Cooperation within the therapeutic relationship improves metacognitive functioning: preliminary findings

Submitted: August 7, 2023
Accepted: October 15, 2023
Published: November 8, 2023
Abstract Views: 997
PDF: 371
HTML: 65
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Both clinical observations and empirical data suggest that metacognitive functioning is a factor strongly associated with a good psychotherapeutic outcome. It has been suggested that some interpersonal social motivations (i.e., attachment and cooperation) may be associated with different levels of metacognitive functioning also within the therapeutic relationship. The aim of this study was to explore the relationship between cooperation and metacognitive monitoring within 58 psychotherapy sessions from seven different patients. All patients were initially assessed through a detailed psychiatric interview. Patients’ adult attachment styles were evaluated using the Attachment Style Questionnaire. The association between the activation of patients’ interpersonal social motivations (e.g., cooperation and attachment) and the modifications of metacognitive abilities during sessions was investigated using the Assessing Interpersonal Motivations in Transcripts method and the Metacognition Assessment Scale have been used. Our results showed that the activation of the patient’s cooperative system is positively associated with an increase in metacognitive functioning, while the activation of attachment is not. The results of the present study have important implications for clinicians: they give empirical support for the role of cooperation in fostering metacognition within the therapeutic relationship.



PlumX Metrics


Download data is not yet available.


Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in Clinical Practice. Washington, DC: American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders - DSM-5. (5th ed.). Arlington: American Psychiatric Publishing. DOI:
Bateman, A., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: mentalization-based treatment. Oxford, UK: Oxford University Press. DOI:
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. doi: 10.1037/h0085885 DOI:
Colle, L., Dimaggio, G., Carcione, A., Nicolo, G., Semerari, A., & Chiavarino, C. (2020). Do Competitive Contexts Affect Mindreading Performance? Frontiers in Psychology, 11, 1284. doi: 10.3389/fpsyg.2020.01284 DOI:
Cortina, M., & Liotti, G. (2014). An evolutionary outlook on motivation: Implications for the clinical dialogue. Psychoanalytic Inquiry, 34(8), 864-899. DOI:
Dimaggio, G., Carcione, A., Nicolo, G., Conti, L., Fiore, D., Pedone, R., . . . & Semerari, A. (2009). Impaired decentration in personality disorder: a series of single cases analysed with the Metacognition Assessment Scale. Clinical Psychology & Psychotherapy, 16(5), 450-462. doi: 10.1002/cpp.619 DOI:
Farina, B., Della Marca, G., Maestoso, G., Amoroso, N., Valenti, E. M., Carbone, G. A., . . . & Imperatori, C. (2018). The Association among Default Mode Network Functional Connectivity, Mentalization, and Psychopathology in a Nonclinical Sample: An eLORETA Study. Psychopathology, 51(1), 16-23. doi: 10.1159/000485517 DOI:
Farina, B., Liotti, M., & Imperatori, C. (2019). The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension. Frontiers in Psychology, 10, 933. doi: 10.3389/fpsyg.2019.00933 DOI:
Farina, B., & Meares, R. (2022). The Traumatic Disintegration Dimension. In M. J. Dorahy, S. N. Gold & J. A. O'Neil (Eds.), Dissociation and the dissociative disorder: Past, present, future. New York: Routledge. DOI:
Farina, B., Speranza, A. M., Dittoni, S., Gnoni, V., Trentini, C., Vergano, C. M., . . . & Della Marca, G. (2014). Memories of attachment hamper EEG cortical connectivity in dissociative patients. European Archives of Psychiatry and Clinical Neuroscience, 264(5), 449-458. doi: 10.1007/s00406-013-0461-9 DOI:
Fassone, G., Lo Reto, F., Foggetti, P., Santomassimo, C., D'Onofrio, M. R., Ivaldi, A., . . . & Picardi, A. (2016). A Content Validity Study of AIMIT (Assessing Interpersonal Motivation in Transcripts). 23(4), 319-328. doi: 10.1002/cpp.1960 DOI:
Fassone, G., Valcella, F., Pallini, S., Scarcella, F., Tombolini, L., Ivaldi, A., . . . & Liotti, G. (2012). Assessment of Interpersonal Motivation in Transcripts (AIMIT): an inter- and intra-rater reliability study of a new method of detection of interpersonal motivational systems in psychotherapy. 19(3), 224-234. doi: 10.1002/cpp.742 DOI:
Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman (Eds.), Attachment in adults: Clinical and developmental perspectives (pp. 128-152). Guilford Press: Guilford Press.
Fonagy, P., Campbell, C., Constantinou, M., Higgitt, A., Allison, E., & Luyten, P. (2021). Culture and psychopathology: An attempt at reconsidering the role of social learning. Development and Psychopathology, 1-16. doi: 10.1017/S0954579421000092 DOI:
Fossati, A., Feeney, J. A., Donati, D., Donini, M., Novella, L., Bagnato, M., . . . & Maffei, C. (2003). On the dimensionality of the Attachment Style Questionnaire in Italian clinical and nonclinical participants. Journal of Social and Personal Relationships, 20(1), 55-79. doi: 10.1177/02654075030201003 DOI:
Fox, K. C. R., Muthukrishna, M., & Shultz, S. (2017). The social and cultural roots of whale and dolphin brains. Nature Ecology & Evolution, 1(11), 1699-1705. doi: 10.1038/s41559-017-0336-y DOI:
Frith, C. D. (2012). The role of metacognition in human social interactions. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 367(1599), 2213-2223. doi: 10.1098/rstb.2012.0123 DOI:
George, C., Kaplan, N., & Main, M. (1984). Adult Attachment Interview. Westwood: University of California. DOI:
Gilbert, P. (1989). Human nature and suffering. Hove, UK: Lawrence Erlbaum.
Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: a common factors perspective. Psychotherapy (Chicago, Ill.), 51(4), 467-481. doi: 10.1037/a0034332 DOI:
Lee, M., Ahn, H. S., Kwon, S. K., & Kim, S. I. (2018). Cooperative and Competitive Contextual Effects on Social Cognitive and Empathic Neural Responses. Frontiers in Human Neuroscience, 12, 218. doi: 10.3389/fnhum.2018.00218 DOI:
Lichtenberg, J. (1989). Psychoanalysis and Motivation. Hillsdale, NJ: The Analytic Press.
Liotti, G. (2011). Attachment disorganization and the controlling strategies: An illustration of the contributions of attachment theory to developmental psychopathology and to psychotherapy integration. Journal of Psychotherapy Integration, 21(3), 232–252. doi: 10.1037/a0025422 DOI:
Liotti, G. (2017). Conflicts between motivational systems related to attachment trauma: Key to understanding the intra-family relationship between abused children and their abusers. Journal of Trauma & Dissociation, 18(3), 304-318. doi: 10.1080/15299732.2017.1295392 DOI:
Liotti, G., Cortina, M., & Farina, B. (2008). Attachment theory and multiple integrated treatments of borderline patients. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 36(2), 295-315. doi: 10.1521/jaap.2008.36.2.295 DOI:
Liotti, G., & Farina, B. (2016). Painful incoherence: the self in borderline personality disorder. In M. Kyrios, R. Moulding, M. Nedeljkovic, S. S. Bhar, G. Doron & M. Mikulincer (Eds.), The self in understanding and treating psychological disorders (pp. 169-178). Cambridge: Cambridge University Press. DOI:
Liotti, G., & Gilbert, P. (2011). Mentalizing, motivation, and social mentalities: theoretical considerations and implications for psychotherapy. Psychology and Psychotherapy, 84(1), 9-25; discussion 98-110. doi: 10.1348/147608310X520094 DOI:
Liotti, G., & Monticelli, F. (2008). I sistemi motivazionali nel dialogo clinico: Il manuale AIMIT. Milano: Raffaello Cortina Editore.
Luyten, P., Campbell, C., Allison, E., & Fonagy, P. (2020). The Mentalizing Approach to Psychopathology: State of the Art and Future Directions. Annual Review of Clinical Psychology, 16, 297-325. doi: 10.1146/annurev-clinpsy-071919-015355 DOI:
Luyten, P., Campbell, C., & Fonagy, P. (2020). Borderline personality disorder, complex trauma, and problems with self and identity: A social-communicative approach. Journal of Personality, 88(1), 88-105. doi: 10.1111/jopy.12483 DOI:
Monticelli, F., Imperatori, C., Carcione, A., Pedone, R., & Farina, B. (2018). Cooperation in psychotherapy increases metacognitive abilities: a single-case study. Rivista di Psichiatria, 53(6), 336-340. doi: 10.1708/3084.30768
Safran, J. D., & Muran, J. C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Consulting and Clinical Psychology, 64(3), 447-458. doi: 10.1037//0022-006x.64.3.447 DOI:
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procacci, M., & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology & Psychotherapy, 10(4), 238-261. doi: 10.1002/cpp.362
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolò, G., Procacci, M., & Alleva, G. (2003). How to evaluate metacognitive functioning in psychotherapy? The metacognition assessment scale and its applications. Clinical Psychology & Psychotherapy, 10(4), 238-261. doi: 10.1002/cpp.362 DOI:
Semerari, A., Carcione, A., Dimaggio, G., Nicolo, G., Pedone, R., & Procacci, M. (2005). Metarepresentative functions in borderline personality disorder. Journal of Personality Disorders, 19(6), 690-710. doi: 10.1521/pedi.2005.19.6.690 DOI:
Semerari, A., Carcione, A., Dimaggio, G., Nicolò, G., & Procacci, M. (2007). Understanding minds: Different functions and different disorders? The contribution of psychotherapy research. Psychotherapy Research, 17(1), 106-119. DOI:
Talia, A., Miller-Bottome, M., Katznelson, H., Pedersen, S. H., Steele, H., Schroder, P., . . . & Taubner, S. (2019). Mentalizing in the presence of another: Measuring reflective functioning and attachment in the therapy process. Psychotherapy Research, 29(5), 652-665. doi: 10.1080/10503307.2017.1417651 DOI:
Talia, A., Taubner, S., & Miller-Bottome, M. (2019). Advances in research on attachment-related psychotherapy processes: seven teaching points for trainees and supervisors. Research in Psychotherapy, 22(3), 405. doi: 10.4081/ripppo.2019.405 DOI:
Tomasello, M. (2018). How children come to understand false beliefs: A shared intentionality account. Proceedings of the National Academy of Sciences of the United States of America, 115(34), 8491-8498. doi: 10.1073/pnas.1804761115 DOI:
Tomasello, M. (2020). The role of roles in uniquely human cognition and sociality. Journal for the Theory of Social Behaviour, 50(1), 2-19. doi: 10.1111/jtsb.12223 DOI:
Wiltshire, T. J., Philipsen, J. S., Trasmundi, S. B., Jensen, T. W., & Steffensen, S. V. (2020). Interpersonal coordination dynamics in psychotherapy: A systematic review. Cognitive Therapy and Research, 44, 752-773. doi: 10.1007/s10608-020-10106-3 DOI:

How to Cite

Farina, B., Liotti, M., Imperatori, C., Tombolini, L., Gasperini, E., Mallozzi, P., Russo, M., Simoncini Malucelli, G., & Monticelli, F. (2023). Cooperation within the therapeutic relationship improves metacognitive functioning: preliminary findings. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3).

List of Cited By :

Crossref logo