Abstract: 1. Introduction to mentalization 2. Using the mentalization model to understand severe personality disorder 3. Changing views of Borderline Personality Disorder 4. The structure of mentalization based treatment 5. Assessment of mentalization 6. Assessment of interpersonal and relational world 7. Therapist stance 8. Principles of intervention 9. The mentalizing focus and basic interventions 10. Mentalizing and group therapy 11. Frequently asked questions

Abstract: Our approach to understanding self pathology in personality disorder assumes that the capacity to mentalize, that is, the capacity to conceive of mental states as explanations of behavior in oneself and in others, is a key determinant of self-organization. Along with contributory capacities of affect regulation and attention control mechanisms, the capacity for mentalization is acquired in the context of early attachment relationships. Disturbances of attachment relationships will therefore disrupt the normal emergence of these key social-cognitive capacities and create profound vulnerabilities in the context of social relationships. Ours is fundamentally a psychoanalytic approach but we have elaborated our model of social development on the basis of empirical observations as well as clinical work. We define mentalization as a form of mostly preconscious imaginative mental activity, namely, perceiving and interpreting human behavior in terms of intentional mental states (e.g., needs, desires, feelings, beliefs, goals, purposes, and reasons). Mentalizing is imaginative because we have to imagine what other people might be thinking or feeling; an important indicator of high quality of mentalization is the awareness that we cannot know absolutely what is in someone else’s mind. We suggest that a similar kind of imaginative leap is required to understand one’s own mental experience, particularly in relation to emotionally charged issues. In order to conceive of others as having a mind, the individual needs a symbolic representational system for mental states and also must be able to selectively activate states of mind in line with particular intentions, which requires attentional control.

Abstract: Continuing debates over the relative importance of the role of interpretation leading to insight versus the relationship with the analyst as contributing to structural change are based on tradition...

Abstract: Affect consciousness refers to the ability to adequately perceive, reflect upon and express affect. The concept is used in clinical work with adults, but lacks an equivalent for children's experience of affect. This paper examines the developmental prerequisites for affect consciousness, as well as the concept's applicability to work with children. The main focus is on the development of affect regulation throughout the first 6 years of life. Special emphasis is put on the role of attachment and the unfolding of mentalization ability in this development. The role of play as an organizing factor for affective experience is discussed. Observation of play is highlighted as a strong indicator of affect consciousness in children.

Abstract: The relationship between Kernberg's psychodynamic model of personality organization (PO) and dissociation has not yet been explored. Seventy-two nonclinical subjects and 222 psychiatric patients completed the Dissociative Experiences Scale and the Inventory of Personality Organization. Its Reality Testing subscale emerged as the most important predictor for all facets of dissociation. Discussing our results in the framework of Fonagy and coworkers' model of mentalization, we suggest that dissociation may reflect the preoedipal "pretend" mode of psychic functioning while impaired reality testing and psychotic experiences might be indicative of the "psychic equivalent" mode.

Abstract: Introduction Autism is a developmental disorder which causes severe cognitive and social deficits and affects four in every ten thousands individuals. A triad of impairments ─ impairments in social interaction, impairments in verbal and non verbal communication and an inappropriately restrictive behaviour ─ are found across the entire autistic population and are critical for a diagnostic. Characteristically, the severity of these impairments varies from individuals to others and even, within the same individual. Because autism is marked by great variation, it is mostly referred to as the Autistic Spectrum of Disorders (ASD). Although not universal in autism, deficits in language, particularly delays in language acquisition, are the principal early manifestation of the disorder . Again, the range of language abilities varies and goes from total muteness to the use of an apparent grammatically complex language. But it appears that over half of the autistic population is affected by some sort of language impairments. In many cases, these impairments involve all aspects of language ─ pragmatic, lexical, syntactic, morphological, phonological and phonetic. The heterogeneity of the autistic population does not make the task of finding a cause for the spectrum of disorders easy. But one theory, Mind-blindness, has been very popular among psychologists working on ASD. The Mind-blindness hypothesis holds that one unique deficit, in the cognitive function of mentalizing, causes the range of deficits found in autism. Children with autism are prevented from a normal development because they lack a Theory of Mind, which is the ability to recognize that one and others have mental states, such as thoughts, wishes, intentions or beliefs and that these can be different from self’s. Language impairments found in autism come as consequences of more general deficiencies in communication caused by this deficit in the Theory of Mind. In this paper, we argue that recent research into language impairments in autism and other developmental disorders invites us to re-evaluate this common consensus. Of

Abstract: Transference has been a core concept of the psychoanalytic model of the mind ever since its introduction by Freud in 1895 (Laplanche and Pontalis 1967). Throughout the many controversies and vicissitudes of psychoanalytic theory over the past century, the emphasis on transference as a reliable psychological phenomenon and essential ingredient in psychoanalytic treatment has not weakened. Moreover, while many psychoanalytic concepts have either been adopted into mainstream psychology (e.g., somatic drives, the unconscious, defense mechanisms) or marginalized (e.g., the death instinct, penis envy), transference has maintained its status as an essentially psychoanalytic concept not integrated into other models of the mind or other modes of psychotherapy. In a seemingly unrelated sphere, cognitive psychology, cognitive neuroscience, and diagnostic psychiatry have been moving over the past decade to a greater emphasis on social cognition and interpersonal functioning (Insel 1997; Ochsner and Lieberman 2001). Quantitative researchers who historically have emphasized concrete cognitive processes such as those directly related to intelligence, memory, and perception, or related psychiatric symptoms, now acknowledge the importance of having a better understanding of social interactions and associated cognitions. Research has begun to link neurocognitive developmental deficits in certain disorders to impaired social cognitive processes (Akshoomoff, Pierce, and Courchesne 2002). There is also growing evidence that affect dysregulation, as in borderline personality disorder, is associated with impairments in specific areas of social cognition, a finding that begins to explain the strong association between early traumatic experience and later psychiatric illness (Fonagy et al. 1996; Paris et al. 1999). The importance of processes such as transference and social cognition becomes most clear in a third domain, that of psychotherapy process and outcome research. Though psychotherapy research has been relatively unsuccessful in its attempt to show which treatments work best for which patients in which circumstances, studies consistently demonstrate that the nature of the relationship between patient and therapist, whatever the therapeutic modality, is a powerful predictor of outcome (Frank and Gunderson 1990; Piper et al. 1991). This dimension is found as well in studies of pharmacological treatments and the placebo effect (Mayberg et al. 2002). We propose that a generalized concept of transference, defined as an unconscious aspect of social cognition, is an emerging core concept that can be used to unite theoretical and empirical investigations into normal mental functioning, psychopathology, and psychotherapeutic change. We intend to explore and more precisely describe these phenomena using a paradigm developed over the past fifteen years by Susan Andersen, a cognitive and social psychologist at New York University (Andersen and Baum 1994; Andersen and Berk 1998; Andersen and Chen 2002; Berk and Andersen 2000; Glassman and Andersen 1999). This paradigm is guided by the theory that a normal person's perceptions and affective responses vis-a-vis the self and others are heavily influenced by the activation of significant relationship representations from the past. In the basic version of Andersen's paradigm, college students participate in two sessions, two weeks apart, which they are led to believe are unrelated. During the first session, the students are asked to describe significant others in their lives and then to rank the importance of sentences they use to describe each one. In the second session, the students are told that the experimenter is studying social interactions and that they will be observed interacting with a (fictional) stranger (called the target) seated in the next room. The subjects are then shown a series of sentences describing the target. In the experimental condition, half of these sentences are drawn from the subject's own description of a significant other. In the control condition, half of the sentences are drawn from a significant-other description given by another subject (the “yoked-control”). Subjects are next shown a second series of sentences and asked to rate how likely it is that they have just been shown these descriptions about the target. Some of these sentences are taken from those that were actually shown; others are from the original significant-other description and were not shown in the second session. Andersen and her colleagues demonstrated that when subjects are asked to rate their remembrance of sentences presented in the second session but taken from descriptions of their own significant others, they falsely remember having been shown other sentences, not presented, taken from those same descriptions. This does not happen, however, when the sentences are taken from the yoked control's significant- other description. This supports the conclusion that hearing about someone who resembles a significant other activates a representation or transference pattern that influences social memories. Andersen and her colleagues also demonstrated that resemblance to a significant other affected, in predicted ways, a subject's conscious mood and feelings about the target (Andersen and Baum 1994; Andersen et al. 1995), self-concept (Hinkley and Andersen 1996), facial affect, expectancies, motivation to meet the target (Andersen, Reznik, and Manzella 1996), and even conversation patterns (Berk and Andersen 2000). This was true even when significant-other descriptions were presented subliminally (Glassman and Andersen 1999). Given the reliability of this behavioral task and its strong relevance to transference and social cognition, we believe that the next step is to adapt a version for the fMRI environment, confirm the behavioral findings, and study the activation of brain regions associated with this process. If successful, we plan to use this adapted paradigm for three long-term lines of research. First, we hope to demonstrate a link between performance on the Andersen paradigm and certain areas of psychopathology. Specifically, we predict that character pathology, such as that associated with borderline and histrionic personalities, will be associated with higher-than-normal effects of transference on memory, affect, motivation, and self/other representations. Autism and Asperger's Syndrome should be associated with lower-than-normal effects of transference. In making these connections, we believe that our transference paradigm is a more clinically relevant and specific measure than other frequently used tests of social cognition, such as theory of mind or facial affect recognition (Baron-Cohen et al. 1999; Calarge, Andreasen, and O'Leary 2003; Fletcher et al. 1995; Grady and Keightley 2002; Gregory et al. 2002). Second, we hope to adapt the transference paradigm to children and adolescents and conduct a series of studies demonstrating the development of transference patterns and its association with normal or pathological affect regulation over time. The behavioral and neuroimaging components of the paradigm could then be linked to other developmentally useful concepts, including attachment and mentalization. Finally, we intend to use the transference paradigm to study the process and outcome of psychoanalysis and psychotherapy. We believe that a major shortcoming of current psychotherapy research has been the absence of measures that reliably capture the structural changes brought about by an effective treatment (Gabbard, Gunderson, and Fonagy 2002; Westen, Novotny, and Thompson-Brenner 2004; Westen and Shedler 1999). The transference paradigm could tie a reliable behavioral and neurobiological measure of psychological structure to therapeutic change in psychoanalysis, as well as in other effective treatments.

Abstract: T he panel chair, Glen Gabbard, opened the two-day panel with some reflections on the place of mentalization theory in psychoanalytic discourse. Although in recent years we have had few new paradigms, mentalization theory appears to be a genuinely new model of psychoanalytic developmental and clinical theory. This model extends the clinical observations of object relations theory and calls to mind Fairbairn’s assertion that the libidinal motivation of the infant is primarily “object seeking.” Mentalization theory provides models both of early childhood psychological development and of psychotherapeutic practice. The fundamental therapeutic application of mentalization to psychodynamic technique lies in the observation that adult patients may experience corrective developmental experiences “when the patient finds himself in the eyes of the therapist.”

Abstract: Transference‐focused psychotherapy and mentalization‐based treatment are new psychoanalytic treatment forms for borderline patients. How do these forms of treatment differ and how are they alike? What interventions do they yield in clinical practice? In the past few years two methods of psychoanalytic treatment for borderline patients have been developed: transference‐focused therapy and mentalization‐based treatment. This paper explores the similarities and differences between them, with a special focus on how the different theories lead to different interventions in clinical practice. TFP takes the central problem to be the disorder in object relations, while MBT focuses on the self as agent. Further differences concern notions of the role of aggression, the presence of mental representations and the position of the therapist. Interventions formulated by therapists of both frames of reference in response to some therapy fragments differed substantially. Both theories share a desire to develop a psychoan...

Abstract: Social cognition is an ability to perceive socially relevant stimuli and to behave accordingly. It is connected with the processing of information brought about by significant social stimuli. Recently, social cognition is a topic of intensive research in psychology, neurosciences and psychiatry. Processes involved in social cognition include: perception of emotion, input of eye contact, reaction to voice prosody or decision-making in social situations. A particular role is played by the mentalizing capabilities (mind-reading) i.e. ability to interpret behaviour of others by attributing them certain mental states. Such an ability is often conceptualized as the Theory of Mind (ToM). This paper is a review of issues connected with disturbances of social cognition in patients with schizophrenia. Deficits in perceptions of face emotion and disturbances of Theory of Mind function in schizophrenia were discussed with special regard to their potential role as endophenotypes of vulnerability to schizophrenia. Also, relations between social cognition and basic neurocognitive processes were presented, as well as the effect on social cognition of different methods of schizophrenia treatment.

Abstract: A group of non-native, early signing deaf children between the ages of 7 and 11 years were tested on a referential communication task. A group of hearing children matched for sex and mental and chronological age were also included in the study. The aim was to study the deaf children's ability to take another persons perspective in a task that resembled a real-life communicative situation to a higher extent than the standard theory of mind (ToM) tasks. A further aim was to investigate the possible importance of a number of background variables such as mental and chronological age, working memory, and false-belief attribution. Results show that the hearing children outperformed the deaf children on the referential communication task and that results were highly correlated with both chronological and mental age, as well as with working memory. There was a positive, but not significant, correlation between false belief and success on the referential communication task. This is an indication that the two tasks tap different abilities and that false belief might be necessary, but not sufficient in order to be skilled in the art of referential communication. The possible role of working memory in the referential communication task is also discussed. The results support the hypothesis of the importance of early talk about mental states for the later development of ToM abilities.

Abstract: Literature Review: Is Atypical Mentalizing a Risk Factor for Psychosis The literature review summarises models and rationale underpinning investigation of atypical mentalizing as a risk factor for psychosis, and reviews longitudinal and cross-sectional studies relating to this It concludes that, although differences in social cognition can be demonstrated to be associated with risk for psychosis, findings to date are mixed, and a focus on the presence or absence of mentalizing skills has limited exploration of the nature of these putative differences Empirical Paper: Theory of Mind and its Relation to Schizotypy This section reports an experimental comparison of the performance of high and low schizotypes on verbal and non-verbal measures of theory of mind In the non-verbal domain, high schizotypes were significantly more likely than low schizotypes to read meaning in randomness and to impute agency or mental states where none were obviously implied These tendencies were associated with positive schizotypy in particular The findings are discussed in relation to Frith's (1992) cognitive model of schizophrenia and existing studies of theory of mind and schizotypy and schizophrenia Critical Appraisal: A critical review of the process of the above study is presented Observations made during the planning, data collection, data analysis and interpretation stages of the project are described, and suggestions are made for future research

Abstract: In some patients, among them the so-called psychosomatic patients, somatically-experienced affects are not transformed into words and symbols. Due to deficient mentalization, affective arousal is not linked to a meaningful and emotionally experienced self-representation. These patients do not experience affects as their own, and the analyst does not get through to their self-state by way of interpretation. The aim of this paper is to elaborate on the concept of “affirmation” and to argue in favour of affirmative interventions, supplementing classical interpretation, in the treatment of patients with deficient affect mentalisation. It is further argued that intonation and the sound quality of the analyst's voice play a decisive part in conveying affirmative messages to the emotionally isolated patient.

Abstract: Mental Language and Understanding of Epistemic and Emotional Mental States.- The Mental Verbs in Different Conceptual Domains and in Different Cultures.- The Socialization of Theory of Mind.- Relations Among Theory of Mind, Metacognitive Language, Reading Skills and Story Comprehension In L1 and L2 Learners.- Culture and Mental States.- Mind Over Grammar.- The Silent Understanding of the Mind.- Social and Intrapersonal Theories of Mind.- Discursive Practices and Mentalization Ability in Adults at Work.