Metacognitive Interpersonal Therapy for dependent PD: working with
experiential practices.
MIT is a third wave integrative psychotherapy, specifically designed to
treat personality disorders (PD) (Dimaggio et al., 2007, 2015, 2020).
There is growing evidence of the effectiveness of MIT in treating PD in
both individual and group therapy (Dimaggio et al., 2017; Gordon-King et
al., 2018; Inchausti et al., 2023; Simonsen et al., 2021; Popolo et al.,
2018, 2019; 2022). These studies demonstrated robust treatment adherence
and therapeutic improvements in symptoms, social functioning, and
ability to reflect on mental states.
When specifically applied to DPD (Dimaggio et al., 2007) MIT attempts at
increasing awareness of inner states, realizing own negative ideas about
the self are not necessarily true, forming and sustaining healthy
self-images, increase emotion regulation, sustain agency and autonomy
and adopting more socially adaptive behaviours.
MIT follows a series of semi-structured procedures, divided into two
phases: (1) a shared formulation of functioning and (2) the promotion of
change (Dimaggio et al., 2015, 2020). During the shared formulation of
functioning, therapists first collect and explore autobiographical
narrative episodes, with the goal of forming a shared understanding of
maladaptive interpersonal patterns with their client patients (Dimaggio
& Lysaker, 2010). In its most recent form, MIT adopts a wide range of
experiential techniques, including, mindfulness-based exercises, guided
imagination and rescripting, role-playing and the two-chair approach,
body exercises, and behavioral experiments (Dimaggio et al., 2020).
These techniques are used on the basis that emerging evidence suggests
that they make a unique contribution to psychotherapeutic change beyond
focusing on relational factors alone. Bodywork is also essential when
access to internal states and critical distance cannot be achieved
through clinical dialogue. Several authors (Dimaggio et al, 2020;
Haeyen, 2022; Haeyen & Dimaggio, 2024; Ogden & Fisher, 2015), in fact,
highlight the importance of working with body techniques to help
patients overcome their automatisms, reduce suffering and pursue
well-being. For example, bodywork allows observing and exploring how the
body reacts in the course of memories related to problematic episodes,
and this way developing a richer awareness of self-states. When focusing
on the body instead of on the behaviors of others, the person is more
leaning to consider suffering coming from an inner source and so try and
regulate emotions and overcome distress. Moreover, proposing patients to
repeatedly change posture or movements helps them discover how their
thoughts change accordingly, and they have the power to change ideas and
regulate affects, instead than repeating the same patterns or remaining
prey of negative ideas and emotions out of control.
Summing up, in the context of MIT for DPD, body work has 3 main goals:
1) increasing awarenss of inner self and in particular their wishes and
goals; 2) promote autonomus emotion regulation instead of over-relying
on others; 3) realize own ideas about the self and the others are mere
ideas and are not necessarily true; 4) increase experience and awareness
of healthy aspects of the self and use them as a guide for 5) more
adaptive social behaviours, based on their core wishes and goals instead
than acted with the sole goal of granting the proximity of the others.