There is a growing interest in psychotherapeutic approaches to pre-psychotic high-risk states or first-episode psychosis, where mentalization-based treatment has shown its utility. This article presents a mentalization-based approach for the treatment of those individuals diagnosed with an evolved schizophrenia spectrum disorder, whose characteristics make them especially inaccessible to reflective psychotherapeutic treatment. A synthesis of the conceptual frameworks that justify the needs for technical modification of the mentalization-based treatment foundational techniques is carried out, followed by the proposal of adaptations, with a focus in self-agency and patient-therapist dyad. Therapeutic interventions are outlined, including illustrative examples. The mentalizing approach presented here holds promise for future research and treatment opportunities for patients with evolved schizophrenia and other serious mental disorders.
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http://dx.doi.org/10.3389/fpsyt.2024.1240393 | DOI Listing |
Psychodyn Psychiatry
December 2024
Professor of Psychological Therapies with Children and Young People, University College London, UK; Director of the Child Attachment and Psychological Therapies Research Unit (ChAPTRe); Director of the Child Attachment and Psychological Therapies Research Unit (ChaPTRe), Anna Freud, London.
It is now more than 30 years since Peter Fonagy published his classic 1991 paper introducing the concept of "mentalization" into the psychoanalytic literature, and in the period since then mentalization-based treatment (MBT) has emerged as an important therapeutic approach. In reviewing the history of this treatment, it is often assumed that MBT emerged at the interface between three domains: first, the developmental research on theory of mind; second, the clinical challenges of treating borderline personality disorder; and third, the empirical research on intergenerational patterns of attachment. This article suggests that there was one more domain, which was equally important to the development of MBT and which is perhaps less widely recognized.
View Article and Find Full Text PDFEpistemic trust-trust in the relevance and utility of social learning-is central to helping processes between clients and workers in helping services. Yet, due to their experiences, clients may develop predispositions toward stances of epistemic mistrust or epistemic credulity. From an AMBIT (adaptive mentalization-based integrative treatment) perspective, this article argues that epistemic mistrust and credulity are both social injustice and further social injustice.
View Article and Find Full Text PDFPsychodyn Psychiatry
December 2024
Research Department of Clinical, Educational and Health Psychology, University College, London, UK; The Anna Freud Centre, London, UK.
This article reviews an approach to working with families that grounds in systemic thinking the framework of mentalization-based treatment. Employing a mentalizing stance, this approach aims to interrupt coercive, nonmentalizing cycles of interaction within the family system and replace them with mentalizing conversations in which epistemic trust and the shared social-emotional learning of the we-mode can be generated. The process thus promoted is a spiral of shared attention and co-mentalizing, constantly lost and then recovered, in which therapist and family members learn to hear, recognize, understand, and trust one another and repair the inevitable disruptions in mentalizing and trust that allow family members to experience a way of shared knowing- the we-mode-that they can apply to communicate and solve problems both within the family system and in the broader social systems in which the family is embedded.
View Article and Find Full Text PDFPsychodyn Psychiatry
December 2024
Division of Child and Adolescent Psychiatry, Department of Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
This article seeks to further specify how the mentalization-based approach may inform clinical intervention before the onset of psychosis, that is, during the stage of clinical high-risk for psychosis (CHR-P). We first review the concept of CHR-P, as well as the research evidence of the impact of early intervention. Next, we present evidence for the centrality of mentalizing as a process that may mitigate the risk for psychosis.
View Article and Find Full Text PDFPsychodyn Psychiatry
December 2024
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Depression is a very common mental health problem in adolescence. Although over the past decades a number of psychological interventions for depression in adolescence have been developed and empirically evaluated, recent systematic reviews and meta-analyses suggest that there is considerable room for improvement of their effectiveness. This is particularly true for the treatment of adolescents with "complex" depression, that is, those where depression is embedded within broader personality and relational problems, often related to a history of attachment trauma.
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