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

Laura Faith,1 Courtney Wiesepape,2 Marina Kukla,3,4 Paul Lysaker1,2, † 1Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA; 2Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; 3HSR&D Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA; 4Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA†Dr Paul Lysaker passed away on July 25, 2023Correspondence: Laura Faith, Department of Psychiatry, Richard L Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN, 46202, USA, Tel +1-317-476-5708, Email Laura.Faith@va.govIntroduction: Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients’ experience of recovery oriented approaches, there are less studies examining clinicians’ perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis.Methods: Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services.Results: Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work.Discussion: As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.Keywords: psychosis, recovery, psychotherapy, therapeutic alliance, qualitative, clinician experience