Addressing Metacognitive Capacity in the Psychotherapy for Schizophrenia: A Case Study

Deficits in metacognition, that is, in the ability to think about one’s own thinking and the thinking of others, have been identified as a significant barrier to recovery from schizophrenia. While this has raised the possibility that individual psychotherapy might be focused to help persons with schizophrenia improve their capacity for metacognition, little has been written about what that might entail. To explore this issue, a case study is presented in which ongoing assessments of metacognition were used to guide the selection of interventions. Interventions were chosen in particular to match the client’s capacity for metacognition at that time and were conceptualized as offering maximal opportunities for the practice and development of metacognitive capacity. Improvements in function and the development of the ability to perform increasingly complex acts of metacognition are reported over the course of approximately 1.5 years of therapy and implications for research and theory are discussed.