Abstract: 1. EPIDEMIOLOGICAL AND ETIOLOGICAL RESEARCH ON BORDERLINE PERSONALITY DISORDER Definition of the problem Epidemiology Clinical picture The natural history of BPD Studies of mechanisms and aetiological factors 2. THERAPY RESEARCH AND OUTCOME Psychological treatments Drug treatments Problems of outcome research 3. MENTALIZATION-BASED UNDERSTANDING OF BORDERLINE PERSONALITY DISORDER The developmental roots of BPD The relevance of the attachment theory perspective Optimal self-development in a secure attachment context The impact of an insecure base The impact of attachment trauma 4. CURRENT MODELS OF TREATMENT FOR BPD Transference focused therapy Dialectical behaviour therapy Cognitive behaviour therapy Cognitive analytic therapy Psychodynamic-interpersonal Therapeutic communities Other North American approaches Other European approaches Mentalization: the common theme in psychotherapeutic approaches to BPD 5. TREATMENT ORGANIZATION Service models The treatment programmes Staff Assessment Engagement in treatment Supporting the team Care programme approach Adherence 6. TRANSFERABLE FEATURES OF THE MBT MODEL Structure Consistency, constancy and coherence Relationship focus Flexibility Intensity Individual approach to care Use of medication Integration of modalities of therapy 7. STRATEGIES OF TREATMENT Enhancing mentalization Bridging the gaps Transference Retaining mental closeness Working with current mental states Bearing in mind the deficits Real relationships 8. TECHNIQUES OF TREATMENT Identification and appropriate expression of affect Establishment of stable representational systems Formation of coherent sense of Self Development of a capacity to form secure relationships 9. IMPLEMENTATION PATHWAY Step 1 - Consider the context in which you work ... Step 2 - Apply organizational principles Step 3 - Modify the aims and techniques of your current practice Step 4 - Implement procedures for dealing with challenging behaviours Step 5 - Constantly evaluate your practice Appendices References

Abstract: Psychoanalytically oriented partial hospital treatment for BPD has been shown to be more effective than treatment as usual in a randomized controlled trial and over 18 months of follow-up. Focus of treatment, in the context of group and individual psychotherapy, was on increasing the patient's capacity for mentalization, the capacity to think about mental states of oneself and others as separate from, yet potentially causing actions. We summarize the research and outline the essential theoretical and practical components of mentalization-based treatment. Core aspects of treatment include enhancing mentalization, bearing in mind patient deficits, using transference, retaining mental closeness, and working with current mental states. Finally, it is proposed that mentalization is a common theme in psychotherapy of BPD and may explain why different treatments "work."

Abstract: Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the treatment of borderline personality disorder (BPD), a common psychiatric condition with important implications for public health, that has received the most attention. Patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing. It has been tested in research trials and found to be an effective treatment for BPD when delivered by mental health professionals given limited additional training and with moderate levels of supervision. This supports the general utility of MBT in the treatment of BPD within generic mental health services.

Abstract: Thirty-four adults with severe traumatic brain injuries (TBI) and 34 matched control participants were asked to interpret videotaped conversational exchanges. Study participants were asked to judge the speakers' emotions, the speakers' beliefs (first-order theory of mind), what the speakers intended their conversational partners to believe (second-order theory of mind), and what they meant by remarks that were sincere or literally untrue (i.e., a lie or sarcastic retort). The TBI group had marked difficulty judging most facets of social information. They could recognize speaker beliefs only when this information was explicitly provided. In general, emotion recognition and first-order theory of mind judgments were not related to the ability to understand social (conversational) inference, whereas second-order theory of mind judgments were related to that ability.

Abstract: Autism is a neurodevelopmental syndrome characterized by impaired social and executive functions Functional magnetic resonance imaging (fMRI) is a non-invasive technique that allows investigation of the neural networks underlying cognitive impairments in autism In this article, brain imaging studies investigating the functional brain anatomy of autism are reviewed Face recognition, theory of mind and executive functions have all been explored in functional neuroimaging studies involving autistic patients The available literature suggests an involvement of abnormal functional mechanisms in face recognition, mentalization and executive functions in adults with high-functioning autism or Asperger's syndrome, possibly due to brain maturation abnormalities, and resulting in dysfunctional reciprocal cortico-subcortical connections Future functional neuroimaging research should investigate subgroups of autistic children and adolescents longitudinally and attempt to integrate genetic, cognitive and empirical approaches Such studies will be instrumental in furthering understanding of the pathophysiology of autism and in exploring the importance of dimensional measures of the broader phenotype currently defined as autism

Abstract: Abstract The mentalizing (theory of mind) system of the brain is probably in operation from around 18 months of age, allowing implicit attribution of intentions and other mental states. Between the ages of 4 and 6 years explicit mentalizing becomes possible, and from this age children are able to explain the misleading reasons that have given rise to a false belief. Neuroimaging studies of mentalizing have so far only been carried out in adults. They reveal a system with three components consistently activated during both implicit and explicit mentalizing tasks: medial prefrontal cortex (MPFC), temporal poles and posterior superior temporal sulcus (STS). The functions of these components can be elucidated, to some extent, from their role in other tasks used in neuroimaging studies.

Abstract: Does the ability to know one's own mind depend on the ability to know the minds of others? According to the 'theory theory' of first-person mentalizing, the answer is yes. Recent alternative accounts of this ability, such as the 'moni- toring theory', suggest otherwise. Focusing on the issue of introspective access to propositional attitudes (beliefs, desires, intentions, and the like), I argue that a better account of first-person mentalizing can be devised by combining these two theories. After sketching a hybrid account, I show how it can do justice to competing intuitions about the nature of introspective self-awareness. I close by drawing some methodological morals about the study of mentalizing and the role of introspective evidence in cognitive science. From an early age, we find it easy and natural to understand ourselves and others in mentalistic terms, taking up what philosophers call the 'intentional stance' (Dennett, 1971). Psychologists refer to this capacity as 'mentalizing' (Frith, 1992), meaning the capacity to understand what people are thinking and perceiv- ing and feeling, why they are acting as they are, why they have acted as they have in the past, how they will act in the future, and so on. It is, in short, the everyday yet extraordinary capacity to negotiate the landscape of the mental: to 'mindread', as Baron-Cohen, 1995 colourfully puts it. Some of us — skilled poker players, politicians, con artists — are better at it than others. But all of us do it, more or less effortlessly, all the time. Mentalizing in this broad sense is a complex affair, comprising a host of more fine-grained cognitive abilities. Central among these is the ability to ascribe beliefs, desires, intentions, and other propositional attitudes to oneself and oth- ers. This more specialized ability, the ascription of propositional attitudes, is the topic of my discussion. Unless otherwise indicated, when I talk about mentalizing, it is this narrower sense of the term that I have in mind. (The reasons for this limitation will emerge in due course.) The question I will explore is this:

Abstract: The concept of mentalization seeks to understand the transformation processes of physical quantity into psychical quality through the emergence, development and organization of mental representations. Often discussed in relation to the functioning of both the id and the ego, it is here proposed that the degree of mentalization also determines the level of functioning and maturity of the hostile, self-punitive superego. Luquet's description of four layers of thought (primary mental representations, metaprimary thinking, metaconscious intuitive thinking, conscious verbal thought) serves as a guide to explore issues of the forms of thinking involved in punitive superego activity. Technical implications are also examined to suggest that three steps can be differentiated in the developing capacity to represent the superego and to become conscious of its workings. The first objective is to help the ego observe its own activity, in the face of a still, unobserved hostile endopsychic agent (Gray, 1994). The second step is to meet the form and intentions of this agent, to facilitate its mental representation and elaboration. Achievement of the final step implies a growing capacity to take some responsibility for this hostile inner agent, once its activity is comparatively more available to self-observation.

Abstract: As a general proposition having a mind entails being able to recognise another mind. Indeed Bion's theory of alpha-function implies that the very development of a mind at all depends in the first place on another mind. Such an 'other mind' acts as a container. Thus a mind evolves from interpersonal and group dynamics. This paper attempts to explore some consequences of these propositions for group therapy and for understanding mentalization. Bion was fascinated that the experience of being in the presence of another person's mind is a difficult one. Having a mind is not easy, and his contributions add considerably to the debate about what is it to have a mind. In a late paper, he described the problem of having a mind that is aware of minds: When two characters or personalities meet, an emotional storm is created. If they make a sufficient contact to be aware of each other, or even to be un aware of each other, an emotional state is produced by the conjunction of these two individuals, these two personalities, and the resulting disturbance is hardly likely to be something which could be regarded as necessarily an improvement on the state of affairs had they never met at all. But since they have met, and since this emotional storm has occurred, then the two parties to this storm may decide to "make the best of a bad job". What this means in analysis is this.

Abstract: In this paper, I have reported how a woman with a long history of paranoid schizophrenia was able to use psychoanalytic psychotherapy in the NHS to work through a delusional belief of having her father's child. As a result of the therapy she was able to recover a reflective function and to represent herself, again, as a non-psychotic person. I have described the clinical framework of the therapy as based on the psychodynamic developmental therapy and the mentalization model, as developed by Fonagy and Target (1996), which posits that the development of a core or psychological self is not a given and can occur only through early object relationships with a caregiver who enables the child to integrate two modes of functioning, the psychic equivalence and the pretend modes. If the care-giver is abusive or unable to acknowledge or think about a piece of reality the child will not be able to do so on her own and, as a result, will experience the unthinkable thought in a psychic equivalence mode. In the clinica...

Abstract: Abstract Background: Theory of Mind (ToM) ability allows attribution of mental states to oneself and others. Recent studies suggest that impairment of ToM may be a partial cause of social-communication impairment in adults with right hemisphere disorder, frontal lobe damage, and the frontal variant of frontotemporal dementia. Initial evidence has also been presented for a ToM impairment in individuals with Alzheimer's disease (AD), but extant investigations have inadequately controlled for other cognitive impairments. Aims: The purpose of this study was to determine whether individuals with AD exhibit a ToM impairment that is distinguishable from cognitive and executive function deficits, and to investigate whether memory support affects their ToM performance. Methods & Procedures: Ten participants with mild to moderate AD completed first‐order and second-order false belief tasks with and without memory support, and their performances on ToM testing were compared to those of elderly controls. All ToM testing was controlled with memory, comprehension, and general inferencing questions. AD participants completed neuropsychological testing to concurrently assess general cognitive functioning, memory, and executive functioning. Independent and paired t‐tests compared experimental and control group ToM performances. Correlations assessed relations between ToM and neurocognitive test performances. Outcomes & Results: Results indicated that, in the absence of memory support, AD participants did not exhibit a specific ToM difficulty as compared to control participants. However, significant group differences for specific ToM impairment that appeared to be separable from comprehension, memory, and general inferencing difficulties emerged during ToM testing when memory support was provided. Correlations between ToM performance and neurocognitive test performances were not significant; however, four of the eight AD participants who exhibited specific, ToM difficulty also had difficulty with executive function testing. Conclusions: These results indicate that individuals with mild to moderate AD may possess an underlying, mild, specific ToM impairment, which becomes apparent during supported memory testing. Such mild ToM impairment in moderate AD individuals must be further investigated, and possible contributions of executive function impairments to apparent ToM difficulty further explored before the current results can be confidently generalised to a larger AD population.

Abstract: OBJECTIVE There is an increasing interest in the background of mentalization deficit in schizophrenia. On the one hand, according to developmental psychological studies, mentalization development is connected with the development of pragmatic language skills. On the other hand, studies suggest that mentalization is dependent on the maturation of neurocognitive skills such as executive functions. Our study investigated the role of these domains in the mentalization deficit of schizophrenia. METHOD 28 patients with schizophrenia and 20 control patients with depression took part in the first part of the study. Participants were presented first-order and second-order mentalization tasks, metaphor and irony tasks for the assessment of mentalizing skills. The pragmatic language skills were examined by "question and answer" vignettes. 20 patients with schizophrenia took part in the second part of the study. The test battery was completed with a picture recognition task and neurocognitive tests were made by all patients. RESULTS Patients with schizophrenia performed significantly worse in the irony and pragmatic tasks, but there was no correlation between their performances in the irony and in the pragmatic tasks. Selective attention and verbal working memory showed correlation with the cumulative verbal mentalization index. Selective attention correlated with the recognition of complex mental states from pictures as well, but the successful decoding of complex mental states was dependent on the recognition of basic expressions. Attention correlated with mental state recognition as well. CONCLUSIONS Our results suggest that the mentalization deficits of people with schizophrenia cannot be explained by pragmatic language deficits alone, and the manifest impairment is the consequence of disturbances in multiple cognitive processes. Basic neurocognitive factors such as attention, selective attention and verbal working memory can influence the mentalization skills.

Abstract: The authors conceptualize Davies's account of the difficult session with her patient Karen as a mentalization mismatch: an expectable failure on the analyst's part to understand the mental state of the patient. In response, the patient used projective identification to re-create the link to the analyst that was temporarily severed. They argue that the therapeutic impasse produced by Karen's successful externalization of a persecuting part of her self is more than repetition of a past relationship. It is the current experience of a disorganized self: a pervasive state for the borderline patient, and a temporary but no less disorganized state in the analyst.

Abstract: Although a number of advanced theory of mind tasks have been developed, there is sparse information on whether performance on different tasks is associated. The study examined the performance of 20 high-functioning 6- to 12-year-old children with autism spectrum disorder and 20 controls on three high-level theory of mind tasks: Strange Stories, Cartoons and the children's version of the Eyes task. The pattern of findings suggests that the three tasks may share differing, non-specific, information-processing requirements in addition to tapping any putative mentalizing ability. They may also indicate a degree of dissociation between social-cognitive and social-perceptual or affective components of the mentalizing system.

Abstract: Background: The construct of alexithymia implies a deficit in symbolization for emotional, somatic, and mental states. However, the etiologic factors for alexithymia have not yet been fully elucidated. The present study investigated the use of mentalizing language, i.e. the utterance of internal states, from a developmental perspective according to attachment organization and disorganization. Methods: A longitudinal design across 4 time points was applied to a volunteer sample of 42 children. At 12 months, children were tested with the strange situation procedure, the standard measure of attachment at the optimal age, and attachment classifications were taken of videotapes. At ages 17, 23, 30 and 36 months, mother and child were observed in simplified separation episodes of 30 min duration. Transcripts of the sessions were subject to coding of internal state words. Results: During the investigated span, securely attached children rapidly acquired emotion, physiology, cognition and emotion-regulatory language, whereas insecurely attached and disorganized children either completely lacked internal state language or displayed a considerable time lag in the use of emotion and cognition vocabulary. Conclusion: The results raise the possibility that alexithymia might be a consequence of deficits in the development of internal state language in the context of insecure or disorganized childhood attachment relationships.