The process of recovery of sense of self in the face of persecutory delusions and hostility

People with psychosis who hold a persecutory delusion (PD) may think that others are focusing their attention on them, with malevolent intentions and plots. Such beliefs may result in significant suffering and social life disruption. The most well-known intervention for PDs is cognitive behavioural therapy, in which the main goals are to reduce stigma, help clients question their delusional attributions and reduce sustaining factors such as repetitive thinking. The merits of these approaches notwithstanding, in many cases clients may end treatment with significant residual symptoms. This has stimulated clinical research towards the development of treatments focused on different variables: a) helping clients understand how delusional perceptions are connected to their sense of self, and b) promoting a richer sense of personal identity as embedded in their unique self-narratives. Metacognitive Interpersonal Therapy (MIT) adapted for psychosis is one such therapy. In the last few years MIT has been subject to initial empirical validation with promising results. In this chapter, we describe the stages of treatment for a young man, at the onset of persecutory type of delusional disorder treated with MIT. According to MIT, PDs may be correlated with: 1) an experience of the self as ontologically vulnerable, a sense of being weak and inferior to others; 2) impaired metacognition, namely the ability-characterised by variable levels of complexity, to understand one's and others' mind(s). We will show how MIT helped the client to improve their metacognitive abilities and access healthy parts of themself, in order to consider the persecutory ideas as an expression of his feeling of vulnerability, and to adopt a critical distance from that self-perception and from the perception of others' intentions as malevolent.