Studies of Symptom-Specific RF (original) (raw)
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Comprehensive Psychiatry, 2015
Objective: Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses). Methods: Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18 months, and 3 and 6 years. Results: RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program. Conclusion: These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
Journal of Consulting and Clinical Psychology, 2006
Changes in attachment organization and reflective function (RF) were assessed as putative mechanisms of change in 1 of 3 year-long psychotherapy treatments for patients with borderline personality disorder (BPD). Ninety patients reliably diagnosed with BPD were randomized to transference-focused psychotherapy (TFP), dialectical behavior therapy, or a modified psychodynamic supportive psychotherapy. Attachment organization was assessed with the Adult Attachment Interview and the RF coding scale. After 12 months of treatment, participants showed a significant increase in the number classified secure with respect to attachment state of mind for TFP but not for the other 2 treatments. Significant changes in narrative coherence and RF were found as a function of treatment, with TFP showing increases in both constructs during treatment. No changes in resolution of loss or trauma were observed across treatments. Findings suggest that 1 year of intensive TFP can increase patients' narrative coherence and RF. Future research should establish the relationship between these 2 constructs and relevant psychopathology, identify treatment components responsible for effecting these changes, and examine the long-term outcome of these changes.
The British journal of psychiatry : the journal of mental science, 2015
Borderline personality disorder is associated with deficits in personality functioning and mentalisation. In a randomised controlled trial 104 people with borderline personality disorder received either transference-focused psychotherapy (TFP) or treatment by experienced community therapists. Among other outcome variables, mentalisation was assessed by means of the Reflective Functioning Scale (RF Scale). Findings revealed only significant improvements in reflective function in the TFP group within 1 year of treatment. The between-group effect was of medium size (d = 0.45). Improvements in reflective function were significantly correlated with improvements in personality organisation.
Transference-focused psychotherapy (TFP) and dialectical behavior therapy (DBT) are 2 treatment models designed to treat patients with borderline personality disorder (BPD). Although originating in separate theoretical orientations, TFP and DBT have been effective in treating BPD patients. Reflective functioning (RF), defined as interpreting the behaviors of self and others as motivated by the underlying mental states of self and others, has been suggested as an effective therapeutic process common to all BPD treatment models. Expert raters provided TFP and DBT prototypes as well as a prototype of RF process using the Psychotherapy Process Q-Set. Three hypotheses were tested: (1) The TFP prototype would be positively correlated with a previously constructed psychodynamic therapy (PDT) prototype and not with a previously constructed cognitive—behavioral therapy (CBT) prototype or the DBT prototype, (2) the DBT prototype would be positively correlated with the CBT prototype and not with the PDT prototype, and (3) the RF process prototype would be positively correlated with both the TFP and DBT prototypes. The TFP and DBT prototypes loaded onto 2 independent factors. The RF process prototype loaded onto both factors. The TFP prototype was positively correlated with the PDT prototype and not with the CBT or DBT prototypes. The DBT prototype was positively correlated with both the CBT and PDT prototypes. The RF process prototype was highly correlated with all prototypes. It is argued that enhancing RF in BPD patients is an implicit process inherent to TFP and DBT and should be explicitly acknowledged.
Changes in Reflective Functioning during Psychoanalytic Psychotherapies
Journal of the American Psychoanalytic Association, 2015
This study examines how reflective functioning (RF) can be assessed in analytic sessions and throughout psychoanalytic psychotherapy. The goals are to replicate in part a study by Josephs and colleagues (2004) by applying the RF Scale to analytic sessions and to study fluctuations of RF within each session. Additionally, RF based on sessions was compared with the RF ratings based on the Adult Attachment Interview (AAI) during the course of two psychoanalytic psychotherapies with a duration of 240 hours. RF changes based on 10 sessions per patient, assessed at baseline and after 80, 160, and 240 hours of therapy, and RF changes based on AAI ratings measured at baseline and after 240 hours of therapy, and in one case at follow-up, were related to changes of symptoms and attachment classifications over time. Results showed that in both cases RF fluctuated within sessions. The average RF rating per session increased over the course of treatment, while the AAI-based RF rating needed long...
Psychoanalytic Psychology, 2018
Avoidant personality disorder (APD) and borderline personality disorder (BPD) are the most frequent personality disorders (PDs) in clinical practice. Although BPD research dominates the field, both PDs are clearly associated with severe functional impairments and substantial treatment challenges. Few have investigated the relationship between core personality vulnerabilities across PDs. However, such research has high clinical relevance, could expand our understanding of the distinct nature of the disorders, and thus have important therapeutic implications. Central PD vulnerabilities have been conceptualized in two, possibly overlapping, constructs: mentalization and affect consciousness (AC). The interrelationship between mentalizing and AC and PD specific differences are, as yet, not well established. The present study investigated the relationship between mentalizing capacity and AC among 73 treatment-seeking patients with APD and/or BPD, 81% females. Mentalization was measured b...
PLOS ONE, 2018
discriminated BPD patients from healthy individuals (area under the curve = 78%, cut of 4.5 points, sensitivity = 73%, specificity = 68%). Within the patient group, regression analyses showed uncertainty about mental states to have a significant unique contribution in predicting BPD severity (p < 0.05), explaining 12% of the variance. Conclusions Results largely supported the reliability and validity of the Italian version of the RFQ. These findings also provide further evidence for the role of impairments in mentalizing and reinforce the rationale for offering mentalization-based interventions to individuals with this disorder.