Metacognitive interpersonal therapy

Domain II · Behavioural & cognitive · Giancarlo Dimaggio, Raffaele Popolo, Giampaolo Salvatore · 2015 · Rome

What it is

Metacognitive Interpersonal Therapy (MIT) is an integrative cognitive therapy for personality disorders. It was developed in Rome by Giancarlo Dimaggio, Raffaele Popolo, Giampaolo Salvatore, Antonella Montano, Paolo Ottavi and colleagues. It grew out of the Italian cognitivist work on…

Format

• Format and dose
• Individual MIT: weekly sessions. Duration varies. The Terzo Centro sample attended weekly for one year (Carcione et al. 2019), and a published MIT case ran 50 sessions over two years (Centonze et al. 2021). The sources do not state session length; 45–50 minutes is the usual assumption.

Who practises it, and how they are trained or regulated

• The 2015 manual sets out MIT as step-by-step formalised procedures in two broad stages: shared formulation of functioning, then promoting change. These rest on assessment and case formulation, building the alliance and drafting a therapy contract. The 2020 book presents an updated decision-making procedure that tells the therapist which experiential technique to use and when. Metacognitive work is sequenced.…
• MIT-G (group): a short-term, manualised group that combines psychoeducation with experiential work, chiefly role-play of significant episodes. It was first developed for young adults with over-regulated personality disorders other than borderline, and runs for 16 sessions. The adolescent adaptation MIT-GA (Logroño, Spain) gives the fullest public structure. It has at least two individual pre-group sessions…
• Metacognitive Interpersonal Therapy (MIT) is an integrative cognitive therapy for personality disorders. It was developed in Rome by Giancarlo Dimaggio, Raffaele Popolo, Giampaolo Salvatore, Antonella Montano, Paolo Ottavi and colleagues. It grew out of the Italian cognitivist work on metacognition, states of mind and interpersonal cycles (Semerari, Carcione, Dimaggio, Nicolò, Procacci; Dimaggio et al. 2007), which…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Formulations that blame the client or others. It's working when the client uses the map's terms between sessions.
• Premature use, which clients can feel as invalidating. It's working when the client offers non-self-referential explanations.
• Repeated stuck sessions with the same feeling in you. It's working when you can pull out of the cycle and the session regains movement.
• Covert substitution of one coping strategy for another. It's working when the time spent on coping falls and the wish becomes more reachable.
• Fear of ending, which itself activates the schema, so address it explicitly. It's working when the client handles new episodes independently.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.