Montano, A., Popolo, R., & Salvatore, G. (2015). Metacognitive interpersonal therapy for personality disorders: A treatment manual. New York, NY: Routledge.
go back to reference Dimaggio, G., Nicolό, G., Semerari, A., & Carcione, A. (2013). Investigating the personality disorder psychotherapy process: The roles of symptoms, quality of affects, emotional dysregulation, interpersonal processes, and mentalizing. Psychotherapy Research, 23(6), 624–632.CrossRefPubMed Dimaggio, G., Nicolό, G., Semerari, A., & Carcione, A. (2013). Investigating the personality disorder psychotherapy process: The roles of symptoms, quality of affects, emotional dysregulation, interpersonal processes, and mentalizing. Psychotherapy Research, 23(6), 624–632.CrossRefPubMed
go back to reference Dimaggio, G., Salvatore, G., Fiore, D., Carcione, A., Nicolό, G., & Semerari, A. (2012). General principles for treating personality disorder with a prominent inhibitedness trait: Towards an operationalizing integrated technique. Journal of Personality Disorders, 26(1), 63–83.CrossRefPubMed Dimaggio, G., Salvatore, G., Fiore, D., Carcione, A., Nicolό, G., & Semerari, A. (2012). General principles for treating personality disorder with a prominent inhibitedness trait: Towards an operationalizing integrated technique. Journal of Personality Disorders, 26(1), 63–83.CrossRefPubMed
go back to reference Dimaggio, G., Semerari, A., Carcione, A., Nicolό, G., & Procacci, M. (2007). Psychotherapy of personality disorders: Metacognition, states of mind and interpersonal cycles. London: Routledge. Dimaggio, G., Semerari, A., Carcione, A., Nicolό, G., & Procacci, M. (2007). Psychotherapy of personality disorders: Metacognition, states of mind and interpersonal cycles. London: Routledge.
go back to reference Hamm, J. A., & Firmin, R. L. Disorganization and individual psychotherapy for schizophrenia: A case report of metacognitive reflection and insight therapy. Journal of Contemporary Psychotherapy. doi:10.1007/s10879-016-9326-7 Hamm, J. A., & Firmin, R. L. Disorganization and individual psychotherapy for schizophrenia: A case report of metacognitive reflection and insight therapy. Journal of Contemporary Psychotherapy. doi:10.​1007/​s10879-016-9326-7
go back to reference Hillis, J. D., Leonhardt, B. L., Vohs, J. L., Buck, K. D., Salvatore, G., Popolo, R., et al. (2015). Metacognitve reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. Journal of Clinical Psychology, 71, 125–135.CrossRefPubMed Hillis, J. D., Leonhardt, B. L., Vohs, J. L., Buck, K. D., Salvatore, G., Popolo, R., et al. (2015). Metacognitve reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. Journal of Clinical Psychology, 71, 125–135.CrossRefPubMed
go back to reference Leonhardt, B. L., Benson, K., George, S., Buck, K. D., Shaieb, R., & Vohs, J. L.(2016). Targeting insight in first episode psychosis: A case study of metacognitive reflection insight therapy (MERIT). Journal of Contemporary Psychotherapy. doi:10.1007/s10879-016-9332-y Leonhardt, B. L., Benson, K., George, S., Buck, K. D., Shaieb, R., & Vohs, J. L.(2016). Targeting insight in first episode psychosis: A case study of metacognitive reflection insight therapy (MERIT). Journal of Contemporary Psychotherapy. doi:10.​1007/​s10879-016-9332-y
go back to reference Levy, K. N., Beeney, J. E., Wasserman, R. H., & Clarkin, J. F. (2010). Conflict begets conflict: Executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder. Psychotherapy Research, 20, 413–422.CrossRefPubMed Levy, K. N., Beeney, J. E., Wasserman, R. H., & Clarkin, J. F. (2010). Conflict begets conflict: Executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder. Psychotherapy Research, 20, 413–422.CrossRefPubMed
go back to reference Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
go back to reference Lysaker, P. H., Buck, K. D., Leonhardt, B. L., Buck, B. E., Hamm, J., Vohs, J. L., & Dimaggio, G. (2014a). Metacognitively focused psychotherapy for persons with schizophrenia: Eight core elements that define practices. In P. H. Lysaker, G. Dimaggio, & M. Brüne (Eds.), Metacognition and social cognition in schizophrenia. New York, NY: Elsevier Press.CrossRef Lysaker, P. H., Buck, K. D., Leonhardt, B. L., Buck, B. E., Hamm, J., Vohs, J. L., & Dimaggio, G. (2014a). Metacognitively focused psychotherapy for persons with schizophrenia: Eight core elements that define practices. In P. H. Lysaker, G. Dimaggio, & M. Brüne (Eds.), Metacognition and social cognition in schizophrenia. New York, NY: Elsevier Press.CrossRef
go back to reference Lysaker, P. H., Carcione, A., Dimaggio, G., Johannesen, J. K., Nicolo, G., Procacci, M., & Semarari, A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with insight, neurocognition, symptom and function. Acta Psychiatrica Scandinavia, 112, 64–71.CrossRef Lysaker, P. H., Carcione, A., Dimaggio, G., Johannesen, J. K., Nicolo, G., Procacci, M., & Semarari, A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with insight, neurocognition, symptom and function. Acta Psychiatrica Scandinavia, 112, 64–71.CrossRef
go back to reference Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40(3), 487–491.CrossRefPubMedPubMedCentral Lysaker, P. H., & Dimaggio, G. (2014). Metacognitive capacities for reflection in schizophrenia: Implications for developing treatments. Schizophrenia Bulletin, 40(3), 487–491.CrossRefPubMedPubMedCentral
go back to reference Lysaker, P. H., Hillis, J., Leonhardt, B., Kukla, M., & Buck, K. D. (2014b). Metacognition in schiozophrenia spectrum disorders: Methods of assessment and associations with psychosocial function, neurocognition, symptoms and cognitive style. In P. H. Lysaker, G. Dimaggio, & M. Brüne (Eds.), Social cognition and metacognition in schizophrenia (pp. 99–111). NY: Elsevier Press.CrossRef Lysaker, P. H., Hillis, J., Leonhardt, B., Kukla, M., & Buck, K. D. (2014b). Metacognition in schiozophrenia spectrum disorders: Methods of assessment and associations with psychosocial function, neurocognition, symptoms and cognitive style. In P. H. Lysaker, G. Dimaggio, & M. Brüne (Eds.), Social cognition and metacognition in schizophrenia (pp. 99–111). NY: Elsevier Press.CrossRef
go back to reference Lysaker, P. H., Kukla, M., Belanger, E., White, D. A., Buck, K. D., Luther, L., et al. (2015). Individual psychotherapy and changes in self-experience in schizophrenia: A qualitative comparison of patients in metacognitively focused and supportive psychotherapy. Psychiatry, 78(4), 305–316.CrossRefPubMed Lysaker, P. H., Kukla, M., Belanger, E., White, D. A., Buck, K. D., Luther, L., et al. (2015). Individual psychotherapy and changes in self-experience in schizophrenia: A qualitative comparison of patients in metacognitively focused and supportive psychotherapy. Psychiatry, 78(4), 305–316.CrossRefPubMed
go back to reference Lysaker, P. H., Vohs, J. L., Ballard, R., Fogley, R., Salvatore, G., Popolo, R., & Dimaggio, G. (2013). Metacognition, self-reflection and recovery in schizophrenia. Future Neurology, 8, 103–115.CrossRef Lysaker, P. H., Vohs, J. L., Ballard, R., Fogley, R., Salvatore, G., Popolo, R., & Dimaggio, G. (2013). Metacognition, self-reflection and recovery in schizophrenia. Future Neurology, 8, 103–115.CrossRef
go back to reference Outcalt, J., Dimaggio, G., Popolo, R., Buck, K. D., Chaudoin-Patzoldt, K. A., George, S., et al. (2016). Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment for substance use disorders. Comprehensive Psychiatry, 64, 22–28.CrossRefPubMed Outcalt, J., Dimaggio, G., Popolo, R., Buck, K. D., Chaudoin-Patzoldt, K. A., George, S., et al. (2016). Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment for substance use disorders. Comprehensive Psychiatry, 64, 22–28.CrossRefPubMed
go back to reference Semerari, A., Carcione, A., Dimaggio, G., et al. (2003). How to evaluate metacognitive function in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology and Psychotherapy, 10, 238–261.CrossRef Semerari, A., Carcione, A., Dimaggio, G., et al. (2003). How to evaluate metacognitive function in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology and Psychotherapy, 10, 238–261.CrossRef
go back to reference Semerari, A., Colle, L., Pellecchia, G., Carcione, A., Conti, L., Fiore, D., et al. (2015). Personality disorders and mindreading: Specific impairments in patients with borderline personality disorder compared to other PDs. Journal of Nervous and Mental Disease, 203(8), 626–631.CrossRefPubMed Semerari, A., Colle, L., Pellecchia, G., Carcione, A., Conti, L., Fiore, D., et al. (2015). Personality disorders and mindreading: Specific impairments in patients with borderline personality disorder compared to other PDs. Journal of Nervous and Mental Disease, 203(8), 626–631.CrossRefPubMed
go back to reference Semerari, A., & Fiore, D. (2007). Borderline personality disorder: Model and treatment. In G. Dimaggio, A. Semerari, A. Carcione, G. Nicolό, & M. Procacci (Eds.), Psychotherapy of personality disorders (pp. 47–80). New York, NY: Routledge. Semerari, A., & Fiore, D. (2007). Borderline personality disorder: Model and treatment. In G. Dimaggio, A. Semerari, A. Carcione, G. Nicolό, & M. Procacci (Eds.), Psychotherapy of personality disorders (pp. 47–80). New York, NY: Routledge.
go back to reference Thiel, T., Hertenstein, E., Nissen, C., Herbst, N., Külz, A. K., & Voderholzer, U. (2013). The effect of personality disorders on treatment outcomes in patients with obsessive- compulsvive disorders. Journal of Personality Disorders, 27(6), 697–715.CrossRefPubMed Thiel, T., Hertenstein, E., Nissen, C., Herbst, N., Külz, A. K., & Voderholzer, U. (2013). The effect of personality disorders on treatment outcomes in patients with obsessive- compulsvive disorders. Journal of Personality Disorders, 27(6), 697–715.CrossRefPubMed
go back to reference van Donkersgoed, R. J. M., de Jong, S., van der Gaag, M., Lysaker, P. H., Wunderink, L., & Pijnenborg, G. H. M. (2014). A manual-based individual therapy to improve metacognition in schizophrenia: Protocol of a multi-center RCT. BMC Psychiatry, 14, 27.CrossRefPubMedPubMedCentral van Donkersgoed, R. J. M., de Jong, S., van der Gaag, M., Lysaker, P. H., Wunderink, L., & Pijnenborg, G. H. M. (2014). A manual-based individual therapy to improve metacognition in schizophrenia: Protocol of a multi-center RCT. BMC Psychiatry, 14, 27.CrossRefPubMedPubMedCentral
Metadata
Title
Metacognitive Reflection and Insight Therapy for Borderline Personality Disorder: A Case Illustration of an Individual in a Long Term Institutional Setting
Authors
Jenifer L. Vohs
Bethany L. Leonhardt
Publication date
01-12-2016
Publisher
Springer US
Published in
Journal of Contemporary Psychotherapy / Issue 4/2016
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI
https://doi.org/10.1007/s10879-016-9335-6

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