ABSTRACT

The tenth chapter of the guidebook to Metacognitive Reflection and Insight Therapy (MERIT) describes the fifth of the eight elements, which comprise the basis for MERIT. This is the first of two process elements. In its first four elements, MERIT focuses on patients’ sense of themselves and others as they become apparent in the agenda, reactions to the therapist, personal narratives, and psychological problems. In Element 5, MERIT asks therapists to jointly reflect with patients about their relationship, the context in which all of these things are being explored. The essential component of Element 5 is that there be joint reflection about the interpersonal processes that are occurring in the therapist-patient dyad. MERIT is based upon the premise that all metacognitive acts are by their nature intersubjective. This element explicitly makes the relationship the subject of reflection itself. Satisfactory adherence to this element requires either frequent attempts to discuss the therapeutic relationship across the course of the session with consideration of the therapist’s role or position, or the emergence of a substantial statement about the therapeutic relationship.