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Chapter 12 - Mentalizing in Psychiatric Practice

from Section 2 - Other Forms of Psychotherapy

Published online by Cambridge University Press:  27 May 2021

By
Anthony W. Bateman
Edited by
Rachel Gibbons  and
Jo O'Reilly
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Summary

The concept of Mentalizing is a recent theoretical development that has made a major contribution to our understanding of, and capacity to clinically work with, patients with a variety of different disorders. This has been particularly significant in the treatment of borderline personality disorder (BPD). Mentalizing draws upon psychoanalytic, cognitive and relational models of psychological functioning, attachment theory and neuroscience. It is central to psychiatric practice for a number of reasons. First it is a transdiagnostic concept and so is applicable to a range of mental health conditions spanning childhood to old age [1]. Second its position as a well-developed component of the literature on neurobiology and higher-order cognition (HOC) gives it a central place in neuropsychiatry and cognitive psychology [2]. The component of HOC that is called mentalizing has the capacity to rearrange processes within the brain and assure ‘business as usual’ notwithstanding adverse conditions.Mentalizing increases resilience to adversity, protecting psychological vulnerable individuals from relapse, and improving therapeutic outcomes [5]. Focussing on mentalizing helps people consider how teams, systems and services interact to facilitate or undermine interventions and the delivery of services; a non-mentalizing team and system has a negative impact on clinical care by creating an environment that impedes the implementation of reliable and responsive pathways to care and the realisation of skillful treatment [6].

Type
Chapter
Information
Seminars in the Psychotherapies , pp. 147 - 160
Publisher: Cambridge University Press
Print publication year: 2021

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References

Bateman, A, Fonagy, P. Handbook of Mentalizing in Mental Health Practice. Washington DC: American Psychiatric Publishing, 2012.Google Scholar
Rudrauf, D. Structure-function relationships behind the phenomenon of cognitive resilience in neurology: insights for neuroscience and medicine. Adv Neurosci 2014; 2014: 1–28.Google Scholar
Sharp, C, Fonagy, P, Goodyer, I. Social Cognition and Developmental Psychopathology. Oxford: Oxford University Press, 2008.Google Scholar
Jurist, EJ. Mentalized affectivity. Psychoanal Psychol 2005; 22: 426–44.Google Scholar
Fonagy, P, Allison, E, Campbell, C. In Bateman, A, Fonagy, P, eds., Mentalizing, Resilience, and Epistemic Trust. Handbook of Mentalizing in Mental Health Practice, 2nd ed. Washington DC: American Psychiatric Association Publishing. 2019; pp. 63–77.Google Scholar
Bales, D, Verheul, R, Hutsebaut, J. Barriers and facilitators to the implementation of mentalization-based treatment (MBT) for borderline personality disorder. Personal Ment Health 2017; 11: 118–31.Google Scholar
Fonagy, P, Gergely, G, Jurist, EL, Target, M. Affect Regulation, Mentalization and the Development if the Self. New York: Other Press, 2002.Google Scholar
Fonagy, P, Luyten, P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 2009; 21: 1355–81.CrossRefGoogle Scholar
Lieberman, MD. Social cognitive neuroscience: a review of core processes. Annu Rev Psychol 2007; 58: 259–89.CrossRefGoogle ScholarPubMed
Fonagy, P, Bateman, A. The development of borderline personality disorder: a mentalizing model. J Pers Disord 2008; 22: 4–21.Google Scholar
Fonagy, P, Campbell, C, Bateman, A. Update on Diagnostic Issues for Borderline Personality Disorder. Psychiatric Times July 2016; 33(7).Google Scholar
Luyten, P, Fonagy, P, Lowyck, B, Vermote, R. Assessment of mentalization. In Bateman, A, Fonagy, P, eds., Handbook of Mentalizing in Mental Health Practice. Washington DC: American Psychiatric Association Publishing. 2012; pp. 43–66.Google Scholar
Sharp, C, Ha, C, Carbone, C et al. Hypermentalizing in adolescent inpatients: treatment effects and association with borderline traits. J Pers Disord 2013; 27: 3–18.Google Scholar
Ensink, K, Normandin, L, Target, M et al. Mentalization in children and mothers in the context of trauma: an initial study of the validity of the Child Reflective Functioning Scale. Br J Dev Psychol 2015; 33: 203–17.Google Scholar
Choi-Kain, LW, Fitzmaurice, GF, Zanarini, MC, Laverdiere, O, Gunderson, JG. The relationship between self-reported attachment styles, interpersonal dysfunction, and borderline personality disorder. J Nerv Ment Dis 2009; 197: 816–21.Google Scholar
Gunderson, J, Lyons-Ruth, K. BPD’s interpersonal hypersensitivity phenotype: a gene–environment–developmental model. J Pers Disord 2008; 22: 22–41.Google Scholar
Deckers, JW, Lobbestael, J, van Wingen, GA et al. The influence of stress on social cognition in patients with borderline personality disorder. Psychoneuroendocrinology 2015; 52: 119–29.Google Scholar
Berthelot, N, Ensink, K, Bernazzani, O et al. Intergenerational transmission of attachment in abused and neglected mothers: the role of trauma-specific reflective functioning. Infant Ment Health J 2015; 36: 200–12.Google Scholar
Luyten, P, Fonagy, P. Mentalizing and trauma. In Bateman, A, Fonagy, P, eds., Handbook of Mentalizing in Mental Health Practice, 2nd ed. Washington DC: American Psychiatric Association Publishing. 2019.Google Scholar
Weightman, MJ, Air, TM, Baune, BTFP. A review of the role of social cognition in major depressive disorder. Front Psychiatry 2014; 5: 179–83.Google Scholar
Luyten, P, Fonagy, P. The stress–reward–mentalizing model of depression: an integrative developmental cascade approach to child and adolescent depressive disorder based on the research domain criteria (RDoC) approach. Clin Psychol Rev 2018; 64: 87–98.CrossRefGoogle ScholarPubMed
Lemma, A, Target, M, Fonagy, P. Brief Dynamic Interpersonal Therapy: A Clinician’s Guide. Oxford: Oxford University Press, 2011.Google Scholar
Billeke, P, Boardman, S, Doraiswamy, PM. Social cognition in major depressive disorder: a new paradigm? Transl Neurosci 2013; 4: 437–47.CrossRefGoogle Scholar
Sharp, C, Vanwoerden, SJ Hypermentalizing in borderline personality disorder: a model and data. J Infant Child Adolesc Psychother 2015; 14: 33–45.Google Scholar
Fotopoulou, A, Tsakiris, M. Mentalizing homeostasis: the social origins of interoceptive inference. Neuropsychoanalysis 2017; 19: 3–28.Google Scholar
Hobson, P. Concerning knowledge of mental states. Br J Med Psychol 1990; 63: 199–214.CrossRefGoogle ScholarPubMed
Debbané, M, Benmiloud, J, Salaminios, G et al. Mentalization-based treatment in clinical high-risk for psychosis: a rationale and clinical illustration. J Contemp Psychother 2016; 46: 217–25.Google Scholar
Bion, WR. Differentiation of the psychotic from the non-psychotic personalities. Int J Psychoanal 1957; 38: 266–75.Google Scholar
Debbané, M, Salaminios, G, Luyten, P et al. Attachment, neurobiology, and mentalizing along the psychosis continuum. Front Hum Neurosci 2016; 10: 406.Google Scholar
Bateman, A, Fonagy, P. Mentalization Based Treatment: A Practical Guide. Oxford: Oxford University Press, 2006.Google Scholar
Bateman, A, Fonagy, P. Mentalization Based Treatment for Personality Disorders: A Practical Guide. Oxford: Oxford University Press, 2016.Google Scholar
Gabbard, G. When is transference work useful in dynamic psychotherapy. Am J Psychiatry 2006; 163(10): 1667–9.Google Scholar
Bateman, A, Fonagy, P. The effectiveness of partial hospitalization in the treatment of borderline personality disorder – a randomised controlled trial. Am J Psychiatry 1999; 156: 1563–9.Google Scholar
Bateman, A, Fonagy, P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry 2008; 165: 631–38.Google Scholar
Bales, D, van Beek, N, Smits, M et al. Treatment outcome of 18-month, day hospital mentalization-based treatment (MBT) in patients with severe borderline personality disorder in the Netherlands. J Pers Disord 2012; 26: 815–20.Google Scholar
Bales, DL, Timman, R, Andrea, H et al. Effectiveness of day hospital mentalization-based treatment for patients with severe borderline personality disorder: a matched control study. Clin Psychol Psychother 2015; 22: 409–17.CrossRefGoogle ScholarPubMed
Bales, D, Timman, R, Luyten, P, Busschbach, J, Verheul, R. Implementation of evidence-based treatments for borderline personality disorder: the impact of organizational changes on treatment outcome of mentalization-based treatment. Personal Ment Health 2017; 11(4): 266–77.Google Scholar
Petersen, B, Toft, J, Christensen, L et al. A 2-year follow-up of mentalization orientated group therapy following day hospital treatment for patients with personality disorders. Personal Ment Health 2010; 4: 294–301.CrossRefGoogle Scholar
Bateman, A, Fonagy, P. Randomized controlled trial of out-patient mentalization based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry 2009; 1666: 1355–64.Google Scholar
Bateman, A. Treating borderline personality disorder in clinical practice. Am J Psychiatry 2012; 169: 1–4.Google Scholar
Somma, A, Ferrara, M, Terrinoni, A et al. Hypermentalizing as a marker of borderline personality disorder in Italian adolescents: a cross-cultural replication of Sharp and colleagues’ (2011) findings. Borderline Personal Disord Emot Dysregulation 2019; 6: 5. doi:10.1186/s40479-019-0104-5.Google Scholar
Sharp, C, Kalpakci, A, Mellick, W. First evidence of a prospective relation between avoidance of internal states and borderline personality disorder features in adolescents. Eur Child Adolesc Psychiatry 2015; 24: 283–90.Google Scholar
Bo, S, Sharp, C, Beck, E et al. First empirical evaluation of outcomes for mentalization-based group therapy for adolescents with BPD. Personal Disord 2017; 8: 396–401.CrossRefGoogle ScholarPubMed
Rossouw, T, Fonagy, P. Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2012; 51: 1304–13.Google Scholar
Asen, E, Fonagy, P. Mentalization-based therapeutic interventions for families. J Fam Ther 2012; 34: 347–70.Google Scholar
Midgley, N, Alayza, A, Lawrence, H, Bellew, R. Adopting minds: a mentalization based therapy for families in a post-adoption support service: preliminary evaluation and service user experience. Adopt Foster 2018; 42: 22–37.Google Scholar
Bateman, A, Fonagy, P. A randomized controlled trial of a mentalization-based intervention (MBT-FACTS) for families of people with borderline personality disorder. Personal Disord 2019; 10(1): 70–9.Google Scholar
Bateman, A, Fonagy, P, Bolton, R. Antisocial personality disorder: a mentalizing framework. Focus (Am Psychiatr Publ) 2013; XI(2): 178–86.Google Scholar
Bateman, A, O’Connell, J, Lorenzini, N, Gardner, T, Fonagy, P. A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry 2016; 304: 304–11.Google Scholar
Philips, B, Wennberg, P, Konradsson, P, Franck, J. Mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: a randomise controlled feasibility study. Eur Addict Res 2018; 24: 1–8.CrossRefGoogle ScholarPubMed
Robinson, P, Hellier, J, Barrett, B et al. The NOURISHED randomised controlled trial comparing mentalization-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder. Trials 2016; 17: 549–63.Google Scholar
Fuggle, P, Bevington, D, Cracknell, L et al. The Adolescent Mentalization-based Integrative Treatment (AMBIT) approach to outcome evaluation and manualization: adopting a learning organization approach. Clin Child Psychol Psychiatry 2015; 20(3): 419–35.CrossRefGoogle ScholarPubMed
Asen, E, Campbell, C, Fonagy, P. Social systems: beyond the microcosm of the individual and family. In Bateman, A, Fonagy, P, eds., Handbook of Mentalizing in Mental Health Practice. Washington DC: American Psychiatric Association Publishing. 2019; pp. 229–43.Google Scholar

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