The mediating role of reflective functioning and general psychopathology in the relationship between childhood conduct disorder and adult aggression among offenders.

BACKGROUND: The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression. METHODS: A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires. RESULTS: Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression. CONCLUSIONS: These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.

Childhood maltreatment, dissociation and borderline personality disorder: Preliminary data on the mediational role of mentalizing in complex post-traumatic stress disorder.

OBJECTIVES: Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. DESIGN: We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. METHOD: Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated. RESULTS: Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. CONCLUSIONS: Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD.

Rupture and Repair in Mentalization-Based Group Psychotherapy.

The article explores ideas about the role of group mentalizing-the experience of joint attention and shared intentionality-as a process that can support the emergence of more collaborative and salutogenic social functioning. This is based on developmental and evolutionary thinking about the importance of joint attention in human social cognitive development and functioning. The importance of experiencing rupture and repair as part of the process of thinking together-while also working with the separate nature of our thoughts-is described, emphasizing that it is through an understanding of the complex and inevitably uneven and challenging nature of joint attention and social cooperation that such cooperation is itself made possible.

Single-session Mentalization-based Treatment Group for Law Enforcement Officers.

Law enforcement violence has emerged as a leading public health concern, and law enforcement officers are themselves at greater risk for a range of psychiatric disorders. Drawing on the significant empirical support for mentalization-based treatment (MBT), this paper explores the use of MBT as a transdiagnostic psychotherapy for law enforcement professionals. By helping patients to mentalize-that is, to "read," access, and reflect on mental states in oneself and other people-MBT could be useful as a dual-focus treatment, able to simultaneously impact psychiatric illness among law enforcement officers while also indirectly impacting the problem of law enforcement violence in the broader society. The core psychotherapeutic principles of MBT are reviewed, along with common vulnerabilities in mentalizing likely to arise for law enforcement professionals in the context of high emotional and interpersonal intensity. The authors outline a novel application of MBT which has implications for psychiatric treatment as well as police training: the single-session psychoeducation and psychotherapy group, where law enforcement officers practice both self-reflection and empathy in situations of relational conflict. Utilizing group process from a residential treatment program for first responders with mental health and substance use disorders, a case example is offered to illustrate this intervention.

Mentalizing, Attachment, and Epistemic Trust in Group Therapy.

This article sets out the relevance of recent theoretical developments in the areas of mentalizing, attachment and epistemic trust in relation to group therapy. It begins with an account of the role of mentalizing in the attachment context in the development of epistemic trust-defined as trust in the authenticity and personal relevance of interpersonally transmitted knowledge about how the social environment works. It then explains the particular way in which this emphasis on social communication is pertinent to group therapy and its function as a training ground for mentalizing and the initial experimentation with the opening of epistemic trust in a social context. The article finishes with an account of how mentalization-based group work is undertaken.

Resenha: Las psicosis: los tratamientos psicológicos y su eficacia

Reflexão sobre a diferença, ressaltada por lacan, entre passado e história

Organizações de pele grossa e de pele fina e encenação em distúrbios fronteiriços e narcísicos

Encenação nos distúrbios fronteiriços e narcísicos, baseados em distinção proposta por Rosenfeld entre 2 tipos de narcisismo: de pele grossa e de pele fina, ou, os defensivamente agressivos e os frágeis e vulneráveis. A encenação é qualquer ação mútua na relação paciente-analista que surja no contexto de dificuldades no trabalho contratransferencial

Las psicosis: los tratamientos psicológicos y su eficacia / Psicopatología y psicoterapia de la psicosis

Hay un consenso generalizado entre los profesionales de la salud mental, los pacientes y su entorno de que los acercamientos psicoterapéuticos son efectivos para los enfermos psicóticos. Este libro actualiza los conocimientos que sobre el tema tienen psiquiatras, psicólogos y psicoterapeutas de cualquier orientación que ejercen en un moderno servicio de salud mental