ABSTRACT

In helping patients to recover from serious mental illness, it is expected Metacognitive Reflection and Insight Therapy (MERIT) therapists will encounter a number of different problems and challenges. This sixteenth chapter of the MERIT guidebook will discuss some of the most commonly encountered difficulties, including comorbid substance use, anger, emotional distress and potential dangerousness to self and others, poor insight, symptom exacerbation, crises and hospitalization, comorbid medical conditions, an entrenched illness identity, and past negative experiences with psychiatric treatment. Finally, recovery as the ultimate outcome is discussed. To recover, persons must manage their own recovery, clarifying the psychiatric, psychological, and social challenges they face, and then determining how to move toward health. As a result, specific outcomes will differ between patients. Wellness may mean, for example, a reduction in stigma, an improvement in self-esteem, a decrease in anxiety, or a lessening of the domination of symptoms. This is why MERIT is an individualized approach that rejects any practice that has a predetermined focus on a specific issue such as symptoms.