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.
Highlights
Mentalizing capacity, or reflective function (RF), is an aspect of personality functioning described as ‘the capacity to make sense of self and of others in terms of subjective mental states and mental processes’ [1, p83]
The possibility arises that the capacity for mentalizing of others in this profession is characterised by the opposite of what Harari et al [11] describe in Borderline Personality Disorder (BPD)
In BPD they identify enhanced emotional empathy combined with impaired cognitive empathy, Psychological Therapists’ enhanced mentalizing capacities may be defined by their ability to inhibit the impact of others’ emotions on the self
Summary
Mentalizing capacity, or reflective function (RF), is an aspect of personality functioning described as ‘the capacity to make sense of self and of others in terms of subjective mental states and mental processes’ [1, p83]. Part of the emerging evidence is that those with BPD have a heightened sensitivity (affective empathy) to the emotions of others [8,9,10]. This sensitivity to distress in the other can have a ‘contagion effect’ leading to the unmoderated emotional arousal in the self [11, 12]. The resulting complex profile of mentalizing capacity has been termed the ‘double dissociation’ hypothesis [11]; combining impaired self-mentalizing with some proficiency in mentalizing others’ feelings coupled with impairment in relation to others’ thoughts
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