ABSTRACT
The sixth chapter of the Metacognitive Reflection and Insight Therapy (MERIT) guidebook explains how MERIT is defined by the presence of eight elements or processes designed to assist adults with serious mental illness to recapture metacognitive abilities. The first four MERIT elements are content oriented, the fifth and six are process oriented and the seventh and eight are superordinate. While the elements are interrelated, each must be considered individually, and therapists are expected to attend to all elements as the session progresses. The first element calls for therapists to understand and make manifest patients’ agendas, or what they are seeking in session. These agendas can be in or out of awareness and can be multiple and contradictory. Finding the patient’s agenda should be an interactive process where there is a smooth and continuous interplay between therapists listening and observing, monitoring their own reactions, offering a reflection, then thinking together with patients about their response. Satisfactory adherence requires therapists to make multiple attempts to make the patient’s agenda manifest across the session or have a significant joint discussion about the patient’s agenda. Element 1 allows for patients to be aware of different intentions and motives they themselves possess in the moment.
