فراشناخت بعنوان پیش بینی کننده اتحاد درمانی در بیش از 26 هفته از روان درمانی در اسکیزوفرنی

Research to identify client factors that impact treatment outcome has found that deficits in metacognitive abilities and weaker therapeutic alliance are both associated with poorer treatment outcomes for schizophrenia. However, it is unknown if metacognition and therapeutic alliance are related in any way, in particular, if metacognitive abilities predict therapeutic alliance. This study explored whether differing capacities for mastery, a domain of metacognition that involves the ability to use knowledge about mental states to respond to psychological challenges, predicted client perceptions of therapeutic alliance assessed by the Working Alliance Inventory — Short Form (WAI-S). Participants were 63 adults with schizophrenia or schizoaffective disorder enrolled in a 6-month program of cognitive behavioral or supportive therapy, placed into a high, intermediate or minimal mastery group as measured by the Metacognitive Assessment Scale (MAS). Repeated measures ANOVA found group effects for the total WAI-S score, with the high and intermediate mastery groups having better alliance scores than the minimal mastery group. The group effects approached significance when neurocognition was controlled for. Results suggest that greater capacity for mastery predict stronger therapeutic alliance, but do not predict its development over time.

Recent studies have found that deficits in metacognitive abilities (e.g. Lysaker et al., 2010a and Lysaker et al., 2010c) and weaker therapeutic alliance (e.g. Davis and Lysaker, 2007) are both associated with poorer treatment outcomes for persons who have schizophrenia. However, it is unknown if metacognition and working alliance are related in any way for persons with schizophrenia. For instance, might the ability to “think about thinking” be associated with the ability to form a stronger therapeutic alliance? And, might limitations in metacognitive abilities impede the development of a working relationship in therapy? We anticipated that metacognitive abilities would be related to therapeutic alliance since the ability to conceptualize a psychological problem and think about it flexibly would seem to be a prerequisite for clients to develop a shared treatment focus and approach with their therapists. In studies of individuals with personality disorders, Dimaggio et al. (2010) suggest that metacognitive deficits are an impediment to development of therapeutic alliance, while Fonagy et al. (2002) propose that therapeutic alliance is a vehicle for developing metacognitive abilities in this population. Perhaps a clearer understanding of the metacognitive correlates of therapeutic alliance in schizophrenia may help to identify persons at risk for forming a poor alliance as well as point to the need for innovation in therapies for persons with schizophrenia. For example, perhaps treatment outcomes of individuals who have metacognitive deficits may be enhanced by an initial therapy focus on interventions that improve metacognition thereby improving alliance versus an immediate focus on the presenting problem.