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      Improving the therapist’s metacognition and capacity to intersubjectively attune with a patient with psychosis through the exploration of the therapist’s developmental history: a case report

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          Abstract

          Clinical literature emphasizes how symptoms of psychosis can be efficiently targeted by psychological treatments. The most well-known approach to these symptoms is cognitive-behavioral therapy; but in the last few decades also other approaches are enriching the landscape, focusing on the dysfunctions in mentalization or metacognition, a spectrum of mental activities involving thinking about one’s own and others’ mental states. This huge amount of theoretical reflection and empirical research focused on the implementation of treatments does not seem to be associated with an attention to the inner world of the therapist who relates to the patient with psychosis; for example, to the impact of the therapist’s developmental history on the therapeutic relationship. In this paper the authors are inspired by an intersubjective perspective, according to which although the treatment is for the patient’s benefit, both the patient’s and the therapist’s developmental history and psychological organization are equally relevant for understanding the clinical exchange. On this basis, the authors make a “parallel” analysis of the clinical case of a young woman with symptoms of psychosis (i.e., persecutory delusions, auditory verbal hallucinations, social withdrawal) and its supervision process. They show how the therapeutic relationship can be significantly conditioned by the therapist’s developmental history; and how a process of supervision focused on the exploration of the traumatic elements of this history can effectively promote the therapist’s metacognitive capabilities, a functional patient-therapist intersubjective attunement, and a good clinical outcome.

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          Most cited references34

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          Burden and consequences of child maltreatment in high-income countries.

          Child maltreatment remains a major public-health and social-welfare problem in high-income countries. Every year, about 4-16% of children are physically abused and one in ten is neglected or psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to three times this number are exposed to any type of sexual abuse. However, official rates for substantiated child maltreatment indicate less than a tenth of this burden. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences. Child maltreatment substantially contributes to child mortality and morbidity and has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood. Neglect is at least as damaging as physical or sexual abuse in the long term but has received the least scientific and public attention. The high burden and serious and long-term consequences of child maltreatment warrant increased investment in preventive and therapeutic strategies from early childhood.
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            Metacognitive capacities for reflection in schizophrenia: implications for developing treatments.

            Models of schizophrenia, which focus exclusively on discrete symptoms and neurocognitive deficits, risk missing the possibility that a core feature of the disorder involves a reduced capacity to construct complex and integrated representations of self and others. This column details a new methodology that has been used to assess deficits in the metacognitive abilities that allow persons to form complex ideas about themselves and others and to use that knowledge to respond to psychosocial challenges in schizophrenia. Evidence is summarized supporting the reliability and validity of this method, as well as links this work has revealed between metacognition and psychosocial outcomes. It is suggested that this work points to the need to develop interventions which move beyond addressing symptoms and specific skills, and assist persons to recapture lost or atrophied metacognitive capacity and so form the kind of ideas about themselves and others needed, to move meaningfully toward recovery.
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              The Journey of the Counselor and Therapist: Research Findings and Perspectives on Professional Development

                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                26 June 2023
                2023
                : 14
                : 1195695
                Affiliations
                [1] 1Department of Humanities, Letters, Cultural Heritage, Education Sciences, University of Foggia , Foggia, Italy
                [2] 2Studio Maya, Psychiatry, Psychotherapy, Criminology, Research, Training , Salerno, Italy
                Author notes

                Edited by: George Salaminios, University College London, United Kingdom

                Reviewed by: Joe Druce, Central and North West London NHS Foundation Trust, United Kingdom; Katja Simoncelli, South London and Maudsley NHS Foundation Trust, United Kingdom

                *Correspondence: Gianpaolo Salvatore, gianpaolo.salvatore@ 123456unifg.it
                Article
                10.3389/fpsyt.2023.1195695
                10332146
                8eecb2ab-db3a-413a-9492-b605cc7ccbdc
                Copyright © 2023 Salvatore, Di Somma, Buonocore, Conza, Di Sturco, Fimiani, Manfredi, Marciano, Pallotta, Proto and Sateriale.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 28 March 2023
                : 30 May 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 6, Words: 5357
                Categories
                Psychiatry
                Case Report
                Custom metadata
                Schizophrenia

                Clinical Psychology & Psychiatry
                psychosis,developmental trauma,clinical supervision,intersubjective attunement,therapeutic relationship,metacognition,mentalization

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