Trauma and meaningmaking in the recovery of the self: Implications for metacognitive reflection and insight therapy (MERIT)

People experiencing psychosis often suffer inordinately high rates of trauma associated with functional impairments and difficulties forming an integrated sense of self. Given these high rates, there is a need for treatments that can flexibly address the impact of trauma in the context of psychosis. This may entail attending to fragmented narrative episodes and alterations in meta-cognitive capacity. Past work on Metacognitive Reflection and Insight Therapy (MERIT) has suggested a role for metacognitive psychotherapy in assisting individuals experiencing psychosis with a history of trauma to pursue self-directed recovery. The literature related to MERIT has identified a focus on assisting people to make sense of their experiences and has highlighted the treatment's ability to be tailored for individuals in various states of disorder and recovery. To date though, there has been limited direct exploration of how MERIT might be adapted to specifically address trauma. In this chapter, we offer a brief overview of the research concerning the intersection of trauma and psychosis, then explore how MERIT might be used to effectively address trauma in psychotherapy with individuals experiencing psychosis. We highlight considerations for the application of both the general preconditions for MERIT, as well as the eight practice elements, in psychotherapy with individuals with psychosis and trauma histories.