Choi-Kain Lois W, Gunderson John G
Department of Psychiatry, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA.
Am J Psychiatry. 2008 Sep;165(9):1127-35. doi: 10.1176/appi.ajp.2008.07081360. Epub 2008 Aug 1.
This article aims to review the development of the concept of mentalization, its applications in the understanding and treatment of borderline personality disorder, and the issue of its assessment. While conceptually derivative of theory of mind, Fonagy's concept of mentalization concerns more affectively and interpersonally complex understandings of oneself and others, reflecting abilities that enable an individual not only to navigate the social world effectively but also to develop an enriched, stable sense of self. The components of mentalization can be organized around self-/other-oriented, implicit/explicit, and cognitive/affective dimensions. Concepts of mindfulness, psychological mindedness, empathy, and affect consciousness are shown to partially overlap with mentalization within these three dimensions. Mentalization is assessed by the measure of reflective function, a scale to be used adjunctively on semistructured narrative interviews such as the Adult Attachment Interview. Its validity has not been fully tested, and its usage has been hampered by the time and expense it requires. Although the concept of mentalization is a useful heuristic that enables clinicians to adopt a coherent treatment approach, it may be too broad and multifaceted to be operationalized as a marker for specific forms of psychopathology such as borderline personality disorder. Research elucidating the relationship between reflective function, overlapping concepts, and features of borderline psychopathology is needed.
本文旨在回顾心理化概念的发展、其在边缘型人格障碍理解与治疗中的应用以及评估问题。虽然从概念上讲，心理化源自心理理论，但费纳吉的心理化概念更关注对自己和他人的情感及人际方面的复杂理解，反映了使个体不仅能有效应对社会世界，还能形成丰富、稳定的自我意识的能力。心理化的组成部分可围绕自我/他人导向、内隐/外显以及认知/情感维度进行组织。正念、心理敏锐性、共情和情感意识等概念在这三个维度上与心理化部分重叠。心理化通过反思功能量表进行评估，该量表可辅助用于半结构化叙事访谈，如成人依恋访谈。其有效性尚未得到充分检验，且其使用因所需时间和费用而受到阻碍。尽管心理化概念是一种有用的启发式方法，能使临床医生采用连贯的治疗方法，但它可能过于宽泛和多面，难以作为边缘型人格障碍等特定心理病理形式的标志物进行操作化。需要开展研究以阐明反思功能、重叠概念与边缘型心理病理特征之间的关系。
