Metacognitive Reflection and Insight Therapy with a Patient with Low Medication Adherence: The Interplay Between Personal, Functional and Clinical Recovery

People experiencing severe mental illness who are forced to be hospitalized due to an acute condition do not often agree with the method of treatment offered to them in psychiatric wards. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative form of psychotherapy that helps therapists focus together with their patients on thinking about patients’ thoughts and feelings. Through shared thinking and reflection, psychotic content can be discussed and differences between therapist and patient perceptions regarding the patient’s condition and possible treatment options can be understood. In addition, a common language is created regarding the patient’s agendas and aspirations with this approach. In the case described, we describe a patient that felt misunderstood and that she was mistreated for years. As a result, she objected to the method of treatment offered to her and expressed distrust in her ability to recover. We demonstrate how with the help of MERIT she achieved personal recovery, followed by functional recovery, and finally a partial clinical recovery.