Metacognitive Reflective and Insight Therapy for a Person Who Gained Maximal Levels of Metacognitive Capacity and Was Able to Terminate Therapy

Schizophrenia often involves a loss of metacognitive capacity, or the ability to form a complex and integrated sense of self and others. Independent of symptoms and impairments in neurocognition, metacognitive deficits are a barrier to the formation and sustenance of goal-directed activities of daily life and ultimately to recovery. Metacognitive reflective and insight therapy (MERIT) is a form of psychotherapy intended to assist patients to recover metacognitive capacity through intensive individual therapy. This paper presents a case illustration of how MERIT assisted a patient with prolonged schizophrenia and significant metacognitive deficits to develop a robustly complex understanding of himself and others and then to use that knowledge to agentically monitor his own experiences and effectively respond to life challenges. The eight elements of MERIT that stimulate and promote metacognitive capacity are presented with an emphasis on how they were implemented when the patient had reached some of the higher levels of metacognitive function.