Abstract: The editors of Handbook of Mentalizing in Mental Health Practice have authored two previous books aimed at establishing mentalizing as a developmental and clinical concept.

Abstract: Section 1. Biological Processes.- 1. The brain, emotional awareness and implicit emotion regulation.- 2. Non-conscious emotion regulation.- 3. Self-regulating brain and health.- 4. Body language and emotions.- 5. Emotions in animals.- Section 2. Psychological Processes.- 6. Mindfulness, emotion regulation, health.- 7. Implicit emotion theory and well-being.- 8. Self-Control.- 9. Emotion regulation as form of self-regulation.- 10. Rumination, emotion regulation, and health.- 11. Language, emotion, and well-being.- Section 3. Social Perspective.- 12. Self-conscious emotions and social functioning.- 13. Social sharing and wellbeing.- 14. Intergroup emotions.- 15. Aging, emotions and well-being.- 16. Attachment and emotion regulation.- Section 4. Clinical Perspective.- 17. Emotional vitality and health.- 18. Positive emotions, resiliency.- 19. Mentalization, emotion regulation and somatoform disorders.- 20. Type D, attachment, emotion regulation, and health.- 21. Emotions and somatic well-being.

Abstract: Objectives. Although there has been increased interest in applying attachment theory to the psychological understanding of psychosis, research to date has focused on self-reported attachment and psychotic symptomatology. This study presents evidence for applying attachment and mentalization constructs to understanding engagement and adaptation to first-episode psychosis (FEP), using a narrative based interview. Design. A cross-sectional cohort design was used. Methods. Thirty-four individuals with a first episode of psychosis were interviewed using the Adult Attachment Interview. Attachment classifications and reflective function scores were derived from the interview. Psychotic symptomatology, premorbid adjustment, duration of untreated psychosis, and psychological variables were also measured. Results. Attachment distribution was heterogeneous in the sample, although the majority of participants were classified dismissing of attachment. Mentalization scores were consistent with previous clinical samples. Attachment and mentalization were unrelated to psychotic symptomatology. Conclusions. The current study demonstrates, albeit with a small clinical sample, the importance of assessing attachment and mentalization via narrative methods. The findings also have clinical implications for understanding the process of engagement and adaptation in FEP.

Abstract: Mentalization has been proposed as a key concept in understanding therapeutic change in patients with Borderline Personality Disorder (BPD). However, little is known about mentalization in chronic depression. This study investigated the role of mentalization in the long-term psychoanalytic treatment of chronic depression. Mentalization measured with the Reflective Functioning Scale (RFS) was examined in patients with chronic depression (n = 20) in long-term psychoanalytic treatment and compared to healthy controls (n = 20). Results show that global RF scores did not differ significantly between patients and controls. However, depressed patients tended to have lower RF scores concerning issues of loss. Furthermore, RF was unrelated to symptoms and distress as assessed by the Beck Depression Inventory (BDI) and the SCL-90. RF did not predict therapeutic outcome as measured with the BDI but predicted changes in general distress after 8 months of psychoanalytic treatment as measured by the SCL-90. Moreover, correlations between RF and the Helping Alliance Questionnaire indicated that patients with higher RF were able to establish a therapeutic alliance more easily compared to patients with low RF.

Abstract: This article outlines the evidence base and current psychotherapeutic treatment approaches for individuals with a diagnosis of antisocial personality disorder (ASPD). It examines the application of...

Abstract: The ability to attribute mental states to others is crucial for social competency. To assess mentalizing abilities, in false-belief tasks participants attempt to identify an actor’s belief about an object’s location as opposed to the object’s actual location. Passing this test on explicit measures is typically achieved by 4 years of age, but recent eye movement studies reveal registration of others’ beliefs by 7 to 15 months. Consequently, a 2-path mentalizing system has been proposed, consisting of a late developing, cognitively demanding component and an early developing, implicit/automatic component. To date, investigations on the implicit system have been based on single-trial experiments only or have not examined how it operates across time. In addition, no study has examined the extent to which participants are conscious of the belief states of others during these tasks. Thus, the existence of a distinct implicit mentalizing system is yet to be demonstrated definitively. Here we show that adults engaged in a primary unrelated task display eye movement patterns consistent with mental state attributions across a sustained temporal period. Debriefing supported the hypothesis that this mentalizing was implicit. It appears there indeed exists a distinct implicit mental state attribution system.

Abstract: A study is reported of a psychoanalytic intervention in a very violent and prejudiced Jamaican school with disenfranchised children 7-9 grades who had failed academic streaming examinations. Over the period of 3 years of the intervention using mentalization and power issues approaches grounded in attachment theory, children were assisted to feel connected and valued by their school. There were striking improvements in academic performance, decreased victimization, and increased helpfulness especially in boys including significant trickle down effects to grades 1-6. Overall, the school became a place teachers wanted to join and the Jamaican government recognized their success and built a new school for them in a better location.

Abstract: Objectives. The present study explores the relationship between the mentalization of distinct affect categories and the severity of borderline personality disorder (BPD) symptoms. Mentalization is assessed by both the level of verbal elaboration (VE) achieved by discrete affects (explicit mentalization) and the proportion of these individual affects in verbal expression (implicit mentalization). Design and methods. Sixty-four outpatients completed a series of questionnaires and took part in an interview designed to produce eight relationship episodes that involved four basic emotions: sadness, joy, anger, and fear (two of each). Affect mentalization was assessed with the Grille de l’Elaboration Verbale de l’Affect (GEVA), an observer-rated measure of levels of elaboration of verbalized affect, and the measure of affect content (MAC), which identifies the content of the verbalized affect (e.g., anger). Diagnostic criteria were obtained with the BPD scale of the Structured Clinical Interview for DSM-IV (SCID-II) questionnaire. Alexithymia was assessed with the 20-item Toronto Alexithymia Scale (TAS-20). Results. The severity of BPD symptoms was related to lower levels of VE of sadness. It was also associated with a higher frequency of hostility directed against others. The level of VE of sadness and the proportion of hostility showed incremental predictive value of borderline symptomatology over demographic information, the presence of a depressive disorder and alexithymia. Conclusions. These findings point to an association between the severity of BPD symptoms and a difficulty mentalizing specific affective domains largely recognized as being central to borderline pathology, namely sadness and hostility.

Abstract: In this study, situational antecedents and mentalization of guilt were examined by asking children and adolescents for written narratives. The sample of 240 participants, aged between 9 years and 15 years 6 months, was divided into two groups of 120 children (M = 9 years and 7 months; SD = 0.4) and 120 adolescents (M = 14 years and 7 months; SD = 0.4). Participants displayed typical development, were recruited at schools in Milan city, and came from middle-class backgrounds. There was an equal number of males and females in each of the two age groups. Both content analysis for antecedents and mental states language analysis for mentalization were applied to the texts. We found that the distribution of guilt antecedents varied as a function of age, and only in the adolescent group as a function of gender. We also found that the use of mental states language varied very significantly with age, but not with gender. The results support the idea that in the transition from childhood to adolescence antecedents ...

Abstract: This article discusses the important advances in a recent field of science dealing with the brain processes implicated in understanding social situations and interacting with others. Many behavioral studies on schizophrenia have shown the impairment of these processes and their preferential relation with disorganization and negative syndromes. Brain imaging is a powerful method to identify brain systems participating in these processes in healthy subjects and will be used increasingly to study mental disorders such as schizophrenia. A few preliminary studies have opened this field of research and allowed for the drawing of some limited conclusions. We emphasize the importance of developing an integrated neurocognitive framework to account for the multifaceted nature of social cognition deficits in schizophrenia. Inspired by contemporary models of empathy and social cognition that identify different components such as shared representation, mentalizing, self/other distinction, we show how schizophrenia affects these components at the behavioral and functional levels. We also outline the interest of this model to understand putative abnormalities of contextual integration within the area of mentalization. Finally, we discuss how specialized measures of brain functions during the performance of these precisely defined mental processes might be used as outcome predictors.

Abstract: Possibly no other psychoanalytic concept has caused as much ongoing controversy, and attracted so much criticism, as that of 'repression'. Repression involves denying knowledge to oneself about the content of one's own mind and is most commonly implicated in disputes concerning the possibility of repressed memories of trauma (and their subsequent recovery). While fundamental in Freudian psychoanalysis, recent developments in psychoanalytic thinking (e.g., 'mentalization') have downplayed the importance of repression, in part due to less emphasis being placed on the importance of memory within therapy.

Abstract: Many adults with serious mental illness experience difficulties thinking about their own mental states and the mental states of others. Increasing amounts of evidence have suggested that these difficulties underpin many of the struggles these persons subsequently experience trying to cope with symptoms and distress, to solve social problems and to negotiate with others in order to accomplish important life goals. In this special issue, the contributing authors explore the problems associated with impaired mental state understanding in different psychiatric conditions using a wide range of tools, from laboratory tasks, to self-reports, to discourse analysis. Also, both population-based studies and single-case analyses are adopted. The intent is to shed light how various difficulties in understanding mental states can be detected using different approaches and how findings can be meaningfully integrated within an internally consistent theoretical framework.

Abstract: Many mathematically gifted adolescents are characterized as being indolent, underachieving and unsuccessful despite their high cognitive ability. This is often due to difficulties with social and emotional development. However, research on social and emotional interactions in gifted adolescents has been limited. The purpose of this study was to observe differences in complex social strategic behaviors between gifted and average adolescents of the same age using the repeated Ultimatum Game. Twenty-two gifted adolescents and 24 average adolescents participated in the Ultimatum Game. Two adolescents participate in the game, one as a proposer and the other as a responder. Because of its simplicity, the Ultimatum Game is an apt tool for investigating complex human emotional and cognitive decision-making in an empirical setting. We observed strategic but socially impaired offers from gifted proposers and lower acceptance rates from gifted responders, resulting in lower total earnings in the Ultimatum Game. Thus, our results indicate that mathematically gifted adolescents have deficiencies in social valuation and mentalization.

Abstract: — This article offers the concept of embodiedself-awareness (ESA) as a contrast to parental embodiedmentalizing, which is presumed to be implicit and outsideawareness. ESA, which consists of awareness of bothsensorimotor and emotional states, is essential for allforms of human development and self-regulation and islearned via mutual embodied attunement in interpersonalrelationship. Failure to develop ESA reflects a dissociationfrom the experience of living in a human body and issymptomatic of attachment problems and a wide varietyof physical and psychological disorders that may be reme-diated through clinical practices that enhance embodiedawareness. KEYWORDS— embodied self-awareness; attunement; parent–infant communicationConsider the difference between learning a new motor skill—-like a tennis stroke or a guitar chord—and delivering a skilledperformance. In the learning phase, repetition and slowing downheighten one’s awareness of the body’s sensations and move-ments, including muscle fatigue, pain, miscoordination, and flu-idity. One also becomes aware of a host of emotions related tothe action and the learning process, such as frustration, impa-tience, or elation. I call these felt sensations embodied self-awareness (ESA): the ability to sense, in the present moment andwithout mediating thought, these sensorimotor feelings alongwith the motivational and emotional feelings that accompanythem. ESA is an essential component of all forms of humandevelopment and well-being. Its absence at any age is a form ofdissociation from the lived body and is often accompanied bysymptoms of depressed moods, feelings of stress and lack of con-trol, attachment insecurity, and chronic physical disease (Fogel,2009).In their review article, Shai and Belsky (2011) define parentalembodied mentalization (PEM) as ‘‘parents’ capacity to (a)implicitly conceive, comprehend, and extrapolate the infant’smental states from the infant’s whole-body movement (i.e., kines-thetics), and (b) adjust their own kinesthetic patterns accord-ingly’’ (p. 175; emphasis added). Their argument is noteworthybecause it uses the word embodied to bring the infant’s gestures,actions, movements, and postures into the process through whichparents interpret and respond to their infants.Underlying this definition, however, is the proposition thatPEM is implicit mentalizing (which they describe as ‘‘noncon-scious, nonverbal, automatic’’) and not explicit mentalizing(which they describe as ‘‘verbal, re flective, controlled’’). My con-cept of ESA

Abstract: Attachment theory is a very influential general concept of human social and emotional development, which emphasizes the role of early mother-infant interactions for infant’s adaptive behavioural and stress copying stra tegies, personality organization and mental health. Individuals with disrupted development of secure attachment to mother/primary caregiver are at higher risk of developing mental disorders. This theory consists of the complex developmental psycho-neurobiological model of attachment and emerges from principles of psychoanalysis, evolutionary biology, cognitive-developmental psychology, ethology, physiology and control systems theory. The progress of modern neuroscience enables interpretation of neurobiological aspects of the theory as multi-level neural interactions and functional development of important neural structures, effects of neuromediattors, hormones and essential neurobiological processes including emotional, cognitive, social interactions and the special key role of mentalizing. It has multiple neurobiological, neuroendocrine, neurophysiological, ethologic al, genetic, developmental, psychological, psychotherapeutic and neuropsychiatric consequences and is a prototype of complex neuroscientific concept as interpretation of modern integrated neuroscience.

Abstract: In this study we investigated whether psychology students differ than students who have chosen non-helping professions in psychological features important for helping activities: attachment and empathy. The sample consisted of psychology students from Belgrade and Novi Sad (N=452) and students from several Belgrade University faculties for non-helping professions. The revised version of Attachment Questionnaire was used for assessment of attachment, while empathy was assessed by Empathy Quotient. The results confirmed hypotheses about the greater prevalence of secure attachment pattern, higher empathic capacity, better mentalizing, and more positive model of the other among the future helpers. These differences between student groups are present at the enrolment, with gender controlled. Finally, the prevalence of the secure attachment pattern and high empathy scores rises with the years spent at studying psychology. We concluded that psychology studies are chosen by persons with higher motivation and capacities for helping professions. Although women outnumber men, differences between the future helping professionals and others cannot be explained by the gender structure of the sample, since men in the helping professions have better results than women in the nonhelping ones.

Abstract: In their 2004 article, J. R. Allen, Bennett, and Kearns invited us to carry on their exploration of “thinking psychologically.” In this article, the author does so by offering further reflections a...

Abstract: Alexithymia, characterized by deficits in the awareness and differentiation of emotional states, is hypothesized as underlying somatoform disorders. Mentalization as a construct investigated in cognitive psychology is defined as the ability to refer mental states of others in order to predict their behavior. Developmental psychologists claim that the ability to represent emotions mentally is the cornerstone for the emergence of mentalizing capacity. Therefore, linking alexithymia and mentalization, it is argued that patients with somatoform disorders may not only be hampered in their ability to be consciously aware of their emotions, but may also suffer from deficits in mentalizing capacity and, therefore, may be impaired in their understanding of social interaction. Clinical observations and empirical evidence that support this hypothesis are reviewed.

Abstract: Part 1 of the thesis reviews the literature on the measurement of mentalization in adult clinical populations. As mentalization is a broad multi-faceted term, the search incorporates the related concepts of Theory of Mind (ToM) and Emotional Intelligence (EI) as these have been widely operationalised. The review presents a framework for different types of measures, including performance-based tasks and self-report questionnaires, and considers their relative psychometric strengths. It finds an absence of any one measure that covers the breadth of the mentalization construct, however, a set of recommendations are made for an optimal approach using currently available tools. Part 2 presents an empirical study of the relationship between mentalizing capability and severity of Antisocial Personality Disorder (ASPD) in an offender sample. The results show that some specific mentalizing measures were able to modestly predict severity of ASPD. These were the ability to take the perspective of another person, the ability to read mental states from the ‘eyes’ and a general inability to mentalize. These findings suggest that a greater understanding of mentalizing capacities in people with ASPD may support improved risk assessment and clinical treatments. The study’s limitations are considered and its implications for further research and practice. Part 3 presents a critical appraisal of the process of undertaking this research. It describes some of the challenges to joint working across the NHS and the Criminal Justice System. It considers how the use of psychometric assessment can be improved in an ASPD/offender population. It builds on the literature review to recommend how the operationalisation of mentalization can be further enhanced.

Abstract: The following paper explores the concepts of reflective functioning, metacognition (Main et al. in Adult attachment scoring and classification systems. Regents of the University of California, Berkeley, 2002), and mentalization (Fonagy and Target in Mind to mind: Infant research, neuroscience and psychoanalysis. Other Press, New York, 2008; Fonagy et al. in Affect regulation, mentalization and the development of the self. Other Press, New York, 2002). Using an extended case illustration, the author demonstrates how she uses the clinical process to develop more mature reflective and mentalization capacities with a client through dream analysis, identification of affect states, therapeutic ruptures and mutual play.

Abstract: The concept of structural dissociation can provide useful information for increasingly complex applications of mentalizing in therapeutic settings; however, little integration of the two approaches has emerged. Grounded in the intricate case of a woman diagnosed with dissociative identity disorder, this case study integrates and applies the concepts of structural dissociation and mentalizing from an attachment perspective. Client history includes pervasive spiritual and sexual abuse, as well as extreme neglect throughout her development. The presenting problems, relevant history (including the profound impact of neglect), and the therapeutic models that guided treatment are described. Also presented are the specific therapeutic interventions that have facilitated and strengthened therapeutic alliances, levels of integration, and mentalizing capacity in this challenging but rewarding study of human resiliency.

Abstract: This article shows that psychodynamic perspectives are particularly relevant in working with people who have Asperger's syndrome (AS). It is believed that a central problem among people with AS is difficulty in understanding their own mind and the mind of others. Recent discussion of factors involved in fostering change in psychoanalytic psychotherapy stresses the importance of a theory of mind, known as mentalization, that refers to the effort by the therapist to understand the patient's mind. It is in this demonstration of the activity of coming to know the mind of another that psychodynamic perspectives may be particularly helpful in working with persons with AS to come to understand their own mind and to know the minds of others. Psychodynamic psychotherapy is also important in helping persons with AS to deal with difficulties and frustrations that they have encountered in their life.

Abstract: This study investigated the possibility of developing the mentalization capacity in the psychotherapy of children who suffered abuse. Based on psychoanalytic theory and studies in reflective function and mentalization capacity, we carried out a qualitative study, guided by the clinical method. The procedure adopted was the Multiple Case Study and the participants were two girls aged 10 and 12 years old and their caregivers. The instruments used to collect data were semi-structured interviews, Play Time, Fables Test and Manchester Child Attachment Story Task - MCAST, in addition to psychotherapy sessions. The MCAST was reapplied after the first 20 sessions of psychotherapy. The results showed insecure attachment, limited capacity for mentalization before psychotherapy and changes in mentalization after the first 20 sessions.

Abstract: Intersubjective analysts have made an important contribution to our current thinking regarding analyst-patient interaction and intersubjectivity has become a major influence in current American psychoanalysis. However, intersubjective and relational phenomena have not been integrated into the personality theory of psychoanalysis, as reflected currently in the structural theory/ ego psychology. Freud's theory of personality, as it has evolved into ego psychology, includes variables relating to the identical phenomena of human experience addressed by the relational and intersubjective analysts. The critiques of Freudian theory by these analysts evidence significant misperceptions about ego psychology. Intersubjective and relational processes are ego functions that can be subsumed within ego psychology without doing violence to their import. Intersubjectivity is the subjective experience of an interpersonal interaction that becomes part of intrapsychic structure. It is a component of the mentalization of int...