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An Integrative-Relational Approach in Schizophrenia: From Philosophical Principles to Mentalization-Based Practice

  • João G. Pereira
  • Martin Debbané
Chapter
Part of the Studies in Brain and Mind book series (SIBM, volume 12)

Abstract

In this paper, we explore psychosis and schizophrenia as prototype disturbances, where mentalizing failures are widely seen. We attempt to describe how the process of rekindling mentalizing within attachment relationships (here, the patient-therapist relationship) can have a protective effect not just on the onset of the disturbance, but also when psychosis is already actively installed. We start by discussing mentalizing in training, practice and supervision. We also try to understand it contextually, as a relational concept, within the history of psychological therapies.

Keywords

Mentalizing Psychosis Relational Integrative 

References

  1. Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing.Google Scholar
  2. Arnedo, J., Svrakic, D. M., Del Val, C., Romero-Zaliz, R., Hernandez-Cuervo, H., Genetics, Molecular, et al. (2015). Uncovering the hidden risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. The American Journal of Psychiatry, 172(2), 139–153.CrossRefGoogle Scholar
  3. Aron, L. (1996). A meeting of minds. Hillsdale, MI: The Analytic Press.Google Scholar
  4. Badiou, A. (1989). Manifesto for philosophy. New York: State University Press.Google Scholar
  5. Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Cambridge, MA: Bradford MIT Press.Google Scholar
  6. Bartels-Velthuis, A. A., Blijd-Hoogewys, E. M., & van Os, J. (2011). Better theory-of-mind skills in children hearing voices mitigate the risk of secondary delusion formation. Acta Psychiatrica Scandinavica, 124, 193–197. https://doi.org/10.1111/j.1600-0447.2011.01699.x CrossRefGoogle Scholar
  7. Bateman, A. W., & Fonagy, P. (2004). Psychotherapy for borderline personality disorder: Mentalization based treatment. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  8. Bateman, A. W., & Fonagy, P. (2006). Mentalization-based treatment for borderline personality disorders – a practical guide. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  9. Bateman, A. W., & Fonagy, P. (2012). Handbook of mentalizing in mental health practice. Arlington, TX: American Psychiatric Publishing.Google Scholar
  10. Bateman, A. W., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders: A practical guide. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
  11. Bateman, A. W., Fonagy, P., & Luyten, P. (2012). Introduction and overview. In A. W. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 3–42). Arlington, TX: American Psychiatric Publishing.Google Scholar
  12. Bateman, A. W., O’Connell, J., Lorenzini, N., Gardner, T., & Fonagy, P. (2016). A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry, 16(1), 936–912. https://doi.org/10.1186/s12888-016-1000-9
  13. Bion, W. R. (1962). Learning from experience. London: Heinemann.Google Scholar
  14. Brent, B. K. (2009). Mentalization-based psychodynamic psychotherapy for psychosis. Journal of Clinical Psychology, 65(8), 803–814.CrossRefGoogle Scholar
  15. Brent, B. K, & Fonagy, P (2014). A mentalization-based treatment approach to disturbances of social understanding in schizophrenia. In P. Lysaker, G. Dimaggio, M. Brune (Ed.), Social cognition and metacognition in schizophrenia: Psychopathology and treatment approaches (Chapter: 15, pp. 245–259). Elsevier Science & Technology.Google Scholar
  16. Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: Ontogeny, assessment, and application in the treatment of borderline personality disorder. The American Journal of Psychiatry, 165, 1127–1135. https://doi.org/10.1176/appi.ajp.2008.07081360 CrossRefGoogle Scholar
  17. Clemmensen, L., van Os, J., Drukker, M., Munkholm, A., Rimvall, M. K., Vaever, M., et al. (2016). Psychotic experiences and hyper-theory-of-mind in preadolescence—A birth cohort study. Psychological Medicine, 46, 87–101. https://doi.org/10.1017/s0033291715001567 CrossRefGoogle Scholar
  18. Clemmensen, L., van Os, J., Skovgaard, A. M., Vaever, M., Blijd-Hoogewys, E. M., Bartels-Velthuis, A. A., et al. (2014). Hyper-theory-of-mind in children with psychotic experiences. PLoS One, 9, e113082. https://doi.org/10.1371/journal.pone.0113082 CrossRefGoogle Scholar
  19. Debbané, M., & Barrantes-Vidal, N. (2015). Schizotypy from a developmental perspective. Schizophrenia Bulletin, 41, S386–S395. https://doi.org/10.1093/schbul/sbu175 CrossRefGoogle Scholar
  20. Debbané, M., Benmiloud, J., Salaminios, G., Solida-Tozzi, A., Armando, M., Fonagy, P., et al. (2016). Mentalization-based treatment in clinical high-risk for psychosis: A rationale and clinical illustration. Journal of Contemporary Psychotherapy, 1–9. https://doi.org/10.1007/s10879-016-9337-4
  21. Debbané, M., Salaminios, G., Luyten, P., Badoud, D., Armando, M., Solida-Tozzi, A., et al. (2016). Attachment, neurobiology, and mentalizing along the psychosis continuum. Frontiers in Human Neuroscience, 10, 73–22. https://doi.org/10.3389/fnhum.2016.00406
  22. Debbané, M., Van der Linden, M., Gex-Fabry, M., & Eliez, S. (2009). Cognitive and emotional associations to positive schizotypy during adolescence. Journal of Child Psychology and Psychiatry, 50, 326–334. https://doi.org/10.1111/j.1469-7610.2008.01961.x CrossRefGoogle Scholar
  23. Debbané, M., Van der Linden, M., Glaser, B., & Eliez, S. (2008). Source monitoring for actions in adolescents with 22q11.2 deletion syndrome (22q11DS). Psychological Medicine, 38, 811–820. https://doi.org/10.1017/S003329170700222X CrossRefGoogle Scholar
  24. Fairbairn, W. R. D. (1952). An object-relations theory of the personality. New York: Basic Books.Google Scholar
  25. Fonagy, P. (1991). Thinking about thinking: Some clinical and theoretical considerations in the treatment of a borderline patient. The International Journal of Psycho-Analysis, 72, 639–656.Google Scholar
  26. Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy (Chicago, Ill.), 51, 372–380. https://doi.org/10.1037/a0036505 CrossRefGoogle Scholar
  27. Fonagy, P., & Bateman, A. W. (2016). Adversity, attachment, and mentalizing. Comprehensive Psychiatry, 64, 59–66.CrossRefGoogle Scholar
  28. Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.Google Scholar
  29. Foucault, M. (1972). Histoire de la Folie a L’Age Classic. Paris: Gallimard.Google Scholar
  30. Foucault, M. (1975). Surveiller et Punir: Naissance de la prison. Paris: Gallimard.Google Scholar
  31. Freud, S. (1895). Project for a scientific psychology. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (S. E.) (Vol. 1, pp. 283–397). London: Hogarth Press.Google Scholar
  32. Freud, S. (1914). On narcissism: An introduction. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (S. E.) (Vol. 14, pp. 67–104). London: Hogarth Press.Google Scholar
  33. Freud, S. (1933). New introductory lectures on psycho-analysis. The standard edition of the complete psychological works of Sigmund Freud, Volume XXII, pp. 1–182.Google Scholar
  34. Ghent, E. (1989). Credo: The dialectics of one-person and two-person psychologies. Contemporary Psychoanalysis, 25, 200–237.CrossRefGoogle Scholar
  35. Gilbert, & Orlans. (2011). Integrative therapy: 100 key points and techniques. London: Routledge.Google Scholar
  36. Goerlich, K. S., Aleman, A., Martens, S., & Hooker, C. (n.d.) (manuscript in preparation). I know how you’ll feel: Affective mentalizing in alexithymia, an fMRI study [Online]. Available from dissertations.ub.rug.nl/FILES/faculties/medicine/2011/k.s.../05c5.pdf. Accessed 23 Mar 2016.
  37. Goffman, E. (1959). The presentation of self in everyday life. New York: Anchor Books.Google Scholar
  38. Green, M. F., Horan, W. P., & Lee, J. (2015). Social cognition in schizophrenia. Nature Reviews Neuroscience, 16(10), 620–631. https://doi.org/10.1038/nrn4005
  39. Heidegger, M. (1962). Being and time. Oxford, UK: Blackwell Publishing.Google Scholar
  40. Jewell, T., Collyer, H., Gardner, T., Tchanturia, K., Simic, M., Fonagy, P., & Eisler, I. (2015). Attachment and mentalization and their association with child and adolescent eating pathology: A systematic review. The International Journal of Eating Disorders, 49(4), 354–373. https://doi.org/10.1002/eat.22473
  41. Jurist, E. L., Slade, A., & Bergner, S. (2008). Mind to mind; infant research, neuroscience, and psychoanalysis. New York: Other Press.Google Scholar
  42. Kim, H. S., Shin, N. Y., Jang, J. H., Kim, E., Shim, G., Park, H. Y., et al. (2011). Social cognition and neurocognition as predictors of conversion to psychosis in individuals at ultra-high risk. Schizophrenia Research, 130, 170–175. https://doi.org/10.1016/j.schres.2011.04.023 CrossRefGoogle Scholar
  43. Klein, M. (1945). The Oedipus complex in the light of early anxieties. In: Love, guilt and reparation and other works: The writings of Melanie Klein (Vol. 1, pp. 370–419). Hogarth Press, 1975.Google Scholar
  44. Kohut, H. (1977). The restoration of the self. New York: International Universities Press.Google Scholar
  45. Luyten, P., van Houdenhove, B., Lemma, A., Target, M., & Fonagy, P. (2012). A mentalization-based approach to the understanding and treatment of functional somatic disorders. Psychoanalytic Psychotherapy, 26(2), 121–140. https://doi.org/10.1080/02668734.2012.678061
  46. Lysaker, P. H., Leonhardt, B. L., Pijnenborg, M., van Donkersgoed, R., de Jong, S., & Dimaggio, G. (2014). Metacognition in schizophrenia spectrum disorders: Methods of assessment and associations with neurocognition, symptoms, cognitive style and function. The Israel Journal of Psychiatry and Related Sciences, 51(1), 54–62.Google Scholar
  47. Lysaker, P. H., Vohs, J., Hillis, J. D., Kukla, M., Popolo, R., Salvatore, G., et al. (2014). Poor insight into schizophrenia: Contributing factors, consequences and emerging treatment approaches. Expert Review of Neurotherapeutics, 13(7), 785–793. https://doi.org/10.1586/14737175.2013.811150
  48. Marty, P. (1968). A major process of somatization: The progressive disorganization. International Journal of Psychoanalysis, 49, 246–249.Google Scholar
  49. Marty, P. (1991). Mentalisation et psychosomatique. Paris: Synthélabo.Google Scholar
  50. Mitchell, S. (2000). Relationality. Hillsdale, NJ: The Analytic Press.Google Scholar
  51. Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., et al. (2013). Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: The PACE 400 study [Evaluation studies research support, non-US Gov’t]. JAMA Psychiatry, 70(8), 793–802.CrossRefGoogle Scholar
  52. Pereira, J. G. (2010). Transference and the therapeutic relationship – working for or against it? Grupanaliseonline [online]. Available at: http://grupanalise.pt/en/images/stories/revistaonline_ingls/Transference_and_the_Therapeutic__Relationship_working_for_or_against_it.pdf. Accessed 14 Nov 2016.
  53. Pereira, J. G. (2014). What Works in Mentalization Based Treatment: systematic case studies in personality disorder and addictions. Unpublished doctoral dissertation. London: Middlesex University.Google Scholar
  54. Pereira, J. G. (2015). An integrative-relational framework of intervention at Casa de Alba: Therapeutic community for severe mental health problems. British Journal of Psychotherapy Integration, 11(2), 37–52.Google Scholar
  55. Peters, E., Ward, T., Jackson, M., Morgan, C., Charalambides, M., McGuire, P., et al. (2016). Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care”. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 15(1), 41–52. https://doi.org/10.1002/wps.20301
  56. Piskulic, D., Liu, L., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., McGlashan, T. H., et al. (2016). Social cognition over time in individuals at clinical high risk for psychosis: Findings from the NAPLS-2 cohort. Schizophrenia Research, 171, 176–181. https://doi.org/10.1016/j.schres.2016.01.017 CrossRefGoogle Scholar
  57. Read, J., & Gumley, A. (2010). Can attachment theory help explain the relationship between childhood adversity and psychosis? In S. Benamer (Ed.), Telling stories? Attachment based approach to the treatment of psychosis (pp. 51–94). London: Karnac Books.Google Scholar
  58. Rudrauf, D. (2014). Structure-function relationships behind the phenomenon of cognitive resilience in neurology: Insights for neuroscience and medicine. Advances in Neuroscience, 4, 1–28.CrossRefGoogle Scholar
  59. Sartre, J. P. (1992). Being and nothingness. New York: Gallimard. (first published in 1943).Google Scholar
  60. Schultze-Lutter, F., & Koch, E. (2010). Schizophrenia proneness instrument: Child and youth version (SPI-CY). Rome: Fioriti.Google Scholar
  61. Stolorow, R., & Atwood, G. (1992). Contexts of being: The intersubjective foundations of psychological life. Hillsdale, NJ: The Analytic Press.Google Scholar
  62. Van Donkersgoed, R. J. M., De Jong, S., Van der Gaag, M., Aleman, A., Lysaker, P. H., Wunderink, L., et al. (2014). A manual-based individual therapy to improve metacognition in schizophrenia: Protocol of a multi-center RCT. BMC Psychiatry, 14, 27.CrossRefGoogle Scholar
  63. Weijers, J., Kate Ten, C., Eurelings-Bontekoe, E., Viechtbauer, W., Rampaart, R., Bateman, A. W., et al. (2016). Mentalization-based treatment for psychotic disorder: Protocol of a randomized controlled trial. BMC Psychiatry, 1–10. https://doi.org/10.1186/s12888-016-0902-x
  64. Winnicott, D. W. (1962). Ego integration in child development. In The maturational processes and facilitating environment (pp. 56–63). London: Hogarth Press.Google Scholar
  65. Wittgenstein, L. (1953). Philosophical investigations. Malden, MA: Blackwell.Google Scholar
  66. Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell’Olio, M., et al. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. The Australian and New Zealand Journal of Psychiatry, 39, 964–971. https://doi.org/10.1080/j.1440-1614.2005.01714.x CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • João G. Pereira
    • 1
  • Martin Debbané
    • 2
  1. 1.Romão de Sousa FoundationUniversity of ÉvoraEstremozPortugal
  2. 2.Faculty of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland

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