Abstract: This article aims to review the development of the concept of mentalization, its applications in the understanding and treatment of borderline personality disorder, and the issue of its assessment While conceptually derivative of theory of mind, Fonagy's concept of mentalization concerns more affectively and interpersonally complex understandings of oneself and others, reflecting abilities that enable an individual not only to navigate the social world effectively but also to develop an enriched, stable sense of self The components of mentalization can be organized around self-/other-oriented, implicit/explicit, and cognitive/affective dimensions Concepts of mindfulness, psychological mindedness, empathy, and affect consciousness are shown to partially overlap with mentalization within these three dimensions Mentalization is assessed by the measure of reflective function, a scale to be used adjunctively on semistructured narrative interviews such as the Adult Attachment Interview Its validity has not been fully tested, and its usage has been hampered by the time and expense it requires Although the concept of mentalization is a useful heuristic that enables clinicians to adopt a coherent treatment approach, it may be too broad and multifaceted to be operationalized as a marker for specific forms of psychopathology such as borderline personality disorder Research elucidating the relationship between reflective function, overlapping concepts, and features of borderline psychopathology is needed

Abstract: Recent studies of the relationship between parenting and child development have included a focus on the parent's capacity to treat the child as a psychological agent. Several constructs have been developed to refer to this capacity, for example maternal mind-mindedness, reflective functioning, and parental mentalizing. In this review article, we compare and contrast different constructs from diverse theoretical backgrounds that have been developed to operationalize parental mentalizing. We examine the empirical evidence to date in support of each of the constructs and review the relevant measures associated with each construct. Next, we discuss the possibility that these apparently diverse constructs may tap into the same underlying neurobiological socio-cognitive system. We conclude by proposing a testable model for describing the links between parental mentalization, the development of mentalizing in children, and child psychopathology.

Abstract: This paper describes a mentalization-based model of the development of borderline personality disorder (BPD). The model takes into account constitutional vulnerability and is rooted in attachment theory and its elaboration by contemporary developmental psychologists. The model suggests that disruption of the attachment relationship early in development in combination with later traumatic experiences in an attachment context interacts with neurobiological development. The combination leads to hyper-responsiveness of the attachment system which makes mentalizing, the capacity to make sense of ourselves and others in terms of mental states, unstable during emotional arousal. The emergence of earlier modes of psychological function at these times accounts for the symptoms of BPD. The model has clinical implications and suggests that the aim of treatment is not only to encourage development of mentalizing but also to facilitate its maintenance when the attachment system is stimulated.

Abstract: In this chapter, we will outline how the concept of mentalizing helps us understand some of the common problems associated with borderline personality disorder and how the theoretical understanding is translated into psychotherapeutic intervention. Mentalizing is the process by which we interpret the actions of ourselves and others in terms of underlying intentional states such as personal desires, needs, feelings, beliefs and reasons. This capacity develops within the context of attachment relationships during infancy and childhood. Borderline personality disorder is conceived of as being a disorder of mentalizing. Vulnerability to a loss in mentalizing particularly in interpersonal or stressful circumstances is a core feature of the disorder. If treatment is to be successful it must either have mentalization as its focus or at the very least stimulate development of mentalizing as an epiphenomenon. Treatment focusing on mentalizing itself is described. © Copyright (c) by The Haworth Press, Inc. All rights reserved.

Abstract: One useful strategy for inferring others' mental states (i.e., mentalizing) may be to use one's own thoughts, feelings, and desires as a proxy for those of other people. Such self-referential accounts of social cognition are supported by recent neuroimaging observations that a single brain region, ventromedial prefrontal cortex (vMPFC), is engaged both by tasks that require introspections about self and by tasks that require inferences about the minds of others perceived to be similar to self. To test whether people automatically refer to their own mental states when considering those of a similar other, we examined repetition-related suppression of vMPFC response during self-reflections that followed either an initial reflection about self or a judgment of another person. Consistent with the hypothesis that perceivers spontaneously engage in self-referential processing when mentalizing about particular individuals, vMPFC response was suppressed when self-reflections followed either an initial reflection about self or a judgment of a similar, but not a dissimilar, other. These results suggest that thinking about the mind of another person may rely importantly on reference to one's own mental characteristics.

Abstract: Mentalizing involves the ability to predict someone else’s behavior based on their belief state. More advanced mentalizing skills involve integrating knowledge about beliefs with knowledge about the emotional impact of those beliefs. Recent research indicates that advanced mentalizing skills may be related to the capacity to empathize with others. However, it is not clear what aspect of mentalizing is most related to empathy. In this study, we used a novel, advanced mentalizing task to identify neural mechanisms involved in predicting a future emotional response based on a belief state. Subjects viewed social scenes in which one character had a False Belief and one character had a True Belief. In the primary condition, subjects were asked to predict what emotion the False Belief Character would feel if they had a full understanding about the situation. We found that neural regions related to both mentalizing and emotion were involved when predicting a future emotional response, including the superior temporal sulcus, medial prefrontal cortex, temporal poles, somatosensory related cortices (SRC), inferior frontal gyrus and thalamus. In addition, greater neural activity in primarily emotion-related regions, including right SRC and bilateral thalamus, when predicting emotional response was significantly correlated with more self-reported empathy. The findings suggest that predicting emotional response involves generating and using internal affective representations and that greater use of these affective representations when trying to understand the emotional experience of others is related to more empathy.

Abstract: Reflective function refers to a quantified index of attachment-related mentalization, that is, the capacity to conceive of mental states as explanations of behavior in oneself and in others. We assume that the capacity to mentalize is a key determinant of self-organization that, along with contributory capacities of affect regulation and attention control mechanisms, 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. Unusually, for what is fundamentally a psychoanalytic approach, we elaborated our model of social development on the basis of empirical observations as well as clinical work.

Abstract: Attachment, trauma, and psychoanalysis : where psychoanalysis meets neuroscience / Peter Fonagy & Mary Target -- Attachment and mentalization in humans : the development of the affective self / Gyorgy Gergely & Zsolt Unoka -- Minds and yours : new directions for mentalization theory / Elliot L. Jurist -- Measuring mentalization across contexts : links between representations of childhood and parenting in an adoption sample / Miriam Steele ... [et al.] -- Mentalization-based treatment of borderline personality disorder / Peter Fonagy & Anthony Bateman -- Mentalization and attachment in borderline patients in transference focused psychotherapy / Otto Kernberg ... [et al.] -- A neurobiological perspective on mentalizing and internal object relations in traumatized borderline patients / Glen Gabbard, Lissa Miller, & Melissa Martinez -- Changes in the representation of self and significant others in the treatment process : links between representation, internalization, and mentalization / Sidney J. Blatt, John S. Auerbach, & Rebecca Smith Behrends -- Parent-infant attachment systems : neural circuits and early-life programming / James E. Swain ... [et al.] -- Mentalization as a frame for working with parents in child psychotherapy / Arietta Slade -- Critical moments as relational moments / Kimberlyn Leary -- Metaphor, activity, acknowledgement, grief : mentalization and related transformations in the psychoanalytic process / Stephen Seligman -- Birth mother, adoptive mother, dying mother, dead mother / Karen Gilmore -- On having to find what you don't know how to look for : two perspectives on reflection / Donnel B. Stern -- Mentalize this!? : dissociation, enactment, and clinical process / Philip M. Bromberg.

Abstract: Most current mainstream research, diagnostic assessment, and treatment strategies focus on specific psychiatric disorders--on diagnoses that are based on manifest symptoms within a categorical, atheoretical approach. This disorder-centered approach has been antithetical to psychoanalytic views, which are fundamentally person centered, focusing on the dynamics of individual lives. Growing realization of the high comorbidity among psychiatric disorders has led to the need to include developmental considerations and hierarchical models in the classification and treatment of psychopathology. In addition, this realization has led to a renewed interest in the principles of equifinality and multifinality--that a given end state can be the result of different developmental paths and that similar developmental factors may lead to dissimilar outcomes. In this chapter these developments are illustrated by research on the impact of early adversity, a central domain in psychoanalytic thought. Findings from various strands of research in the neurosciences and genetic research, in particular, suggest that early adversity leads to vulnerability for a wide variety of both psychiatric and (functional) somatic disorders. These findings have contributed to the rediscovery of the importance of early experiences more generally and to the need for a broad developmental perspective. In this context, we also discuss the danger of reductionism associated with the growing influence and popularity of affective neuroscience and genetics as well as the vital role a psychoanalytic perspective might play in countering this reductionism by reestablishing the importance of meaning and meaning making in understanding and treating patients with a history of early adversity. In particular, we focus on the importance of narrative and mental representations in the development of the capacity for mentalization in these patients.

Abstract: Twelve transcripts, three from each of four patients, taken from the early, mid and late phases of open-ended, long-term psychoanalytic psychotherapy with the same therapist, were analysed for metaphor. Metaphors were categorized into key, novel and conventional. Using grounded theory metaphors were categorized by theme and function. It was found that all metaphors – novel, conventional and key – could be representative of key concepts such as the self, others/relationships and therapy/self transformation and diagnosis or psychopathology; chart change; indicate mentalization (Fonagy et al. 2004). In addition use of metaphors by different patients showed different patterns that co-occurred with good or bad outcome.

Abstract: The study examined associations between maternal mentalization ability, executive functioning, recognition of infant cues, and bonding in a non-clinical sample of mothers. It employed a correlational design. Sixty-four mothers of young infants completed assessments of mentalization ability, executive functioning, and bonding. Photographs of infant facial expressions were utilized to assess ability to recognize infant cues of emotion, but this was not found to correlate with either maternal mentalization or executive functioning ability. Whilst a trend towards a significant positive relationship between mothers' cued ability to attribute mental states and their ability to recognize infant facial expressions was observed, no significant relationships were found between bonding scores and performance on the executive functioning and mentalization measures. The present study contributes to our current understanding of the influence of maternal cognitive factors, specifically mentalization and executive functioning, on the development of the mother-infant relationship. Future research, methodological issues, and clinical and theoretical implications are discussed.

Abstract: Psychoanalytic opinion continues to be dichotomized in regard to the role of trauma versus intrapsychic conflict as contributing to pathogenesis. This paper emphasizes the importance of conflict in both the experience and processing of trauma, so that problems in talking about it and processing it verbally are taken as evidence of conflict and defense. Cumulative trauma and its analysis in children are emphasized. While children in analysis find remembering and talking about their traumas difficult, they can know such experiences and modulate the anxiety of knowing when they do so in play. A clinical vignette is presented to demonstrate this way of using play to promote more advanced mentalization or insightfulness.

Abstract: Summary Mentalization-based grouptherapy – aspects of changing therapeutic stance and intervention styles Mentalization-based-treatment (MBT) has currently proven to be one of the most efficient treatments for patients with (borderline-)personality disorders in a dyadic as well as a group therapy setting. The underlying new theoretical and technical features of MBT-interventions are demonstrated. Furthermore, differences and similarities between MBT and other analytic group therapies are discussed with regard to the therapeutic stance as well as the affect-orientated intervention styles. Finally, prototypic therapeutic interventions that inhibit or enable mentalizing capacities are discussed. In the therapeutic context it is important that interventions which inhibit mentalization should be avoided. The concept of Mentalization-based group therapy should also be integrated in the curricula of group therapy training institutes. It has been shown that role-play is very effective in teaching MBT interventions.

Abstract: Theory of mind (ToM) reasoning may involve a multiplicity of processes, including an initial stage, where cues relevant for social processes are detected and decoded, and a mentalizing stage, where the decoded information is used to reason about mental states. Here we report that the processing of lower-order facial cues relevant to social judgments can be relatively spared in patients with impaired ToM reasoning. We discuss the implications for understanding the mechanisms underlying social judgments in brain-lesioned patients.

Abstract: SUMMARY In this chapter, we will outline how the concept of mentalizing helps us understand some of the common problems associated with borderline personality disorder and how the theoretical understanding is translated into psychotherapeutic intervention. Mentalizing is the process by which we interpret the actions of ourselves and others in terms of underlying intentional states such as personal desires, needs, feelings, beliefs and reasons. This capacity develops within the context of attachment relationships during infancy and childhood. Borderline personality disorder is conceived of as being a disorder of mentalizing. Vulnerability to a loss in mentalizing particularly in interpersonal or stressful circumstances is a core feature of the disorder. If treatment is to be successful it must either have mentalization as its focus or at the very least stimulate development of mentalizing as an epiphenomenon. Treatment focusing on mentalizing itself is described.

Abstract: Patients with schizophrenia have difficulties in representing of the mental states of others. The impairment can be detected not only in the acute phase but also in remission. Patients in remission are able to pass first- and second order "theory of mind" tasks, but they have difficulties to understand more complex situations (such as irony). In our study faux pas tasks were used to assess mentalization deficits among patients with schizophrenia. Seventeen patients with schizophrenia and seventeen matched control individuals were evaluated. A computerized programme was used to present the tasks, to store the answers and the time the participants used to read the questions and answer. The patients with schizophrenia performed a significant impairment in the faux pas tasks. Beside, an improving tendency were found in the patient's answers, that may mean a capacity to "learn" in the dimension of mentalization.

Abstract: My main concern in this article is the relevance of theoretically integrative approaches. I argue that such approaches are methodologically better equipped for the psychology of religion because they correspond with the inherent complexity of religiosity. In order to concretize this matter I critically evaluate the hypothesis proposed by some cognitive researchers that the attraction of counter-intuitive representations provides an explanation of religion. Irrelevant aspects are left out in this hypothesis. In contrast to this I rely on cognitive-analytic perspectives that are based on a broader theoretical foundation. This generates a more complete picture that also connects to the tradition built on Otto's (1923) idea of the wholly other. From this perspective it is more plausible to assume that religious representations are trajectories of the early evolving tripartite sense of self, other and world and, further, formed by individual mentalization capacity. This can be conceptualized in terms of interplay between specific complex representational constellations rooted in different phases of early development. Integrative approaches that depict mental activity as a dynamic and multifaceted phenomenon embedded in intersubjectivity are relevant for the psychology of religion.

Abstract: The author reviews current thinking on the phenomena of failure to mentalize and provides an alternative to the structural defect point of view. Also included are some clinical implications of this alternative viewpoint.