Skip to main content
SpringerLink
Log in

The Assessment of Mentalization: Measures for the Patient, the Therapist and the Interaction

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

Mentalization has been clearly defined in the literature as a relational concept and yet in surveys and transcript-based measures it is almost universally treated as an individual capacity. That approach has value but may not capture the emergent nature of mentalization, as it is jointly constructed within a relational context. We report here on a critical evaluation of measurement approaches commonly used to conceptualize and assess mentalization and argue for the value of conversation analysis (CA) as an alternative approach. A variety of approaches have been shown to have utility in assessing mentalization as an individual capacity. We illustrate how conversation analysis allows for an in-depth-analysis of mentalization as it is co-created across different contexts in real-life therapy sessions. This method of analysis shifts the focus from content to process. Conversation analysis is a potentially valuable tool to support training, to assess treatment integrity, and to improve outcomes with mentalization-based interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Angus, L. E., & Kagan, F. (2013). Assessing client self-narrative change in emotion-focused therapy of depression: An intensive single case analysis. Psychotherapy, 50(4), 525–534.

    Article  Google Scholar 

  • Barreto, A. L., Fearon, R. M. P., Oso´rio, A., Meins, E., & Martins, C. (2016). Are adult mentalizing abilities associated with mind-mindedness? International Journal of Behavioral Development, 40(4), 296–301.

    Article  Google Scholar 

  • Bateman, A., & Fonagy, P. (2013). Mentalization-based treatment. Psychoanalytic Inquiry, 33(6), 595–613.

    Article  Google Scholar 

  • Bressi, C., Fronza, S., Minacapelli, E., Paola Nocito, E., Dipasquale, E., Magri, L., Lionetti, F., & Barone, L. (2017). Short-term psychodynamic psychotherapy with mentalization-based techniques in major depressive disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables—A Pilot study. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 299–313.

    Article  Google Scholar 

  • Davidsen, A. S., & Fosgerau, C. F. (2014). Mirroring patients—or not. A study of general practitioners and psychiatrists and their interactions with patients with depression. European Journal of Psychotherapy & Counselling, 17(2), 162–178.

    Article  Google Scholar 

  • Davidsen, A. S., & Fosgerau, C. F. (2015). Grasping the process of implicit mentalization. Theory & Psychology, 25(4), 434–454.

    Article  Google Scholar 

  • Diamond, D., Stovall-McClough, C., Clarkin, J. F., & Levy, K. N. (2003). Patient-therapist attachment in the treatment of borderline personality disorder. Bulletin of the Menninger Clinic, 67(3), 227–259.

    Article  Google Scholar 

  • Dilks, S., Tasker, F., & Wren, B. (2008). Building bridges to observational perspectives: A grounded theory of therapy processes in psychosis. Psychology and Psychotherapy: Theory, Research and Practice, 81(2), 209–229.

    Article  Google Scholar 

  • Dziobek, I., Rogers, K., Fleck, S., Bahnemann, M., Heekeren, H., Wolf, O., & Convit, A. (2008). Dissociation of cognitive and emotional empathy in adults with asperger syndrome using the multifaceted empathy test (MET). Journal of Autism and Developmental Disorders, 38(3), 464–473.

    Article  Google Scholar 

  • Edwards, D., & Potter, J. (2017). Some uses of subject-side assessments. Discourse studies, 19(5), 497–514.

    Article  Google Scholar 

  • Ekeblad, A., Falkenstrom, F., & Holmqvist, R. (2016). Reflective functioning as predictor of working alliance and outcome in the treatment of depression. Journal of Consulting & Clinical Psychology, 84(1), 67–78.

    Article  Google Scholar 

  • Ensink, K., Maheux, J., Normandin, L., Sabourin, S., Diguer, L., Berthelot, N., & Parent, K. (2013). The impact of mentalization training on the reflective function of novice therapists: A randomized controlled trial. Psychotherapy Research, 23(5), 526–538.

    Article  Google Scholar 

  • Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y.-W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The reflective functioning questionnaire. PLoS ONE, 11(7), e0158678. https://doi.org/10.1371/journal.pone.0158678.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning manual Version 5: For application to adult attachment interviews. London: University College.

    Google Scholar 

  • Freeman, C. (2016). What is mentalizing? An overview. British Journal of Psychotherapy, 32(2), 189–201.

    Article  Google Scholar 

  • Georgaca, E. (2003). Exploring signs and voices in the therapeutic space. Theory and Psychology, 13(4), 541–560.

    Article  Google Scholar 

  • Gratz, K., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.

    Article  Google Scholar 

  • Guilfoyle, M. (2016). Subject positioning: Gaps and stability in the therapeutic encounter. Journal of constructivist psychology, 29(2), 123–140.

    Article  Google Scholar 

  • Hales, S., Lo, C., & Rodin, G. (2015). Managing cancer and living meaningfully (CALM) therapy. In J. C. Holland, W. S. Breitbart, P. N. Butow, P. B. Jacobsen, M. J. Loscalzo & R. McCorkle (Eds.), Psycho-Oncology (pp. 487–491). New York: Oxford University Press.

    Google Scholar 

  • Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M., & Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: The difference one word can make. Journal of General Internal Medicine, 22(10), 1429–1433.

    Article  Google Scholar 

  • Jørgensen, C. R., Freund, C., Bøye, R., Jordet, H., Andersen, D., & Kjølbye, M. (2013). Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: A randomized trial. Acta Psychiatrica Scandinavica, 127(4), 305–317.

    Article  Google Scholar 

  • Karlsson, R., & Kermott, A. (2006). Reflective functioning during the process in brief psychotherapies. Psychotherapy: Theory, Research, Practice, Training, 43(1), 65–84.

    Article  Google Scholar 

  • Karterud, S., Pedersen, G., Engen, M., Johansen, M. S., Johansson, P. N., Schlüter, C., Urnes, O., Wilberg, T., & Bateman, A. (2013). The MBT adherence and competence scale (MBT-ACS): Development, structure and reliability. Psychotherapy Research, 23(6), 705–717.

    Article  Google Scholar 

  • Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychological Review, 34(2), 107–117.

    Article  Google Scholar 

  • Keselman, H., Cromdal, K. O., Kullgard, N., & Holmqvist, R. (2016). Responding to mentalization invitations in psychotherapy sessions—A conversation analysis approach. Psychotherapy Research, 28(4), 654–666. https://doi.org/10.1080/10503307.2016.1219422.

    Article  PubMed  Google Scholar 

  • Koster, A. (2017). Mentalization, embodiment, and narrative: Critical comments on the social ontology of mentalization theory. Theory & Psychology, 27(4), 458–476.

    Article  Google Scholar 

  • Kuipers, G. S., van Loenhout, Z., van der Ark, L. A., & Bekker, M. H. (2016). Attachment insecurity, mentalization and their relation to symptoms in eating disorder patients. Attachment & Human Development, 18(3), 250–272.

    Article  Google Scholar 

  • McCabe, R., Leudar, I., & Antaki, C. (2004). Do people with schizophrenia display theory of mind deficits in clinical interactions? Psychological Medicine, 34(3), 401–412.

    Article  CAS  Google Scholar 

  • Möller, C., Karlgren, L., Sandell, A., Falkenström, F., & Philips, B. (2016). Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence. Psychotherapy Research, 27(6), 749–765. https://doi.org/10.1080/10503307.2016.1158433.

    Article  PubMed  Google Scholar 

  • Palgi, S., Palgi, Y., Ben-Ezra, M., & Shrira, A. (2014). ‘‘I Will Fear no Evil, for I Am with Me’’: Mentalization-oriented intervention with PTSD patients. A case study. Journal of Contemporary Psychotherapy, 44(3), 173–182.

    Article  Google Scholar 

  • Robinson, P., Hellier, J., Barrett, B., Barzdaitiene, D., Bateman, A., Bogaardt, A., Clare, A., Somers, N., O’Callaghan, A., Goldsmith, K., Kern, N., Schmidt, U., Morando, S., Ouellet-Courtois, C., Roberts, A., Skårderud, F., & Fonagy, P. (2016). The NOURISHED randomised controlled trial comparing mentalisation-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, 17, 549.

    Article  Google Scholar 

  • Rodin, G., Lo, C., Rydall, A., Shnall, J., Malfitano, C., Chiu, A., Panday, T., Watt, S., An, E., Nissim, R., Li, M., Zimmermann, C., & Hales, S. (2018). Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. Journal of Clinical Oncology, 36(23), 2422–2432.

    Article  Google Scholar 

  • Rostad, W., & Whitaker, D. (2016). The association between reflective functioning and parent–child relationship quality. Journal of Child and Family Studies, 25(7), 2164–2177.

    Article  Google Scholar 

  • Safran, J. D., Muran, J. C., & Shaker, A. (2014). Research on therapeutic impasses and ruptures in the therapeutic alliance. Contemporary Psychoanalysis, 50(1–2), 211–232.

    Article  Google Scholar 

  • Shaw, C., Chrysikou, V., Lanceley, A., Lo, C., Hales, S., & Rodin, G. (2019). Mentalization in CALM psychotherapy sessions: Helping patients engage with alternative perspectives at the end of life. Patient Education and Counseling, 102(2), 188–197.

    Article  Google Scholar 

  • Shaw, C., Hepburn, A., & Potter, J. (2012). Having the last laugh: On post completion laughter particles. In P. Glenn & E. Holt (Eds.), On laughing: Studies of laughter in interaction (pp. 91–106). London: Bloomsbury Academic.

    Google Scholar 

  • Sperry, M. (2013). Putting our heads together: Mentalizing systems. Psychoanalytic Dialogues, 23(6), 683–699.

    Article  Google Scholar 

  • Vohs, J. L., & Leonhardt, B. L. (2016). Metacognitive reflection and insight therapy for borderline personality disorder: A case illustration of an individual in a long term institutional setting. Journal of Contemporary Psychotherapy, 46(4), 255–264.

    Article  Google Scholar 

Download references

Funding

This work was supported by the Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC). Funding was provided by University Health Network. Funding was provided by Canadian Institutes of Health Research with Grant No. (#MOP 106473). Funding was provided by Princess Margaret Cancer Foundation. Funding was provided by The Campbell Family Cancer Research Institute. Funding was provided by Ontario Cancer Institute. Funding was provided by Ontario Ministry of Health and Long-Term Care.

Author information

Authors and Affiliations

  1. Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada

    Chloe Shaw, Chris Lo, Sarah Hales & Gary Rodin

  2. UCL EGA Institute for Women’s Health, University College London, London, UK

    Chloe Shaw & Anne Lanceley

  3. Institute for Women’s Health, UCL, Rockefeller Building, 21 University Street, London, WC1E 6DE, UK

    Chloe Shaw

Authors
  1. Chloe Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chris Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Lanceley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sarah Hales
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gary Rodin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chloe Shaw.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

The CALM study received approval from University Health Network Research Ethics Board #09-0855-C. Patients and therapists gave written informed consent for their conversations to be recorded for research purposes. All identifying details have been replaced with pseudonyms.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shaw, C., Lo, C., Lanceley, A. et al. The Assessment of Mentalization: Measures for the Patient, the Therapist and the Interaction. J Contemp Psychother 50, 57–65 (2020). https://doi.org/10.1007/s10879-019-09420-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-019-09420-z

Keywords

Search

Navigation