“Life Is Getting There.” A Case Report of Metacognitive Reflection and Insight Therapy (MERIT) with an Individual Diagnosed with Mild Intellectual Disability and Chronic Acute Care Service Utilization

Abstract

Individuals with intellectual disability (ID) face considerable hardship and many experience chronic self-harm, but this population is often neglected in the psychotherapy literature. Metacognitive Reflection and Insight Therapy (MERIT; Lysaker & Klion, 2017) is an integrative psychotherapy model that puts meaning-making at the center of the treatment approach by helping clients with impaired metacognition develop a unique sense of themselves, which can then be used to work through psychological problems. In this article, the authors describe the model, then present a case study of 12 months of psychotherapy with a man experiencing both ID and chronic self-harm in a community mental health center. During the course of treatment, acute care utilization is drastically reduced, agency and metacognitive capacity are greatly improved, but existing societal challenges remain.