‘Rich’ and ‘poor’ in mentalizing: Do expert mentalizers exist?

Abstract

Mentalization theory is concerned with the capacity to notice, and make sense of, thoughts and feelings in self and others. This development may be healthy or impaired and therefore, by extension, it may be theorized that expertise in mentalizing can exist. Furthermore, a continuum from impairment to expertise should exist within separate dimensions of mentalizing: of self and of others. This study hypothesized that three groups would be distinguishable on the basis of their mentalizing capacities. In a cross-sectional design, Psychological Therapists (‘expert’ mentalizers; n = 51), individuals with a diagnosis of Borderline Personality Disorder (‘poor’ mentalizers; n = 43) and members of the general population (‘non-clinical controls’; n = 35) completed a battery of self-report measures. These assessed the mentalizing of self and of others (using an extended version of the Reflective Function Questionnaire (RFQ18)), alexithymia and cognitive empathy. As hypothesized, Psychological Therapists’ scores were higher than controls on self-mentalizing and control group scores were higher than those with BPD. Cognitive empathy scores in the BPD group indicated markedly lower capacities than the other two groups. Contrary to predictions, no significant differences were found between groups on mentalizing others in RFQ18 scores. The Psychological Therapist and BPD profiles were characterized by differential impairment with regards to mentalizing self and others but in opposing directions. Results suggest that the RFQ18 can identify groups with expertise in mentalizing. Implications of these results for the effectiveness of psychological therapy and of Psychological Therapists are discussed.

Does clinical training improve mentalization skills in future therapists? A comparison of first and last year students of clinical psychology and of engineering

“…Therapists in training have also been reported to have higher levels of mentalization skills than the population in general ( Klasen et al, 2019 ). Rogoff et al (2021) found that psychologists reported higher capacity for self-mentalization than the general population as measured by the RFQ18, although this study did not find any significant differences in self-reported capacity for mentalizing others between therapists, patients with borderline personality disorder, and members of the general population, which is quite counterintuitive. The authors argue that both therapists and patients with borderline personality disorder might have some impairments and enhancements of dimensions of mentalization, rendering such labels as “expert” and “poor” mentalization simplistic.…”

Mapping established psychopathology scales onto the Hierarchical Taxonomy of Psychopathology (HiTOP)

“…We included a plethora of measures designed to assess current or persistent signs, symptoms, and characteristic traits of mental disorders, including maladaptive personality traits and measures of personality functioning (see DeYoung et al, 2020, for how maladaptive personality traits are linked to HiTOP). The measures were the Autonomous Functioning Index (AFI; Weinstein et al, 2012), Antisocial Process Screening Device (APSD; Frick & Hare, 2001), Baratt Impulsiveness Scale (BIS‐11; Patton et al, 1995), Brief Symptom Inventory (BSI; Derogatis & Spencer, 1993), Drugs, Alcohol, and Self‐Injury Questionnaire (DASI; Wilkinson et al, 2018), Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986), Experiences in Close Relationships‐Revised (ECR‐R; Fraley et al, 2000), Empathy Quotient (EQ; Baron‐Cohen & Wheelwright, 2004), Green et al Paranoid Thoughts Scale (GPTS; Green et al, 2008), Inventory of Interpersonal Problems (IIP‐32; Horowitz et al, 2000), Life History of Aggression (LHA; Coccaro et al, 1997), Other as Shamer Scale (OAS; Goss et al, 1994), Operationalized Psychodynamic Diagnosis: Structure Questionnaire (OPD‐SQ; Ehrenthal et al, 2012), Personality Assessment Inventory – Borderline Scale (PAI‐BOR; Morey, 2014), Personality Assessment Inventory – Antisocial Scale (PAI‐ANT; Morey, 2014), Posttraumatic Stress Checklist Scale – Civilian Version (PCL‐C; Blanchard et al, 1996), Reflective Functioning Questionnaire – Extended 18‐Item Version (RFQ‐18; Rogoff et al, 2021), Standardized Assessment of Personality: Abbreviated Scale (SAPAS; Moran et al, 2003), Schizotypal Personality Questionnaire (SPQ; Raine, 1991), and Levenson Self‐Report Psychopathy Scale (SRPS; Levenson et al, 1995). For this study, scales were inverted when necessary, so that higher values were geared towards the maladaptive pole of a trait dimension indicating greater severity or impairment in the respective domain.…”

The Spanish version of the reflective functioning questionnaire: Validity data in the general population and individuals with personality disorders

“…The need for easy-to-apply and easy-to-score questionnaires arose. Accordingly, some instruments have been developed: (a) the Mentalizing Stories for Adolescents (MSA) [ 21 ], assessing RF in adolescents; (b) the Parental Reflective Functioning Questionnaire (PRFQ) [ 22 ], assessing PRF; and, (c) assessing RF in adults, the Mentalization Questionnaire (MZQ) [ 23 ], the Mentalization Scale (MentS) [ 24 ], the Certainty About Mental States Questionnaire (CAMSQ) [ 25 ], the Multidimensional Mentalizing Questionnaire (MMQ) [ 26 ], and the 8-item Reflective Functioning Questionnaire (RFQ-8) [ 27 ], which also has a 6-item version [ 28 , 29 ], a 15-item version (RFQ-15) [ 30 ], and a 18-item version (RFQ-18) [ 31 ]. Some modified versions of the RFQ have been developed for adolescents: the 8-item Reflective Functioning Questionnaire for Youth (RFQY) [ 4 ], the 23-item PFQY Scale B [ 32 ], and the 6-item RFQY Scale B [ 32 ].…”