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.