Understanding minds: Different functions and different disorders? The contribution of psychotherapy research
Abstract
Disorders in the ability to understand mental states (metacognition) have an important role in psychopathology. Some clinicians talk of a generalised impairment of metacognition and others of malfunctioning of specific aspects. We compare two contrasting hypotheses. We call the first one ‘fast running’ hypothesis according to which metacognition is a single function, like speed in running. The second one is the ‘tennis playing’ hypothesis according to which metacognition is composed, like the ability to play tennis, of various, relatively independent skills, which can get impaired selectively. We reviewed the main theories and researches on metacognition and, therefore, we outlined a research programme based on them, describing the contribution made by the research on the psychotherapeutic process to this programme.
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Deficits in mentalization are linked to personality disorders, including PN, where individuals engage in intellectualized, detached rumination rather than genuine reflection.
“Deficits in mentalization are linked to personality disorders, including PN, where individuals often engage in intellectualized, detached rumination rather than genuine reflection (129, 130).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [130]
Individuals with PN tend to exhibit a strong drive for control, rooted in feelings of inferiority and powerlessness.
“Rooted in feelings of inferiority and powerlessness, individuals with PN tend to exhibit a strong drive for control, particularly in their interpersonal relationships (130, 146).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [130]
Need for control in PN can manifest as resistance to change, sometimes impeding therapeutic progress.
“Their need for control can manifest as a resistance to change, sometimes impeding therapeutic progress (78, 130, 145).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [130]
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Dimaggio, G., Carcione, A., Nicolò, G., Conti, L., Fiore, D., Pedone, R., Popolo, R., Procacci, M., & Semerari, A. (2009) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.619 · Cited by 59 · see citing works
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Social Cognition and Emotional Functioning in Patients with Binge Eating Disorder
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Outcalt, J., Dimaggio, G., Popolo, R., Buck, K. D., Chaudoin–Patzoldt, K. A., Kukla, M., Olesek, K. L., & Lysaker, P. H. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.10.002 · Cited by 52 · see citing works
Personality Disorders and Mindreading
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Dimaggio, G., Carcione, A., Salvatore, G., Nicolò, G., Sisto, A., & Semerari, A. (2010) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1348/147608310x527240 · Cited by 50 · see citing works
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Lysaker, P. H., Olesek, K. L., Buck, K. D., Leonhardt, B. L., Vohs, J. L., Ringer, J. M., Dimaggio, G., Popolo, R., & Outcalt, J. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2013.11.007 · Cited by 49 · see citing works
Metacognitive Mastery and Intrinsic Motivation in Schizophrenia
Vohs, J. L., & Lysaker, P. H. (2013) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000063 · Cited by 49 · see citing works
Lysaker, P. H., Kukla, M., Dubreucq, J., Gumley, A., McLeod, H., Vohs, J. L., Buck, K. D., Minor, K. S., Luther, L., Leonhardt, B. L., et al. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.06.015 · Cited by 47 · see citing works
Self-citationFiore, D., Dimaggio, G., Nicolò, G., Semerari, A., & Carcione, A. (2008) · Journal of Clinical Psychology · doi:10.1002/jclp.20450 · Cited by 47 · see citing works
Dimaggio, G., Nicolò, G., Semerari, A., & Carcione, A. (2013) · Psychotherapy Research · doi:10.1080/10503307.2013.845921 · Cited by 44 · see citing works
Dimaggio, G., D'Urzo, M., Pasinetti, M., Salvatore, G., Lysaker, P. H., Catania, D., & Popolo, R. (2014) · Journal of Clinical Psychology · doi:10.1002/jclp.22151 · Cited by 43 · see citing works
Metacognition as a Predictor of Improvements in Personality Disorders
Carcione, A., Riccardi, I., Bilotta, E., Leone, L., Pedone, R., Conti, L., Colle, L., Fiore, D., Nicolò, G., Pellecchia, G., et al. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00170 · Cited by 43 · see citing works
Mindreading Dysfunction in Avoidant Personality Disorder Compared With Other Personality Disorders
Moroni, F., Procacci, M., Pellecchia, G., Semerari, A., Nicolò, G., Carcione, A., Pedone, R., & Colle, L. (2016) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000000536 · Cited by 41 · see citing works
Self-citationChange in reflective functioning during psychotherapy—A single-case study
Gullestad, F. S., & Wilberg, T. (2011) · Psychotherapy Research · doi:10.1080/10503307.2010.525759 · Cited by 40 · see citing works
Observing therapeutic interaction in the “Lisa” case
Lepper, G., & Mergenthaler, E. (2008) · Psychotherapy Research · doi:10.1080/10503300701442001 · Cited by 41 · see citing works
Velotti, P., Garofalo, C., Dimaggio, G., & Fonagy, P. (2018) · Mindfulness · doi:10.1007/s12671-018-1048-3 · Cited by 41 · see citing works
Dimaggio, G., Salvatore, G., Popolo, R., & Lysaker, P. H. (2012) · Frontiers in Psychology · doi:10.3389/fpsyg.2012.00529 · Cited by 39 · see citing works
Mindreading abilities in sexual offenders: An analysis of theory of mind processes
Castellino, N., Bosco, F. M., Marshall, W. L., Marshall, L. E., & Veglia, F. (2011) · Consciousness and Cognition · doi:10.1016/j.concog.2011.08.011 · Cited by 38 · see citing works
Behavioral activation as a common mechanism of change across different orientations and disorders
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The Unbearable Dynamicity of Psychological Processes: Highlights of the Psychodynamic Theories
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An intensive case analysis of client metacognition in a good-outcome psychotherapy: Lisa's case
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Mentalizing Mediates the Relationship Between Psychopathy and Type of Aggression in Schizophrenia
Bo, S., Abu-Akel, A. M., Kongerslev, M., Haahr, U., & BATEMAN, A. W. (2013) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000067 · Cited by 38 · see citing works
Metacognitive self-assessment scale: psychometric properties and clinical implications
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Avoidant personality disorder and social phobia: Does mindreading make the difference?
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Dimaggio, G. (2010) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-010-9170-0 · Cited by 33 · see citing works
Metacognitively oriented psychotherapy for schizotypal personality disorder: A two‐case series
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Bo, S., Kongerslev, M., Dimaggio, G., Lysaker, P. H., & Abu-Akel, A. M. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.12.034 · Cited by 32 · see citing works
Struggling to be a person: Lived experience of avoidant personality disorder
Sørensen, K. D., Råbu, M., Wilberg, T., & Berthelsen, E. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22740 · Cited by 31 · see citing works
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Maillard, P., Dimaggio, G., de Roten, Y., Berthoud, L., Despland, J., & Kramer, U. (2017) · Journal of Psychotherapy Integration · doi:10.1037/int0000090 · Cited by 30 · see citing works
Symptom severity and mindreading in narcissistic personality disorder.
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Development and criterion validity of a computerized text analysis measure of reflective functioning
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Anxiety, depression and autonomy–connectedness: The mediating role of alexithymia and assertiveness
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Misso, D., Schweitzer, R., & Dimaggio, G. (2018) · Journal of Psychotherapy Integration · doi:10.1037/int0000111 · Cited by 28 · see citing works
Alexithymia and Personality Disorder Functioning Styles in Paranoid Schizophrenia
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Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder
Simonsen, S., Eikenæs, I. U.-M., Bach, B., Kvarstein, E. H., Gondan, M., Møeller, S. B., & Wilberg, T. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2020.1841290 · Cited by 26 · see citing works
Relationship between mental states in depression: The assimilation model perspective
Osatuke, K., Stiles, W. B., Barkham, M., Hardy, G. E., & Shapiro, D. A. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.11.001 · Cited by 24 · see citing works
Concepts of Metacognition in the Treatment of Patients with Mental Disorders
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Motivational Monitoring: How to Identify Ruptures and Impasses and Enhance Interpersonal Attunement
Monticelli, F., & Liotti, M. (2021) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-020-09485-1 · Cited by 23 · see citing works
Morken, K., Binder, P., Arefjord, N., & Karterud, S. (2019) · Psychotherapy Research · doi:10.1080/10503307.2017.1325021 · Cited by 20 · see citing works
Behavioral activation revisited as a key principle of change in personality disorders psychotherapy.
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Clients' and therapists' stories about psychotherapy.
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Borderline personality disorder, metacognition and psychotherapy
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The regulative function of mentalization and mindfulness in borderline personality organization
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Working with social withdrawal, or hikikomori, in Japan: From shame to pride
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Dysfunctional understanding of mental states in personality disorders: What is the evidence?
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Hitting the Bull’s Eye in Personality Disorders Psychotherapy
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- Authors
- Semerari, A., Carcione, A., Dimaggio, G., Nicolò, G., & Procacci, M.
- Corresponding author
- Semerari, Antonio
- Venue
- Psychotherapy Research
- Publisher
- Informa UK Limited
- Published
- 2007-01
- Volume
- 17
- Issue
- 1
- Pages
- 106-119
- ISSN
- 1050-3307 (ISSN-L)
- 1468-4381
- OpenAlex
- W2149011247
- Cited by
- 163
- References
- 93
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 9 · 2020: 8 · 2019: 10 · 2018: 13 · 2017: 12 · 2016: 7 · 2015: 12 · 2014: 8 · 2013: 9 · 2012: 12
- FWCI
- 4.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy Research (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- metacognition, theory of mind, psychopathology, therapeutic process, metacognitive skills
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