A new study spearheaded by Laura Faith, Courtney Wiesepape, Marina Kukla, and the late Dr. Paul Lysaker delves into the experiences of clinicians who use meaning-oriented and recovery approaches to treat psychosis.
Hailing from institutions like the Richard L Roudebush VA Medical Center and Indiana University School of Medicine, these researchers sought to understand how different clinician groups—those applying Metacognitive Reflection and Insight Therapy (MERIT) versus standard psychiatric rehabilitation services—perceive their work and its impact on recovery. Their findings suggest that, while both groups prioritize the therapeutic relationship and recovery outcomes, MERIT therapists embrace uncertainty and personal growth, adding a dimension to care that transcends traditional medical models.
“It is now widely believed that people with psychosis can recover substantially, if not fully, over time,” the researchers write.
“Recovery is understood to involve a range of highly individualized and subjective outcomes including symptom remission and skill acquisition, sometimes called functional recovery, as well as changes in persons’ subjective sense of self and their place within their communities, sometimes called personal recovery. To date, this has led to an increasing number of therapeutic approaches within psychiatric rehabilitation, including cognitive behavioral therapy for psychosis (CBTp), social skills training, vocational rehabilitation, and supported housing, each of which is supported by research documenting changes in patient’s behavior. While patient perspective and experience of treatment are of tantamount importance to understanding the effects of psychiatric rehabilitation, the experience of clinicians as one half of a dyad is also of crucial importance in understanding the recovery process.”
As conversations about mental health care shift towards more holistic and patient-centered approaches, this study offers valuable insights into the benefits of integrating meaning and recovery-oriented practices into the treatment of psychosis. The research indicates that MERIT therapists, in particular, find their work not only beneficial for their patients but also personally transformative, which could have implications for reducing clinician burnout. These findings underscore the importance of therapeutic approaches that consider the subjective experiences of individuals with psychosis and support the personal growth of both the patient and the therapist.
Faith’s qualitative examination of practitioners from both the traditional therapy approach and MERIT approaches revealed a deeper understanding of the two treatment paradigms. Interviews were conducted with 20 therapists, ten from each model.
The themes that emerged from the interviews with MERIT therapists were 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. On the other hand, the themes for traditional therapists were more limited and included the value of a structured approach, a focus on a strengths-based approach, witnessing behavioral change, and building rapport to support the work.
Both traditional therapy and MERIT-based therapy share certain commonalities. Developing a solid therapeutic relationship and monitoring goals is one of the most critical aspects of each approach. However, there are some differences between the two approaches. MERIT therapists tend to adopt a less structured and hierarchical approach to treatment, with a greater focus on patient autonomy and experience. This difference in approach may result in greater growth for the patient and the therapist.
MERIT therapists believe that one of the critical aspects of their therapy is to sit with the patient in discomfort and uncharted territory. This contrasts with traditional therapy, which typically follows a structured treatment plan. This more open and subjective approach helps the therapist better understand the patient’s experiences from their own perspective. In addition, this approach allows therapists to grow as individuals and may also reduce the likelihood of professional burnout.
Patient autonomy and understanding of lived experience are essential themes that MERIT therapists believe contribute to the recovery of patients who have experienced psychosis. The traditional models of treatment plans, goal attainment, and carefully monitoring outcomes are somewhat counterintuitive to the concept of comfort with uncertainty, subjective processing, and trusting the patient to lead therapists through the healing process. MERIT therapists report that this approach creates unique opportunities for creative and flexible exploration of meaning and agency, which can be both challenging and rewarding for clinicians.
One limitation of this study is that the study setting was in urban US outpatient hospitals, which may not translate to all other settings. Despite this limitation, this setting provides extensive insight into people who have recently or are actively experiencing psychosis. Further study in different outpatient therapeutic environments is warranted. Further, traditional therapists had a range of titles in this study, which could be a limiting factor, and MERIT therapists had individuals still in training within the sample. More research is needed in other locations and with larger samples.
Perhaps the most important finding from Faith’s study is the patient reports of the “ability to integrate current experiences into the understanding of their lives, increased sense of agency, and the ability to understand and manage pain.”
This finding indicates that individuals who have experienced psychosis can recover and lead productive lives. Traditional methods of treatment may not allow patients to recover from within as the treatment plan dictates the path. Healing journeys require flexibility, and a thorough comprehension of the patient’s lived experience is essential in therapeutic settings. MERIT therapy distinguishes itself by leaning into the patient’s experience, unlocking growth in both the patient and the therapist.
The MERIT therapy approach emphasizes connecting with the patient and understanding their experiences. In contrast, traditional treatment planning focuses on observing the patient and their behavior. These are two distinct approaches, with the former being considered more effective.
In the mental health field, exploring new therapeutic approaches that prioritize patients’ experiences and empower them to take the lead in their healing journey is essential. One such approach is MERIT therapy, which was developed in 2014. Unlike traditional therapy, MERIT does not rely on structured external treatment plans. Instead, it encourages patients to find their solutions to their problems. This innovative approach promotes growth for both the patient and therapist and acknowledges the uncertainty that is inherent in the process of healing from mental health issues, such as psychosis. By embracing this uncertainty, MERIT therapy offers a promising alternative to traditional therapy for those who may not benefit from a more structured approach.
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Faith, L., Wiesepape, C., Kukla, M., & Lysaker, P. (2023). Promoting meaning and recovery for psychosis: Comparison of metacognitively-oriented psychotherapists and clinicians in psychiatric rehabilitation. Neuropsychiatric Disease and Treatment, 2179-2194. DOI: https://doi.org/10.2147/NDT.S386004 (Link)
One easy way to learn more about the MERIT approach, for anyone interested, is this recorded webinar that I helped organize: https://www.youtube.com/watch?v=LS-fc2rceWc
Having professionals avoid certainty is also a key principle in Open Dialogue and in CBT for psychosis.
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I’m glad the truth that “psychosis,” which can be created with nothing more serious than sleep deprivation, is now finally being claimed to be curable – as opposed to psychiatry’s and psychology’s systemic societal lies, that it is a “lifelong, incurable, genetic mental illness.”
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I think what this article talks about is why I believe in the peer support initiative in Wisconsin. Those of us that have survived our ordeals with mental health, pain, addiction, and incarceration – as well as suicide and others – are more educated through our successful transition and experiences than someone that just learned about it in a book.
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There’s nothing better than learning from people with lived experience. And that goes for anything in life.
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How does one find a skilled MERIT provider and/or ExpEx to work with a client?
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