Inside the Mind of a Metacognitive Therapist – Part 3 The Meta-Level Dialogue
Inside the Mind of a Metacognitive Therapist – Part 3 The Meta-Level Dialogue

Inside the Mind of a Metacognitive Therapist – Part 3 The Meta-Level Dialogue

I want to share with you how the dialogue in metacognitive therapy is different from other talk therapies that I have done, from my point of view as a therapist.

In metacognitive therapy sessions, I try to keep most of the dialogue at the meta-level (metacognitive mode), instead of at the content-level (object mode).

A meta-level dialogue explores how a person relates to his or her thoughts, feelings and bodily sensations. It’s about how a person thinks about thoughts

Normally, a social chat between two people operates at the content-level, not the meta-level, so it feels quite different to have this kind of dialogue. In essence, a meta-level dialogue explores and challenges underlying metacognitive beliefs that have been shown to guide a person’s thinking style and maintain psychological distress, according to a vast and growing body of research.

In therapy, I would say that I deal with the extended thinking process and other responses to thoughts, the so-called Cognitive Attentional Syndrome, and not the negative automatic thoughts themselves or interpretations of external events as it is done in CBT (Cognitive Behavioral Therapy). A meta-level dialogue is only challenging metacognitive beliefs.

You can see the difference between a meta-level dialogue and a content-level dialogue in the following examples. The following examples are picked out from the therapy room:

A content-level dialogue would sound like this:

  • What thoughts did you have in relation to X?
  • How did that thought make you feel? 
  • What was your behavior in response to that thought?
  • Could there be an alternative way of thinking about the situation?
  • Why do you think that? What else could this mean?

Whereas, a meta-level dialogue would sound like this:

  • When you had that experience, what happened to your thinking?
  • Did you worry or dwell on things? For how long?
  • Did you then pay more attention to what was troubling you?`What was that like?
  • Did you do anything to control the way you felt? What did you do?
  • Did you do anything to control your thoughts? What did you do?
  • How would focusing on threat help you? How strongly do you believe that from 0-100%?
  • What would happen if you didn’t control your thoughts and feelings?
  • How much control do you believe that you have over your worries?

This post is the third part of the series “Inside the Mind of a Metacognitive Therapist“. You might want to catch up on the other parts as well. I hope that you found it useful. See you around.