Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Figures & data

Table 1 MERIT Preconditions and Elements

Precondition
1. Recovery is possible
2. Patients are active agents in their recovery
3. The therapist is a consultant and equal participant
4. Psychosis can be understood
5. Greater awareness can lead to emotional distress
6. Social stigma can profoundly impact persons with psychosis
Element
1. Focus on the patient agenda
2. Insertion of therapist’s mind
3. Eliciting narrative episodes
4. Eliciting the psychological problem
5. Reflection on the therapeutic relationship
6. Reflection upon progress
7. Stimulating reflections about self and others
8. Stimulating reflections about mastery

Table 2 Self-Identified Clinician Positions

Group	Position	#
Metacognitive Reflection and Insight Therapy (MERIT) therapists	Practicum student	5
	Psychology intern	2
	Social worker	1
	Post-doctoral fellow	1
	Clinical psychologist	1
Standard psychiatric rehabilitation (PR-S) clinicians	Case manager	4
	Clinical social worker	2
	Vocational Rehabilitation Specialist	2
	Substance use disorders specialist	1
	Clinical psychologist	1

Figure 1 Clinician interview questions.

Table 3 Themes Generated from Clinician Interviews

MERIT		Standard Psychiatric Rehabilitation
Theme	Subtheme	Theme	Subtheme
Comfort with uncertainty		Value of a structured approach	Focus on treatment plan goals
			Behavioral orientation
			Straightforward roles
Emphasis on collaboration		Focus on a strengths-based approach	Use of positive reinforcement
			Client-centered approach
Being part of therapeutic change		Witnessing behavioral change
Connecting with clients		Building rapport to support the work	Creating a supportive environment
			Prioritizing comfort
Emphasis on patient autonomy
Experiencing growth	Therapist growth
	Personal growth
	Shift in recovery mindset
Therapist use of self-awareness