In-Session Reflective Functioning: Relationship With the Presence and Depth of Work on Conflict or Personality Functioning.

Cecilia De La Cerda,Paula Dagnino

doi:10.3389/fpsyg.2021.725739

Abstract

Mentalizing, conceived as the capacity to attribute intentional mental states as implicit or underlying behavior of an individual or others, has gained interest within psychodynamic clinical research due to its potential as a change mechanism. Variations and qualities of mentalization have been studied through reflective functioning (RF). But only few studies are analyzing it throughout the psychotherapeutic interaction, identifying its level for therapists and patients. In contrast, brief psychodynamic therapy has a long tradition for establishing a focus to be worked upon. Lately, a multischematic focus has arisen, considering both conflict and personality functioning focuses as key elements on successful psychotherapies. This study aimed to identify mentalizing manifestations of patients and therapists through change episodes of one successful brief psychodynamic therapy and establish the relationship between these mentalizing manifestations and the type and depth of the therapeutic focus being worked on (conflict or personality functioning). Only 37.5% of speaking turns were able to be coded with RF; 77% of these had moderate to high RF and 22% had low or failure RF. The patient had 91% of low or failure RF, while the therapist only had 9% of low or failure RF. As for moderate to high RF, patients had 39%, while therapists had 61%. The patient showed a similar number of low or failure RF interventions and moderate to high RF interventions in conflict episodes. Meanwhile, the therapist only performs moderate to high-level RF interventions. In episodes in which personality functioning is worked on, both patient and therapist show a greater presence of interventions of moderate to high levels of RF. Finally, mentalizing interactions and non-mentalizing interactions were found on segments with conflict, and only mentalizing interactions were found on personality functioning segments.

Highlights

Authors from psychoanalysis (e.g., Luborsky, 1984; Green, 1975; Horowitz et al, 1993a,b; Green, 1996) postulate that the clinical approach on the psychodynamics of patients must be understood based on two different central thematics: intrapsychic conflicts and malfunctions or deficits in functioning (Killingmo, 1989, 1990; Schüßler, 2004; Dreher, 2005, 2006; Sugarman, 2006)
From the 272 speaking turns, only 102 (37.5%) were considered as passages able to be coded with Reflective Functioning Scale (RFS)
Considering the passages identified by the RFS, regardless of the participant, on the 102 turns of speech coded with reflective functioning (RF), corresponding to the nine episodes, it was found that 79 turns (77.45%) belonged to passages of moderate to high RF, 23 turns (22.55%) to passages of low or failure of the RF

Summary

Introduction

Authors from psychoanalysis (e.g., Luborsky, 1984; Green, 1975; Horowitz et al, 1993a,b; Green, 1996) postulate that the clinical approach on the psychodynamics of patients must be understood based on two different central thematics (therapeutic focus): intrapsychic conflicts and malfunctions or deficits in functioning (Killingmo, 1989, 1990; Schüßler, 2004; Dreher, 2005, 2006; Sugarman, 2006). In-Session Reflective Functioning work on the psychodynamic process leads to a better understanding of the contents of the mind. To identify them in those segments in which conflict or personality functioning is being worked on, expecting that there will be differences between them in the mentalization quality of the participants. Authors situate the concept of mentalization within the psychodynamic tradition, in what they call “a doubly configured epistemic space,” the empirical perspective of developmental theorists with the clinical understanding of psychoanalytic theorists (Fonagy, 1994). As an antecedent of what will later be defined as reflective function, Fonagy et al (1991) found the distinction between a pre-reflective self, referring to an immediate or unmediated experience of life and a reflective self or reflective function of the self that operates as an internal observer of mental life

Objectives

Methods

Results

Conclusion