ABSTRACT
The ninth chapter of the guidebook to Metacognitive Reflection and Insight Therapy (MERIT) describes the fourth of the eight elements, which comprise the basis for MERIT. Element 4 asks the therapist to jointly identify and reflect with a patient upon a plausible psychological problem he or she is currently facing. Here, the therapist and patient should be thinking together about the psychological difficulties that the patient experiences. A problem is something that frustrates a goal, need, wish, or desire. It must also be a psychological problem that is plausible. As a result, hallucinations or unlikely beliefs are not usually psychological problems, but the feelings of loneliness that result from being shunned as a “voice hearer” or as a person with eccentric beliefs are. As with the preceding elements, this does not necessitate agreement about the “correct” or “true” problem but rather conjoint reflection upon it. Since the goal of this process is to isolate a psychological challenge, which can then be a topic of joint reflection by the patient and therapist, it should not be reduced to the idea that the therapist should “get” the patient to take responsibility.
