Abstract: This study investigates the impact of theory of mind (ToM) deficits on poor insight in schizophrenia. The scale for unawareness of mental disorder (SUMD) was administered to 58 stable outpatients with schizophrenia. First and second order false belief tasks, the Eyes test and a battery of nonToM cognitive measures were administered. The Second order false belief task was the best predictor of each global insight and symptom attribution scores of the SUMD. ToM tasks explained the substantial amount of the variance (ranging from 22.5% to 29.9%) for the insight scores and classified the significant amount of the patients who were aware of the illness correctly. WCST perseveration scores did not contribute to insight scores beyond that contributed by second order false belief tasks. The Second order ToM tasks seems to have critical importance for the awareness of the disorder. Beyond more direct self-evaluation, the awareness of the disorder and its consequences may also require the ability to evaluate the self from the perspective of others. "Understanding the others' belief about another person" may be conceptually very similar to "understanding the others' belief about self" (instead of another person).

Abstract: Part I: Clinical Use of Attachment Research Assessments. Zeanah, Constructing a Relationship Formulation for Mother and Child: Clinical Application of the Working Model of the Child Interview. Koren-Karie, Oppenheim, Goldsmith, Keeping the Inner World of the Child in Mind: Using the "Insightfulness Assessment" with Mothers in a Therapeutic Preschool. Steele, Hodges, Kaniuk, Steele, D'Agostino, Blom, Hillman, Henderson, Intervening with Maltreated Children and Their Adoptive Families: Identifying Attachment-facilitative Behavior. Dozier, Grasso, Lindhiem, Lewis, The Role of Caregiver Commitment in Foster Care: Insights From the "This is My Baby" Interview. Oppenheim, Dolev, Koren-Karie, Sher-Censor, Yirmiya, Salomon, Parental Resolution of the Child's Diagnosis and the Parent-child Relationship: Insights From the "Reaction to Diagnosis" Interview. Part II: Attachment Theory and Psychotherapy. usch, Lieberman, Attachment and Trauma: An Integrated Approach to Treating Young Children Exposed to Family Violence. Powell, Cooper, Hoffman, Marvin, The Circle of Security Project: A Case Study - "It Hurts to Give That Which You Did Not Receive." Goldsmith, Challenging Children's Negative Internal Working Models: Utilizing Attachment-based Treatment Strategies in a Therapeutic Preschool. Slade, Disorganized Mother, Disorganized Child: The Mentalization of Affective Dysregulation and Therapeutic Change.

Abstract: The ability of humans to predict and explain other people’s behaviour by attributing independent mental states such as desires and beliefs to them, is considered to be due to our ability to construct a “Theory of Mind”. Recently, several neuroimaging studies have implicated the medial frontal lobes as playing a critical role in a dedicated “mentalizing” or “Theory of Mind” network in the human brain. In this study we compare the performance of patients with right and left medial prefrontal lobe lesions in theory of mind and in social cognition tasks, with the performance of people with schizophrenia. We report a similar social cognitive profile between patients with prefrontal lobe lesions and schizophrenic subjects in terms of understanding of false beliefs, in understanding social situations and in using tactical strategies. These findings are relevant for the functional anatomy of “Theory of Mind”.

Abstract: Starting from a contemporary critique of the DSM-IV, this paper argues that the diagnostic categories of panic disorder somatization, and undifferentiated somatoform disorders can be understood as belonging to a common type of psychopathology--i.e., the Freudian actual neuroses. In addition to their strong clinical similarity, these disorders share an etiological similarity; and the authors propose a combination of Freud's focus on this type of patient's inability to represent an endogenous drive arousal with the post-Freudian focus on separation anxiety. An etiological hypothesis is put forward based on contemporary psychoanalytic attachment theory, highlighting mentalization. Concrete implications for a psychoanalytically based treatment are proposed.

Abstract: While humans possess a ready capacity to view a target (biological or other- wise) as an intentional agent (i.e. the 'intentional stance'), the conditions necessary for spontaneously eliciting these mentalizing processes are less well understood. Although research examining people's tendency to construe the motion of geometric shapes as intentional has done much to illuminate this issue, due to methodological limitations (a reliance on subjective self-report) this work has not fully addressed the potentially auto- matic and obligatory nature of mentalizing. Acknowledging this problem, recent research using prelinguistic infants, neuroimaging technology and methods that avoid explicit self-report all provide unique paths to circumvent this shortcoming. While work of this kind has generally corroborated the results of previous investigations, it has also raised a number of new issues. One such issue is whether spontaneous mentalizing processes for abstract non-biological stimuli are instantiated in the same neural architecture as those for realistic representations of intentional biological agents. This question is con- sidered in the current chapter. 2006 Empathy and Fairness. Wiley, Chichester (Novartis Foundation Symposium 278) p 110-132 Spontaneous social perception versus controlled social judgements The ability to comprehend the beliefs, emotions and intentions of others is both characteristic of, and necessary for, successful human interaction. Our richly social nature and complex societal hierarchies demand these skills, such that those who exhibit defi cits in this domain experience considerable diffi culty interacting with others (e.g., individuals with autism; Tager-Flusberg 2001). Known as possessing a theory-of-mind (ToM), mentalizing, or adopting the intentional stance, this capacity to view others as possessing mental states can be directed to targets other than conspecifi cs. Not only are we tempted to believe that a pet hamster is 'just like a little person,' we routinely view quite abstract nonliving representations as if they were intentional agents. Be it an animated movie populated by talking

Abstract: This paper illustrates the clinical application of current theorizing about mentalization and reflective functioning and shows how it can synergize with established analytic concepts. The paper presents a single case, that of a middle-aged woman patient with a moderate but significant history of trauma and presenting with narcissistic/borderline and masochistic dynamics. Unlike some applications of the new concepts, however, this paper does not focus the case presentation around them but instead shows how a number of processes contribute to the development of mentalization. These include corrective engagement in enacted repetitions of the patient's past mistreatment, the development of a central metaphor that allows for proto-reflection and playing with painful affects, and a mourning process precipitated by the death of a family member to whom she is ambivalently attached. In the course of the presentation, then, a variety of psychoanalytic concepts are applied, such that the paper works as a synthesis o...

Abstract: Recent interest in the transformative impact of reflective mechanisms on affect regulation has led to a focus on forms of "mentalized affectivity." This article aims at describing a method for assessing affect mentalization as it appears in verbal data. The method will be illustrated by a preliminary exploration of sex differences in the verbal expression of affect in a clinical setting. The Grille de l'Elaboration Verbale des Affects (GEVA) was applied to the transcribed first evaluation interview of 18 female and 18 male patients seeking psychotherapy. Controlling for GAF and language, results reveal that women take more ownership of their affect and are more expressive, verbally and nonverbally, than men, who are more mentally externalizing and use the motor modality more often than women.

Abstract: This paper presents a comparison of two psychoanalytic models of how human beings learn to use their mental capacities to know meaningfully about the world. The first, Fonagy's model of mentalization, is concerned with the development of a self capable of reflecting upon its own and others' mental states, based on feelings, thoughts, intentions, and desires. The other, Bion's model of thinking, is about the way thoughts are dealt with by babies, facilitating the construction of a thinking apparatus within a framework of primitive ways of communication between mother and baby. The theories are compared along three axes: (a) an axis of the theoretical and philosophical backgrounds of the models; (b) an axis of the kind of evidence that supports them; and (c) the third axis of the technical implications of the ideas of each model. It is concluded that, although the models belong to different theoretical and epistemological traditions and are supported by different sorts of evidence, they may be located along the same developmental line using an intersubjective framework that maintains tension between the intersubjective and the intrapsychic domains of the mind.

Abstract: This paper attempts to coalesce considerations of attachment processes, trauma, mentalization, and nonverbal behavior to underscore some of the developmental and therapeutic challenges demonstrated by older-adult child survivors of the Holocaust, and by implication, other child victims of similar genocidal and traumatic events. Young child survivors experienced not only their own traumatic exposure to violence, harm, and loss, but also the stress-transmission of the adult caregivers who raised them in the years that followed. For some, the horrendous losses, combined with impediments to organizing relationships, and to experiences of predictable and trusted continuities, negatively impact the development of the reflective function, and of interpretive skills basic to successful implicit relatedness and explicit exchanges. "Neutral flow" of bodily tension and shape often signals the freezing accompanying nonmentalizing states. Misalignments in individual personality structure and discordances in interpersonal exchange underscore the need to address fundamental building blocks of relatedness and mentalization in the therapeutic process.

Abstract: This issue contains the second part of the Special Feature on theoretical models of borderline personality disorder. The first part was in issue Volume 21 Number 5 published in October 2007. In first of the three articles in Part II, Peter Fonagy and Anthony Bateman offer an additional psychoanalytically-based model of the disorder. Unlike previous models emphasizing structural problems primarily centered on object relationships, they suggest that impaired mentalizing capacity–the ability to make sense of the mental states of self and others–is the core feature of the disorder. Their model postulates that disturbances in early attachment due to the interplay between constitutional and environmental factors leads to hyperresponsiveness of the attachment system. A disturbed attachment relationship hinders the acquisition of mentalizing capacity because the skills involved are acquired in interaction with care-givers who convey sensitive understanding. Impaired mentalizing leads to problematic interpersonal relationships and hinders the development of the self system. Subsequently, hyper-responsiveness of the attachment system makes mentalizing unstable when emotions are strongly aroused. As Fonagy and Bateman note, the formulation has direct implications for treatment. It suggests that important goals in treating BPD are to improve mentalizing capacity and ensure that patients are able to maintain these functions when the attachment system is activated. In the second paper, John Gunderson and Karlen Lyons-Ruth hypothesize that the psychobiological disposition to BPD involves a “constitutional diathesis” involving hypersensitivity to interpersonal stressors. Early in development, this interpersonal hypersensitivity along with other heritable characteristics interacts with problems in the attachment relationship leading to a disorganized pattern of attachment. Gunderson and LyonsRuth note that the developmental pathways linking early disorganized attachment and the subsequent development of BPD are complex and as yet poorly understood. However, they hypothesize that an important factor is the emergence of controlling strategies that may be either controlling and punitive or controlling and care-giving. The model extends Gunderson’s earlier descriptions of the unstable interpersonal relationships of individuals with BPD that involve conflict between needs for closeness and attention with intense fears of rejection or abandonment by proposing that this pattern is not simply acquired in the context of adversity but also has a heritable component.

Abstract: With the concept of procedural unconscious processes, contemporary psychoanalysis goes beyond Freud, who did not know of implicit memory and the resulting procedural relational dynamics. Today, lack of mentalization and symbolization is regarded as another mechanism besides repression constituting the psychodynamic unconscious. From that theoretical background, the manifestation of early pre-reflexive archaic experience can be conceptualized as procedural transference and handled in a way that takes care of the specific functioning inherent to the underlying archaic states of mind. Using material from the analysis of a narcissistic patient, the merging of episodic and procedural modes of transference and how this affected the psychoanalytic technique are demonstrated.

Abstract: The experience of a trauma has multiple consequences for the psychological functioning of the individual. The present work sustains that when the consequences are expressed in the development of the intimacy these would not only be related to the experience of the trauma as a fact but to the individual diffi culties in mentalizing the traumatic fact that is due to repeated parental failure to recognize the self.

Abstract: 1. Attachment and Change I. Bowlby and Beyond 2. The Foundations of Attachment Theory 3. Mary Main: Mental Representations, Metacognition, and the Adult Attachment Interview 4. Fonagy and Forward II. Attachment Relationships and the Development of the Self 5. The Multiple Dimensions of the Self 6. The Varieties of Attachment Experience 7. How Attachment Relationships Shape the Self III. From Attachment Theory to Clinical Practice 8. Nonverbal Experience and the "Unthought Known": Accessing the Emotional Core of the Self 9. The Stance of the Self toward Experience: Embeddedness, Mentalizing, and Mindfulness 10. Deepening the Clinical Dimension of Attachment Theory: Intersubjectivity and the Relational Perspective IV. Attachment Patterns in Psychotherapy 11. Constructing the Developmental Crucible 12. The Dismissing Patient: From Isolation to Intimacy 13. The Preoccupied Patient: Making Room for a Mind of Onea (TM)s Own 14. The Unresolved Patient: Healing the Wounds of Trauma and Loss V. Sharpening the Clinical Focus 15. The Nonverbal Realm I: Working with the Evoked and the Enacted 16. The Nonverbal Realm II: Working with the Body 17. Mentalizing and Mindfulness: The Double Helix of Psychological Liberation

Abstract: Recent research has indicated that parental reflective functioning or mentalization plays a crucial role in the development of a range of healthy adaptations in both parent and child. While many parenting interventions developed over the course of the last 20 years have implicitly attempted to enhance mentalization in parents, this article describes an effort to directly intervene with parents to enhance or encourage the development of reflective capacities. In this article, the broad outlines of a reflective parenting approach are described. Two reflective parenting programs are then considered, one a group intervention designed for low-risk parents, the other a home visiting intervention designed for high-risk parents and children.