Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-26T15:20:39.025Z Has data issue: false hasContentIssue false
  • English
  • Français

Mechanisms of Change in Psychotherapy for People Diagnosed with Schizophrenia: The Role of Narrative Reflexivity in Promoting Recovery

Published online by Cambridge University Press:  10 June 2014

Melissa Greben ,
Robert D Schweitzer  and
Rebecca Bargenquast
Melissa Greben
Affiliation:
School of Psychology and Counselling, Queensland University of Technology, Australia
Robert D Schweitzer*
Affiliation:
School of Psychology and Counselling, Queensland University of Technology, Australia
Rebecca Bargenquast
Affiliation:
School of Psychology and Counselling, Queensland University of Technology, Australia
*
Address correspondence to: Associate Professor Robert Schweitzer School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland, Australia4059. Email: r.schweitzer@qut.edu.au Phone: +61 7 3138 4617 Fax: +61 7 3138 0486
Get access

Abstract

Narrative reflexivity was investigated as a potential mechanism of therapeutic change during a 12–18 month trial of Metacognitive Narrative Psychotherapy for people diagnosed with schizophrenia. Participants were nine adult clients (8 male, 1 female) aged between 25–65 years (M = 44, SD = 12.76) with a diagnosis of schizophrenia consistent with DSM-IV criteria and seven female provisional psychologists aged between 25–29 years (M = 26.8 years, SD = 1.47 years). Recovery and narrative reflexivity were measured at three time points using the Recovery Assessment Scale (RAS) and the Narrative Processes Coding System (NPCS). Results were reported descriptively due to limited sample size (n = 9). The majority of clients (n = 7) reported an increase in recovery over the course of treatment. For six clients, an overall increase in recovery was associated with an increase in narrative reflexivity. This study provides preliminary support for narrative reflexivity as a potential mechanism of therapeutic change in the psychotherapy of people diagnosed with schizophrenia.

Keywords

recoverynarrative reflexivitymetacognitionschizophreniadialogical theorymechanism of change
Type
Articles
Information
The Australian Journal of Rehabilitation Counselling , Volume 20 , Issue 1 , July 2014 , pp. 1 - 14
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, J.M., Skalina, L.M., & McAdams, D.P. (2008). The narrative reconstruction of psychotherapy and psychological health. Psychotherapy Research, 18 (6), 719–734. doi: 10.1080/10503300802326020.Google Scholar
American Psychiatric Association (1980). The diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III). Washington DC.Google Scholar
Angus, L., & Hardtke, K. (1994). Narrative processes in psychotherapy. Canadian Psychology, 35 (2), 190–203. doi: 10.1037/0708-5591.35.2.190.Google Scholar
Angus, L., Levitt, H., & Hardtke, K. (1999). The narrative processes coding system: Research applications and implications for psychotherapy practice. Journal of Clinical Psychology, 55 (10), 1255–1270. doi: 10.1002/(SICI)1097-4679(199910)55:10<1255::AID-JCLP7>3.0.CO;2-F.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Angus, L., & McLeod, J. (2004). Self-multiplicity and narrative expression in psychotherapy. In Hermans, H. J. M. & Dimaggio, G. (Eds.), The Dialogical Self in Psychotherapy: An Introduction. East Sussex: Brunner-Routledge.Google Scholar
Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16 (4), 11–23.Google Scholar
Bargenquast, R., & Schweitzer, R. (2012). Metacognitive narrative psychotherapy for people diagnosed with schizophrenia: An outline of a principle-based treatment manual. Psychosis: Psychological, Social and Integrative Approaches, 1–11. doi:10.1080/17522439.2012.753935.Google Scholar
Bargenquast, R., & Schweitzer, R. (2013). Enhancing sense of recovery and self-reflectivity in people with schizophrenia: A pilot study of Metacognitive Narrative Psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice. Advance online publication. doi: 10.1111/papt.12019.Google Scholar
Buck, K.D., & Lysaker, P.H. (2009). Addressing metacognitive capacity in the psychotherapy for schizophrenia: A case study. Clinical Case Studies, 8 (6), 463–472. doi: 10.1177/1534650109352005.Google Scholar
Corrigan, P.W., & Ralph, R.O. (2005). Introduction: Recovery as consumer vision and research paradigm. In Corrigan, P.W. & Ralph, R.O. (Eds.), Recovery in Mental Illness: Broadening Our Understanding of Wellness. Washington, DC: American Psychological Association.Google Scholar
Corrigan, P.W., Salzer, M., Ralph, R.O., Sangster, Y., & Keck, L. (2004). Examining the factor structure of the recovery assessment scale. Schizophrenia Bulletin, 30 (4), 1035–1041.CrossRefGoogle ScholarPubMed
Davenport, S., Hobson, R., & Margison, F. (2000). Treatment development in psychodynamic interpersonal psychotherapy (Hobson's ‘Conversational Model’) for chronic treatment resistant schizophrenia: Two single case studies. British Journal of Psychotherapy, 16 (3), 287–302. doi: 10.1111/j.1752-0118.2000.tb00520.x.CrossRefGoogle Scholar
Dickerson, F.B., & Lehman, A.F. (2011). Evidence-based psychotherapy for schizophrenia: 2011 update. The Journal of Nervous and Mental Disease, 199 (8), 520–526. doi: 10.1097/NMD.0b013e318225ee78.Google Scholar
Gabbard, G.O. (2005). Psychodynamic Psychiatry in Clinical Practice (4th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
Henderson, S. (2013). The worst disease. Australian and New Zealand Journal of Psychiatry, 47, 499. doi: 10.1177/0004867413491036.Google Scholar
Hermans, H.J.M., & Dimaggio, G. (2004). The Dialogical Self in Psychotherapy. New York: Brunner-Routledge.Google Scholar
Kukla, M., Lysaker, P.H., & Salyers, M.P. (2013). Do persons with schizophrenia who have better metacognitive capacity also have a stronger subjective experience of recovery? Psychiatry Research, Epub ahead of print. doi: 10.1016/j.psychres.2013.04.014.CrossRefGoogle ScholarPubMed
Levitt, H., & Angus, L. (1999). Psychotherapy process measure research and the evaluation of psychotherapy orientation: A narrative analysis. Journal of Psychotherapy Integration, 9 (3), 279–300. doi: 10.1023/A:1023200206826.Google Scholar
Lysaker, P.H., Buck, K.D., Carcione, A., Procacci, M., Salvatore, G., Nicolo, G., & Dimaggio, G. (2011). Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes. Psychology and Psychotherapy: Theory Research and Practice, 84 (58–69). doi: 10.1348/147608310×520436.Google Scholar
Lysaker, P.H., & Buck, K.D. (2009). Metacognition in schizophrenia spectrum disorders: Methods of assessing metacognition within narrative and links with neurocognition. The European Journal of Psychiatry, 15, 2–12. doi: 10.4321/S0213-61632010000400004.Google Scholar
Lysaker, P.H., & Buck, K.D. (2010). Metacognitive capacity as a focus of individual psychotherapy in schizophrenia. In Dimaggio, G. & Lysaker, P.H. (Eds.), Metacognition and Severe Adult Mental Disorders: From Research to Treatment. Hove, UK: Routledge.Google Scholar
Lysaker, P.H., Buck, K.D., & Ringer, J. (2007). The recovery of metacognitive capacity in schizophrenia across 32 months of individual psychotherapy: A case study. Psychotherapy Research, 17 (6), 713–720. doi: 10.1080/10503300701255932.Google Scholar
Lysaker, P.H., Davis, L.W., Eckert, G.J., Strasburger, A.M., Hunter, N.L., & Buck, K.D. (2005). Changes in narrative structure and content in schizophrenia in long term individual psychotherapy: A single case study. Clinical Psychology and Psychotherapy, 12 (5), 406–416. doi: 10.1002/cpp.457.Google Scholar
Lysaker, P.H., Erickson, M.A., Buck, B., Buck, K.D., Olesek, K., Grant, M.L.A., . . . Dimaggio, G. (2011). Metacognition and social function in schizophrenia: Associations over a period of five months. Cognitive Neuropsychiatry, 16 (3), 241–255. doi: 10.1080/13546805.2010.530470.Google Scholar
Lysaker, P.H., Johannesen, J.K., & Lysaker, J.T. (2005). Schizophrenia and the experience of intersubjectivity as threat. Phenomenology and the Cognitive Sciences, 4 (3), 335–352. doi: 10.1007/s11097-005-4067-1.Google Scholar
Lysaker, P.H., & Lysaker, J.T. (2001). Psychosis and the disintegration of dialogical self-structure: Problems posed by schizophrenia for the maintenance of dialogue. British Journal of Medical Psychology, 74, 23–33. doi: 10.1348/000711201160777.CrossRefGoogle ScholarPubMed
Lysaker, P.H., & Lysaker, J.T. (2002). Narrative structure in psychosis: Schizophrenia and disruptions in the dialogical self. Theory Psychology, 12 (2), 207–220. doi: 10.1177/0959354302012002630.Google Scholar
Lysaker, P.H., & Lysaker, J.T. (2010). Schizophrenia and alterations in self-experience: A comparison of 6 perspectives. Schizophrenia Bulletin, 36 (2), 331–340. doi: 10.1093/schbul/sbn077.CrossRefGoogle ScholarPubMed
Lysaker, P.H., & Lysaker, J.T. (2011). Psychotherapy and recovery from schizophrenia: A model of treatment as informed by a dialogical model of the self experience in psychosis. Journal of Contemporary Psychotherapy, 41 (3), 125–133. doi: 10.1007/s10879-010-9157-x.Google Scholar
McNaught, M., Caputi, P., Oades, L.G., & Deane, F.P. (2007). Testing the validity of the Recovery Assessment Scale using an Australian sample. Australian and New Zealand Journal of Psychiatry, 41 (5), 450–457. doi: 10.1080/00048670701264792.Google Scholar
Salvatore, G., Lysaker, P.H., Gumley, A., Popolo, R., Procacci, M., Mari, J., & Dimaggio, G. (2012). Out of illness experience: Metacognition-oriented therapy for promoting self-awareness in individuals with psychosis. American Journal of Psychotherapy, 66 (1), 85–106.Google Scholar
Salvatore, G., Procacci, M., Popolo, R., Nicolo, G., Carcione, A., Semerari, A., & Dimaggio, G. (2009). Adapted metacognitive interpersonal therapy for improving adherence to intersubjective contexts in a person with schizophrenia. Clinical Case Studies, 8 (6), 473–488. doi: 10.1177/1534650109354916.Google Scholar
Sass, L.A., & Parnas, J. (2001). Phenomenology of self-disturbances in schizophrenia: Some research findings and directions. Philosophy, Psychiatry, & Psychology, 8 (4), 347–358. doi: 10.1353/ppp.2002.0027.Google Scholar
Seikkula, J., Alakare, B., & Aaltonen, J. (2011). The comprehensive open-dialogue approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care. Psychosis, 3 (3), 192–204. doi: 10.1080/17522439.2011.595819Google Scholar
Seikkula, J., Alakare, B., Aaltonen, J., Holma, J., Rasinkangas, A., & Lehtinen, V. (2003). Open dialogue approach: Treatment principles and preliminary results of a two-year follow-up on first episode schizophrenia. Ethical Human Sciences and Services, 5 (3), 163–182.Google Scholar
Semerari, A. (ed.). (1999). Psicoterapia cognitiva del paziente grave: Metacognizione e relazione terapeutica [Cognitive psychotherapy of severe patients: Metacognition and therapeutic relationship]. Milan, Italy: Raffaello Cortina.Google Scholar
Vromans, L.P. (2007). Process and outcome of narrative therapy for major depressive disorder in adults: Narrative reflexivity, working alliance and improved symptom and inter-personal outcomes. Doctor of Philosophy, Queensland University of Technology, Brisbane, Queensland.Google Scholar
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34 (3), 523–537. doi: 10.1093/schbul/sbm114Google Scholar