Abstract: Mentalization-based treatment (MBT) is a manualized, evidence-based psychodynamic psychotherapy technique originally developed and evaluated in work with patients with borderline personality disorder (BPD) in a partial hospital setting, but now applied to a variety of disorders in a range of settings. Mentalizing is the capacity to understand other people's and one's own behavior in terms of mental states. The MBT approach assumes that the acquisition of this capacity is influenced by the quality of early relationships with caregivers, including experience of trauma, that it is vulnerable to disruption under interpersonal stress, and that core symptoms of BPD can be understood in terms of impaired mentalizing capacity in the context of attachment relationships. MBT aims to facilitate mentalizing in the context of interpersonally challenging situations. Keywords: social cognition; attachment; mentalization; personality disorders

Abstract: Many adults with significant forms of mental illness, including psychosis and personality disorders, experience deficits in metacognition that are reflected in a limited ability to describe and think about their own mental states and those of others. Above and beyond experiencing symptoms specific to their disorder, they may be unaware of their own emotions, unable to see their own thoughts as subjective and fallible, and struggle to form complex self-representations of themselves as unique beings in the world. Similarly, they have difficulties grasping the thoughts, feelings, and intentions underlying the behavior of others. Moreover, these patients may be relatively unable to use knowledge about themselves and others to respond to psychological and interpersonal challenges. In this introduction to this JCLP: In Session issue on metacognition and mentalizing, we detail different ways to understand these deficits and discuss three unique challenges these present to treating clinicians.

Abstract: We studied potential determinants of the development of children's emotion understanding (EU) from age 4 to 6 in a Norwegian community sample (N = 974) using the Test of Emotion Comprehension. Interpersonal predictors included the accuracy of parental mentalization, parental emotional availability, and teacher-reported child social skills. Intrapersonal child factors were child gender and verbal skills. Overall, children's EU increased significantly over time. After adjusting for child gender, age-4 EU, and parental socio-economic status, greater child verbal and social skills and greater parental mentalization each uniquely predicted growth in EU. Results are discussed in terms of theory and research on children's EU and parents' emotion socialization.

Abstract: Borderline personality disorder (BPD) frequently co-occurs with mood disorders and each influences the course and response to treatment of the other, potentially reducing beneficial outcome. Mentalizing, the ability to infer one's own and others' mental states, is a key factor in both disorders, being a major component of affect regulation and self-identity as well as a central aspect of interpersonal relationships and social function. In this article, we suggest that using mentalization-based treatment may lead to better outcome by addressing the mentalizing problems arising from the dual pathway that leads from depressed mood and BPD to disruption of mentalizing. Some clinical interventions are described to address the mentalizing problems associated with depression and BPD.

Abstract: Attending to the academic and social/emotional developmental needs of students has and continues to be a significant challenge for teachers and relatively little research examining the impact of teacher empathy exists. Empathy is an important skill for educators to facilitate the creation of a positive learning environment with students and professional responsibilities of teachers to be empathic are defined in standards frameworks worldwide. Yet, defining empathy remains somewhat contested in the literature among philosophers, psychologists, anthropologists and neuroscientists. Empathy is not unitary, but rather is composed by experience, sharing, mind perception and mentalization. Simulating the mental states of others, or ‘mentalizing’, is a necessary component for empathic responding to others. Drawing on Fonagy’s mentalization model, we examine the conceptual links between: mentalization and empathy in teachers; whether empathy skills can be taught to teachers; and, implications for classroom practice.

Abstract: Dialectical Behavior Therapy (DBT) and Mentalization-Based Treatment (MBT) are two approaches to the treatment of borderline personality disorder (BPD). While DBT has the most empirical support, MBT has a small but significant evidence base. Dialectical behavior therapy synthesizes behaviorism, mindfulness, and dialectics, while MBT is conceptually anchored in psychoanalysis, attachment theory, cognitive neuroscience, and developmental psychopathology. While coming from strikingly different orientations, DBT and MBT therapists share more interventions and stances than one might suppose. The central purported active ingredient of MBT is the capacity to mentalize, which is crucial for the formation of secure attachment, and this ability is thought to be weak and unstable in individuals with borderline personality disorder. This article explores the question of whether or not mentalizing is already present in DBT practice, whether it would be compatible with DBT conceptually and practically, and whether a focus on mentalizing would be of use to the DBT therapists and their patients.

Abstract: This study investigated the impact of maternal reflective functioning (RF) and attachment security on children’s mentalization. The Adult Attachment Interview (AAI) was administered to mothers in a sample of 41 mother-preadolescent dyads. AAI transcripts were rated in terms of the Berkeley AAI System (Main & Goldwyn, 1998) and the Reflective Functioning Scale (RFS; Fonagy et al., 1998). Preadolescent mentalization was assessed using a semi-structured interview adapted from O’Connor & Hirsch (1999) and also by analyzing mental-state talk produced during an autobiographical interview. Relationships between maternal RF and children’s mentalization were analyzed, with consideration given to the different RFS markers and references to positive, negative, and mixed-ambivalent mental states. Children’s mentalization was positively correlated with the mother’s RF, particularly the mother’s ability to mentalize negative or mixed-ambivalent mental states. No significant differences in mentalization were observed between children of secure and insecure mothers.

Abstract: Objective:This paper provides an overview of mentalization-based therapy (MBT) Multiple strands of research evidence converge to suggest that affect dysregulation, impulsivity and unstable interpe

Abstract: Tracing the development of mentalizing is central to understanding how we come to learn about the mind. Barring significant biological or developmental abnormalities, we all come to form an understanding of the mind and mental states. But how does this happen, and what accounts for individual differences in abilities to reason about mental states (i.e., desires, feelings, intentions)? The first section of the present article brings together relevant developmental research to outline the normative developmental trajectory of mentalizing. The second section delves into attachment research to drive home the point that this fundamental human capacity develops in tandem with early attachment relationships, and underscores the fact that suboptimal attachment contexts can hinder the developmental progression of mentalizing. Biobehavioral mechanisms that have been proposed to mediate this developmental process are discussed in the third section, with a particular focus on the neuropeptide oxytocin.

Abstract: Responsive art making, using arts media to respond to the affect within the therapeutic context, is emerging as an important method in the clinical repertoire of art therapists working within health care settings in the UK. This article develops a rationale for the importance of responsive art making as an interactive mentalizing process that establishes relational change through the interactive art-making process. A clinical vignette helps to illustrate how the art response as a method of communication can be used when words have been unavailable, particularly in conditions of high affect arousal and avoidant attachment patterns. The article concludes that methods of responsive art making require further research and examination with a mental health population.

Abstract: In order to manage with the burden of mental health problems in the world we need to develop cost-effective and safe preventive interventions. Education about resilience to support the ability to cope with life challenges in general, may be a useful strategy. We consider the concepts of Theory of Mind and Mentalization to be relevant in this context. In this paper we describe a simple modular intervention program based on these concepts which can be tailored to specific needs and situations in individual therapy as well as group levels. The program has shown promising results in pilot studies and is now tested in controlled trials in settings such as schools and educational institutions, adults diagnosed with ADHD, and children in care.

Abstract: Objective:Impaired Theory of Mind (ToM) and insecure (adult) attachment styles have been found in persons with schizophrenia as well as in their healthy siblings. ToM refers to the ability to infer...

Abstract: Mentalization has developed through different waves and its definition has gradually changed. Through this process mentalization theorists have not taken a particular position on the philosophical ...

Abstract: People diagnosed with borderline personality disorder (BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy (MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training (MBT-S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or 'off the cuff' discussions. MBT-S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as 'deliberately difficult'. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT-S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT-S could be viewed as ideal as participants applauded its flexibility. The promotion of empathy also sees a move away from iatrogenic damage caused by unhelpful responses to self-harm. In the context of wider research, this study shows that staff nurses find the MBT-S skill set valuable in the generic inpatient setting of acute mental health.

Abstract: Maternal mind-mindedness, which is a measure of maternal mentalization involving mothers' speech, was examined as a predictor of mothers' mirroring of infant behavior during interaction. Five-month-old infants and their mothers engaged in a Still-Face Task in which the mother's mirroring of the infant's behavior was assessed. After the task, the mother was shown a video of her infant in the task and asked to comment on what was happening for her infant; her comments were assessed for mind-mindedness. Maternal mind-mindedness when mothers were asked to reflect upon what was happening for their infants during the task predicted mothers' mirroring behaviors while engaged with their infants in the task. Maternal mirroring behavior may be a manifestation of maternal mentalization that is salient to infants.

Abstract: The British Association of Play Therapists (BAPT) provides a definition of play therapy (PT) that emphasizes humanistic ideals such as using nondirective play techniques to enable the child’s inner resources to bring about growth and change. These therapeutic change processes have never been submitted to empirical testing, partly because of the paucity of valid, reliable instruments to assess child psychotherapy process. Identifying empirically supported change processes is crucial to discovering which change processes work for which child. For example, children with Asperger’s disorder have deficits in mentalization—the ability to interpret behaviors of self and others as motivated by underlying mental states. Would a mentalization-informed PT approach or a traditional PT approach be more effective in treating such patients? The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a psychotherapy session. Items reflect a wide range of therapist attitudes and behaviors, patient attitudes and behaviors, and interactions between therapist and patient. To characterize PT process, 24 BAPT play therapists were asked to use the CPQ to rate the prototypical PT session based on their knowledge of PT operationalized by the BAPT definition. Findings indicated that according to these 24 raters, a therapist who is sensitive to the child’s feelings and level of development characterizes British PT. Two therapists treating a child with Asperger’s disorder over 2 years decreased their session adherence to PT

Abstract: Attachment theory was built by Bowlby as an attempt to link psychoanalysis with the wider world of ethology, cybernetics and evolutionary theory. Initially rejected by the psychoanalytic establishment there has been a gradual rapprochement. This paper attempts to accelerate this process by laying out the points of overlap and distinction between the attachment and psychoanalytic perspectives on clinical treatment. It summarizes the main tenets of attachment theory and then looks in detail at the therapeutic alliance, classification, transference/countertransference, and interpretation and mentalizing from an attachment perspective. A clinical example illustrates how insecure and secure attachment play out in the consulting room, and the paper ends by suggesting that attachment provides a suitable evidence base for the relational/Independent psychoanalytic approach.

Abstract: Working with parents has often been a neglected area in the field of child psychoanalysis. However, in the last three decades new conceptualizations regarding ways of working with parents have emerged in the field. This article explores ways of approaching our work with parents by integrating existing psychodynamic approaches under the conceptual umbrella of contemporary attachment research and practice.

Abstract: This article presents a clinical illustration of a mentalization-based approach to the development of a therapeutic alliance in the treatment of schizophrenia. A clinically focused overview of the attachment-based understanding of mentalization central to the mentalization-based treatment model is first provided. This is followed by a brief summary of the theory and evidence supporting the possible link between attachment disturbances and deficits of mental state understanding in schizophrenia. A case presentation then illustrates the application of core mentalization-based principles and interventions to enhance the therapeutic alliance by addressing disruptions of mentalization and reducing paranoia in the treatment of a patient with early course schizophrenia.

Abstract: This study investigated the structure of mentalization (Bateman & Fonagy, 2012) in a training context. The dual purpose was to evaluate the effectiveness of practicum student training and whether the Linguistic Inquiry method (Pennebaker, 2000) could be used to evaluate the three dimensions of mentalization — relational, cognitive, and emotional. The training utilized the groups and their accounts as devices and mediators to conceptualize the relationship between self-mentalizing training, the academic context and the practicum experience. Accounts from 38 Italian students pursuing master degree in Clinical, Dynamic, and Community Psychology were analyzed by LIWC software. The Wilcoxon test showed a significant increase in mentalizing words during the middle and end of the term, as compared with the beginning. The results displayed a need to promote mentalization within academic settings and indicated the value of this competence for clinical psychology.

Abstract: Objective: The add-on intervention "metacognitive training for borderline patients (B-MCT)" targets cognitive biases in patients with borderline personality disorder (BPD). We aimed to evaluate acceptance, feasibility, and subjective use of this group intervention. Methods: Forty-eight inpatients with BPD were randomly assigned to 8 sessions of B-MCT versus an active control intervention (progressive muscle relaxation). Subjective use was assessed after 4 weeks. Results: B-MCT yielded significantly superior scores relative to the control group on several parameters, for example, use, fun, recommendation, and subjective improvements in symptomatology and cognitive abilities (e.g., perspective taking). Conclusions: The trial provides preliminary evidence for the acceptance and feasibility of metacognitive training in BPD. However, randomized controlled trials with larger samples and symptomatic outcomes are needed to investigate the specific impact of B-MCT on psychopathology and cognition.Keywords: borderline personality disorder; cognitive biases; metacognitive training; cognitionAlong with the cardinal symptom of affect dysregulation (Linehan, 1993), borderline personality disorder (BPD) may also manifest as impulsivity, problems with social interaction, and behavioral disorders (e.g., self-harm) as well as deficits in cognitive functioning, such as dissociative symptoms. Since the 1990s, a growing interest in cognitive processes in BPD has led to a more profound investigation of different facets of social cognition (e.g., theory of mind, interpersonal behavior, trust, and cooperation) and cognitive biases, that is, altered information processing as, for example, dichotomous thinking (for reviews, see Baer, Peters, EisenlohrMoul, Geiger, & Sauer, 2012; Dinsdale & Crespi, 2013). Distorted thinking styles seem to be related with difficulties in interpersonal functioning, frequently found among patients with BPD (Arntz & ten Haaf, 2012; Lazarus, Cheavens, Festa, & Zachary Rosenthal, 2014).Promising psychotherapeutic options have been developed (Barnicot et al., 2012; Stoffers et al., 2012), which target deficits in the ability to interpret behavior based on underlying mental states (mentalization-based therapy [MBT]; Bateman & Fonagy, 2004) or problems in interpersonal relations (e.g., dialectical behavior therapy [DBT]; Linehan, 1993). The available forms of psychotherapy provide symptom relief for a large proportion of the patients. However, they often do not lead to recovery (Zanarini et al., 2014). Many patients with partial BPD continue to suffer from significant psychological strain, poor quality of life, and impairments in psychosocial functioning (Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). In light of suboptimal therapy response of many patients and high costs of treatment (Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008), it has become evident that there is a need for cost-effective and low-threshold measures to complement treatment options. Such an add-on concept was recently developed in form of the open-group metacognitive training for borderline patients (B-MCT; for a description of the training modules, see "Instruments" section and the Appendix). The training is derived from units of the metacognitive training for schizophrenia patients (MCT; for a review, see Moritz et al., 2014), which had been adjusted to address the specific dysfunctional thought patterns of patients with BPD. The B-MCT represents a complementary intervention for evidence-based standard treatments (especially DBT), which targets cognitive biases (e.g., Moritz et al., 2011; Schilling et al., 2012) in an entertaining manner. The intervention is thought to enhance metacognitive awareness (i.e., being aware of one's dysfunctional thinking styles). Patients are encouraged in rethinking premature conclusions and in considering alternative explanations (for a description of the training, see "Metacognitive Training for Borderline Patients" section, Appendix, and http://www. …

Abstract: The introduction of the concept of mentalization in psychological science by Fonagy and colleagues has opened up new perspectives for the understanding of psychopathology, psychotherapy, and child ...

Abstract: Borderline personality disorder (BPD) and mood disorders are highly comorbid, and both disorders share important developmental pathways and underlying neurobiological features. This chapter reviews evidence for the overlap between BPD and mood disorders and presents an attachment and mentalizing approach to the conceptualization and treatment of depressed patients and without marked BPD features. We propose that patients with BPD and mood disorders can be situated on a continuum, with four related features distinguishing individuals with depression with, versus without, marked BPD features: (a) the nature of their depressive experiences; (b) the nature of their mentalizing impairments; (c) the presence of insecure, but organized, attachment in response to stress and arousal versus disorganized attachment; and (d) problems with epistemic trust versus epistemic hypervigilance. We outline the therapeutic implications of these views, arguing that treatments that combine a mental representation and mental process (i.e., mentalizing) focus may be most appropriate for patients with mood problems without marked BPD features. Yet, for patients with more marked BPD features, these treatments may be iatrogenic, as these patients may have serious problems in establishing a therapeutic alliance and lack the reflective capacities needed for such treatments. For these patients, a mental process approach that focuses on restoring the capacity for mentalizing might be more appropriate. Preliminary empirical evidence supporting these assumptions is presented.

Abstract: Objectives:A proof-of-concept study over an 18-month period to determine whether a mentalization-based intervention (MBI) in a metropolitan community mental health service, when added to a recovery...

Abstract: Children and adolescents in foster care settings are at risk for development of emotional and behavioral problems due to a history of traumatic experiences combined with constant changes in their living environment with frequent shifts in caregivers, creating challenges in forming secure attachments. There has been a wealth of research evidence highlighting the importance of secure attachments in promoting the development of healthy mentalization abilities (Fonagy et al., 1991; Fonagy & Target, 2006), which facilitate the processing of traumatic experiences (Sharp, Fonagy, & Allen, 2013). Mentalization is the ability to think about and interpret self and others in terms of mental states (Luyten & Fonagy, 2009). Given the established link between traumatic experiences including child maltreatment with impaired mentalization abilities (Allen, 2013; Fonagy & Luyten, 2009; Ensink et al., 2014a; Ensink et al., 2014b), a mentalization-based approach to the treatment and care of youth is important to implement i...

Abstract: The aim of this study was to examine both the change in attachment state of mind and mentalization competencies as outcomes of a two-year weekly psychodynamic psychotherapy of a female adolescent with anorexia nervosa. The Attachment Interview for Childhood and Adolescence (AICA) was administered at pre and post-treatment, and coded both with the attachment coding system and the Reflective Functioning (RF) scale. At the pre-treatment, the anorexic adolescent was assessed as insecure dismissing with very low level of RF, while in the post-treatment a secure attachment model and higher RF were highlighted. The AICA can be considered a useful method to assess the outcomes in adolescent psychotherapy, like the AAI is useful in adult psychotherapy.

Abstract: This article explores the psychological profile and treatment of young people who present clinically with features of borderline and avoidant personality disorder, along with vulnerable narcissistic traits. Self-harm in these youngsters is often used to regulate internal storms. It is argued that the adolescent phase of development is a trigger point for collapse in these vulnerable young people. In therapy, these patients are difficult to connect with emotionally and treatment can be fraught with strong countertransference reactions. A case study is used to illustrate the use of mentalization-based treatment for adolescents for such individuals.

Abstract: Mentalization can be defined as the capacity to understand implicitly and explicitly our own behaviour and that of others to underline mental states and intentions. It implies the capacity to be aware about mental states and to use this awareness to regulate affects and negotiate interpersonal relationships. Mentalization-based treatment (MBT) is a therapeutic approach that has demonstrated its efficacy in the treatment of borderline personality disorder [1]. As far as we know, no clinical trials have been published on the efficacy of MBT applied to ED [2]. MBT applied to ED has not only purpose to reduce symptoms, but also to enhance the psychological and social competences that are involved in understanding both one’s own and other people’s minds, and, hence, to improve affective regulation. The principal aim of our study is to assess the efficacy of MBT applied to anorexia nervosa (AN) and bulimia nervosa (BN), not only in the reduction of symptoms, but also to reinforce social and psychological skills. To carefully evaluate MBT, we compared the results with those obtained with a short-term psychodynamic treatment (SPT). Methods