Metacognitive Interpersonal Therapy in Groups for Over-Regulated Personality Disorders: A Single Case Study

Abstract

Individuals with personality disorders (PD) demonstrate poor metacognition, here defined as the capacity to use mental state knowledge for regulation of interpersonal relationships. Metacognitive interpersonal therapy (MIT) targets the symptoms of PD via a series of formalized procedures. Its goal is to help individuals improve their metacognitive capacity through developing and enacting more adaptive social behaviors. MIT has been manualized for the treatment of PDs featuring overcontrol, with single case studies providing initial evidence of its effectiveness. Given the need to deliver cost-effective treatments for patients with over-controlled and socially inhibited PDs, we developed MIT in groups (MIT-G), a short-term manualized group treatment with both psychoeducational and experiential aspects (Popolo et al. in Psychol Psychother: Theory Res Pract, 2018. https://doi.org/10.1111/papt.12182). Here we present the case of a young man presenting with Narcissistic PD (vulnerable type) featuring marked avoidant and obsessive-compulsive traits, social inhibition and emotional overcontrol. We describe the therapeutic process and how role-playing significant episodes helped him to improve metacognition, leading to the adoption of more effective social problem solving strategies. Outcomes were positive in terms of increased quality of social relationships, decreased symptoms, better emotion regulation and improved well-being. We conclude by considering how these processes may improve treatment delivery for these types of PD presentations.