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An Integrative-Relational Approach in Schizophrenia: From Philosophical Principles to Mentalization-Based Practice

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Schizophrenia and Common Sense

Part of the book series: Studies in Brain and Mind ((SIBM,volume 12))

Abstract

In this paper, we explore psychosis and schizophrenia as prototype disturbances, where mentalizing failures are widely seen. We attempt to describe how the process of rekindling mentalizing within attachment relationships (here, the patient-therapist relationship) can have a protective effect not just on the onset of the disturbance, but also when psychosis is already actively installed. We start by discussing mentalizing in training, practice and supervision. We also try to understand it contextually, as a relational concept, within the history of psychological therapies.

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References

  • Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • Arnedo, J., Svrakic, D. M., Del Val, C., Romero-Zaliz, R., Hernandez-Cuervo, H., Genetics, Molecular, et al. (2015). Uncovering the hidden risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. The American Journal of Psychiatry, 172(2), 139–153.

    Article  Google Scholar 

  • Aron, L. (1996). A meeting of minds. Hillsdale, MI: The Analytic Press.

    Google Scholar 

  • Badiou, A. (1989). Manifesto for philosophy. New York: State University Press.

    Google Scholar 

  • Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, MA: Bradford MIT Press.

    Google Scholar 

  • Bartels-Velthuis, A. A., Blijd-Hoogewys, E. M., & van Os, J. (2011). Better theory-of-mind skills in children hearing voices mitigate the risk of secondary delusion formation. Acta Psychiatrica Scandinavica, 124, 193–197. https://doi.org/10.1111/j.1600-0447.2011.01699.x

    Article  Google Scholar 

  • Bateman, A. W., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization based treatment. Oxford, UK: Oxford University Press.

    Book  Google Scholar 

  • Bateman, A. W., & Fonagy, P. (2006). Mentalization-based treatment for borderline personality disorders – a practical guide. Oxford, UK: Oxford University Press.

    Book  Google Scholar 

  • Bateman, A. W., & Fonagy, P. (2012). Handbook of mentalizing in mental health practice. Arlington, TX: American Psychiatric Publishing.

    Google Scholar 

  • Bateman, A. W., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders: A practical guide. Oxford, UK: Oxford University Press.

    Book  Google Scholar 

  • Bateman, A. W., Fonagy, P., & Luyten, P. (2012). Introduction and overview. In A. W. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 3–42). Arlington, TX: American Psychiatric Publishing.

    Google Scholar 

  • Bateman, A. W., O’Connell, J., Lorenzini, N., Gardner, T., & Fonagy, P. (2016). 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, 16(1), 936–912. https://doi.org/10.1186/s12888-016-1000-9

  • Bion, W. R. (1962). Learning from experience. London: Heinemann.

    Google Scholar 

  • Brent, B. K. (2009). Mentalization-based psychodynamic psychotherapy for psychosis. Journal of Clinical Psychology, 65(8), 803–814.

    Article  Google Scholar 

  • Brent, B. K, & Fonagy, P (2014). A mentalization-based treatment approach to disturbances of social understanding in schizophrenia. In P. Lysaker, G. Dimaggio, M. Brune (Ed.), Social cognition and metacognition in schizophrenia: Psychopathology and treatment approaches (Chapter: 15, pp. 245–259). Elsevier Science & Technology.

    Google Scholar 

  • Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: Ontogeny, assessment, and application in the treatment of borderline personality disorder. The American Journal of Psychiatry, 165, 1127–1135. https://doi.org/10.1176/appi.ajp.2008.07081360

    Article  Google Scholar 

  • Clemmensen, L., van Os, J., Drukker, M., Munkholm, A., Rimvall, M. K., Vaever, M., et al. (2016). Psychotic experiences and hyper-theory-of-mind in preadolescence—A birth cohort study. Psychological Medicine, 46, 87–101. https://doi.org/10.1017/s0033291715001567

    Article  Google Scholar 

  • Clemmensen, L., van Os, J., Skovgaard, A. M., Vaever, M., Blijd-Hoogewys, E. M., Bartels-Velthuis, A. A., et al. (2014). Hyper-theory-of-mind in children with psychotic experiences. PLoS One, 9, e113082. https://doi.org/10.1371/journal.pone.0113082

    Article  Google Scholar 

  • Debbané, M., & Barrantes-Vidal, N. (2015). Schizotypy from a developmental perspective. Schizophrenia Bulletin, 41, S386–S395. https://doi.org/10.1093/schbul/sbu175

    Article  Google Scholar 

  • Debbané, M., Benmiloud, J., Salaminios, G., Solida-Tozzi, A., Armando, M., Fonagy, P., et al. (2016). Mentalization-based treatment in clinical high-risk for psychosis: A rationale and clinical illustration. Journal of Contemporary Psychotherapy, 1–9. https://doi.org/10.1007/s10879-016-9337-4

  • Debbané, M., Salaminios, G., Luyten, P., Badoud, D., Armando, M., Solida-Tozzi, A., et al. (2016). Attachment, neurobiology, and mentalizing along the psychosis continuum. Frontiers in Human Neuroscience, 10, 73–22. https://doi.org/10.3389/fnhum.2016.00406

  • Debbané, M., Van der Linden, M., Gex-Fabry, M., & Eliez, S. (2009). Cognitive and emotional associations to positive schizotypy during adolescence. Journal of Child Psychology and Psychiatry, 50, 326–334. https://doi.org/10.1111/j.1469-7610.2008.01961.x

    Article  Google Scholar 

  • Debbané, M., Van der Linden, M., Glaser, B., & Eliez, S. (2008). Source monitoring for actions in adolescents with 22q11.2 deletion syndrome (22q11DS). Psychological Medicine, 38, 811–820. https://doi.org/10.1017/S003329170700222X

    Article  Google Scholar 

  • Fairbairn, W. R. D. (1952). An object-relations theory of the personality. New York: Basic Books.

    Google Scholar 

  • Fonagy, P. (1991). Thinking about thinking: Some clinical and theoretical considerations in the treatment of a borderline patient. The International Journal of Psycho-Analysis, 72, 639–656.

    Google Scholar 

  • Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy (Chicago, Ill.), 51, 372–380. https://doi.org/10.1037/a0036505

    Article  Google Scholar 

  • Fonagy, P., & Bateman, A. W. (2016). Adversity, attachment, and mentalizing. Comprehensive Psychiatry, 64, 59–66.

    Article  Google Scholar 

  • Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.

    Google Scholar 

  • Foucault, M. (1972). Histoire de la Folie a L’Age Classic. Paris: Gallimard.

    Google Scholar 

  • Foucault, M. (1975). Surveiller et Punir: Naissance de la prison. Paris: Gallimard.

    Google Scholar 

  • Freud, S. (1895). Project for a scientific psychology. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (S. E.) (Vol. 1, pp. 283–397). London: Hogarth Press.

    Google Scholar 

  • Freud, S. (1914). On narcissism: An introduction. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (S. E.) (Vol. 14, pp. 67–104). London: Hogarth Press.

    Google Scholar 

  • Freud, S. (1933). New introductory lectures on psycho-analysis. The standard edition of the complete psychological works of Sigmund Freud, Volume XXII, pp. 1–182.

    Google Scholar 

  • Ghent, E. (1989). Credo: The dialectics of one-person and two-person psychologies. Contemporary Psychoanalysis, 25, 200–237.

    Article  Google Scholar 

  • Gilbert, & Orlans. (2011). Integrative therapy: 100 key points and techniques. London: Routledge.

    Google Scholar 

  • Goerlich, K. S., Aleman, A., Martens, S., & Hooker, C. (n.d.) (manuscript in preparation). I know how you’ll feel: Affective mentalizing in alexithymia, an fMRI study [Online]. Available from dissertations.ub.rug.nl/FILES/faculties/medicine/2011/k.s.../05c5.pdf. Accessed 23 Mar 2016.

  • Goffman, E. (1959). The presentation of self in everyday life. New York: Anchor Books.

    Google Scholar 

  • Green, M. F., Horan, W. P., & Lee, J. (2015). Social cognition in schizophrenia. Nature Reviews Neuroscience, 16(10), 620–631. https://doi.org/10.1038/nrn4005

  • Heidegger, M. (1962). Being and time. Oxford, UK: Blackwell Publishing.

    Google Scholar 

  • Jewell, T., Collyer, H., Gardner, T., Tchanturia, K., Simic, M., Fonagy, P., & Eisler, I. (2015). Attachment and mentalization and their association with child and adolescent eating pathology: A systematic review. The International Journal of Eating Disorders, 49(4), 354–373. https://doi.org/10.1002/eat.22473

  • Jurist, E. L., Slade, A., & Bergner, S. (2008). Mind to mind; infant research, neuroscience, and psychoanalysis. New York: Other Press.

    Google Scholar 

  • Kim, H. S., Shin, N. Y., Jang, J. H., Kim, E., Shim, G., Park, H. Y., et al. (2011). Social cognition and neurocognition as predictors of conversion to psychosis in individuals at ultra-high risk. Schizophrenia Research, 130, 170–175. https://doi.org/10.1016/j.schres.2011.04.023

    Article  Google Scholar 

  • Klein, M. (1945). The Oedipus complex in the light of early anxieties. In: Love, guilt and reparation and other works: The writings of Melanie Klein (Vol. 1, pp. 370–419). Hogarth Press, 1975.

    Google Scholar 

  • Kohut, H. (1977). The restoration of the self. New York: International Universities Press.

    Google Scholar 

  • Luyten, P., van Houdenhove, B., Lemma, A., Target, M., & Fonagy, P. (2012). A mentalization-based approach to the understanding and treatment of functional somatic disorders. Psychoanalytic Psychotherapy, 26(2), 121–140. https://doi.org/10.1080/02668734.2012.678061

  • Lysaker, P. H., Leonhardt, B. L., Pijnenborg, M., van Donkersgoed, R., de Jong, S., & Dimaggio, G. (2014). Metacognition in schizophrenia spectrum disorders: Methods of assessment and associations with neurocognition, symptoms, cognitive style and function. The Israel Journal of Psychiatry and Related Sciences, 51(1), 54–62.

    Google Scholar 

  • Lysaker, P. H., Vohs, J., Hillis, J. D., Kukla, M., Popolo, R., Salvatore, G., et al. (2014). Poor insight into schizophrenia: Contributing factors, consequences and emerging treatment approaches. Expert Review of Neurotherapeutics, 13(7), 785–793. https://doi.org/10.1586/14737175.2013.811150

  • Marty, P. (1968). A major process of somatization: The progressive disorganization. International Journal of Psychoanalysis, 49, 246–249.

    Google Scholar 

  • Marty, P. (1991). Mentalisation et psychosomatique. Paris: Synthélabo.

    Google Scholar 

  • Mitchell, S. (2000). Relationality. Hillsdale, NJ: The Analytic Press.

    Google Scholar 

  • Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., et al. (2013). Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: The PACE 400 study [Evaluation studies research support, non-US Gov’t]. JAMA Psychiatry, 70(8), 793–802.

    Article  Google Scholar 

  • Pereira, J. G. (2010). Transference and the therapeutic relationship – working for or against it? Grupanaliseonline [online]. Available at: http://grupanalise.pt/en/images/stories/revistaonline_ingls/Transference_and_the_Therapeutic__Relationship_working_for_or_against_it.pdf. Accessed 14 Nov 2016.

  • Pereira, J. G. (2014). What Works in Mentalization Based Treatment: systematic case studies in personality disorder and addictions. Unpublished doctoral dissertation. London: Middlesex University.

    Google Scholar 

  • Pereira, J. G. (2015). An integrative-relational framework of intervention at Casa de Alba: Therapeutic community for severe mental health problems. British Journal of Psychotherapy Integration, 11(2), 37–52.

    Google Scholar 

  • Peters, E., Ward, T., Jackson, M., Morgan, C., Charalambides, M., McGuire, P., et al. (2016). Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care”. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 15(1), 41–52. https://doi.org/10.1002/wps.20301

  • Piskulic, D., Liu, L., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., McGlashan, T. H., et al. (2016). Social cognition over time in individuals at clinical high risk for psychosis: Findings from the NAPLS-2 cohort. Schizophrenia Research, 171, 176–181. https://doi.org/10.1016/j.schres.2016.01.017

    Article  Google Scholar 

  • Read, J., & Gumley, A. (2010). Can attachment theory help explain the relationship between childhood adversity and psychosis? In S. Benamer (Ed.), Telling stories? Attachment based approach to the treatment of psychosis (pp. 51–94). London: Karnac Books.

    Google Scholar 

  • Rudrauf, D. (2014). Structure-function relationships behind the phenomenon of cognitive resilience in neurology: Insights for neuroscience and medicine. Advances in Neuroscience, 4, 1–28.

    Article  Google Scholar 

  • Sartre, J. P. (1992). Being and nothingness. New York: Gallimard. (first published in 1943).

    Google Scholar 

  • Schultze-Lutter, F., & Koch, E. (2010). Schizophrenia proneness instrument: Child and youth version (SPI-CY). Rome: Fioriti.

    Google Scholar 

  • Stolorow, R., & Atwood, G. (1992). Contexts of being: The intersubjective foundations of psychological life. Hillsdale, NJ: The Analytic Press.

    Google Scholar 

  • Van Donkersgoed, R. J. M., De Jong, S., Van der Gaag, M., Aleman, A., Lysaker, P. H., Wunderink, L., et al. (2014). A manual-based individual therapy to improve metacognition in schizophrenia: Protocol of a multi-center RCT. BMC Psychiatry, 14, 27.

    Article  Google Scholar 

  • Weijers, J., Kate Ten, C., Eurelings-Bontekoe, E., Viechtbauer, W., Rampaart, R., Bateman, A. W., et al. (2016). Mentalization-based treatment for psychotic disorder: Protocol of a randomized controlled trial. BMC Psychiatry, 1–10. https://doi.org/10.1186/s12888-016-0902-x

  • Winnicott, D. W. (1962). Ego integration in child development. In The maturational processes and facilitating environment (pp. 56–63). London: Hogarth Press.

    Google Scholar 

  • Wittgenstein, L. (1953). Philosophical investigations. Malden, MA: Blackwell.

    Google Scholar 

  • Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell’Olio, M., et al. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. The Australian and New Zealand Journal of Psychiatry, 39, 964–971. https://doi.org/10.1080/j.1440-1614.2005.01714.x

    Article  Google Scholar 

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Pereira, J.G., Debbané, M. (2018). An Integrative-Relational Approach in Schizophrenia: From Philosophical Principles to Mentalization-Based Practice. In: Hipólito, I., Gonçalves, J., Pereira, J. (eds) Schizophrenia and Common Sense. Studies in Brain and Mind, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-319-73993-9_12

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