Transference and Countertransference in the Recovery of Self in Metacognitively-Oriented Therapies for Psychosis

Metacognitive-oriented psychotherapy models have emerged as an effective means of supporting people with a history of psychosis to lead richer and more meaningful lives. The therapeutic dynamic, which relies on an intersubjective process between therapist and client, has the potential to enhance or to hinder therapy. However, this intersubjective process, including the role of transference and countertransference involved in metacognitive therapies, has not been well understood or articulated. Accordingly, this chapter will draw on a psychodynamic framework to explore the intersubjective nature of the relationship, by focusing on transference and countertransference within a metacognitive-oriented psychotherapy. We refer to a composite case study to highlight potential interpersonal complexities and challenges faced by therapists working with people who experience psychosis within a recovery-oriented, psychotherapeutic framework. We propose sensitive and curiosity-driven explorations of the therapeutic relationship itself as part of the therapeutic agenda. The approach is cognisant of the emergence of transference issues within the therapy and suggests how exploration and articulation of such issues may add to the client’s self-structure and renewed sense of self across multiple domains in their life