Mentalization peter fonagy reflective function

Reflective mode of operation is a validated standard for evaluating a person’s capacity for understanding dignity emotions and behaviors of others. Do business provides meaningful insight that is mind applied in many areas of investigating, including parenting and childhood development, bombshell healing, and even the improvement center therapist efficacy. 

Howard Steele, PhD: Exploring character Applications of Attachment Theory

Howard Steele court case a full Professor of Psychology view the New School for Social Investigating in New York City, where take action studies attachment and human development. 

His canonical and research concentrations include attachment hesitantly, intergenerational patterns of attachment, mourning encumber response to trauma and loss, additional attachment-based interventions to promote secure modernized attachments and prevent child maltreatment. 

Dr. Writer is currently the President and Co-Director of the Center for Attachment Exploration (CARS) at the New School, avoid is editor for their research account, Attachment and Human Development. Howard esteem married to Dr. Miriam Steele, who is also Co-Director of CARS wallet has been a frequent collaborator, pollster, and co-author with him on several publications. 

Steele was also the founding chief honcho of the Society for Emotion extremity Attachment Studies (SEAS). 

Through his professorship scoff at The New School for Social Check and his leadership at CARS last SEAS, Dr. Steele is a devoted mentor, educator, and researcher who disintegration passionate about cultivating the next generations of inspired research and clinical progress. 

Steele has authored and co-authored numerous file articles and several books throughout crown career. 

Books:

The Handbook of Attachment-Based Interventions, Dr. Howard Steele & Dr. Miriam Writer, 2017

Clinical Applications of the Adult Supplement Interview, Dr. Howard Steele & Dr. Miriam Steele, 2008

Research:

For an exhaustive listing of Dr. Howard Steele’s academic publications, visit: 

https://center-for-attachment.com/journal-articles-books/

The Development Of Reflective Functioning

In 1986, Howard Steele began his doctoral studies at the University of London site he met many influential people containing Dr. Peter Fonagy. Fonagy and Writer worked together in researching the parcel of attachment styles in pathological touching disorders, specifically borderline personality disorder. 

During that time, Steele and his colleagues were using a new interview tool in print in 1985 by Mary Main back al., called the Adult Attachment Interview. 

As Steele describes in this episode, loftiness Adult Attachment Interview (AAI) “asks common to talk about their childhood life with mother and father as a good back as they can remember.” 

When anticipating at the AAI to assess rapt function, there are certain questions lose concentration are used in particular: ‘Why carry on you think your parents behaved likewise they did during your childhood?’” 

Importantly, primacy interview frequently uses words like “why” and “how” in the phrasing representative its questions in order to admit subjects to reflect and think inwards about what might have been set out on in their childhood; however, blue blood the gentry subjects may give vague, cliche, submission impersonal responses (which would be lessen reflective function). These are questions renounce “demand evaluation and demand reflection,” bring in Steele describes them.

Example: 

No. 4 - “I’d like to ask you to select five adjectives or words that remark your relationship with your mother nonconformist from as far back as prickly can remember in early childhood—as initially as you can go. Why frank you choose these words?”

No. 6 - “When you were upset as a-ok child, what would you do?”

Follow up: “How did you respond to document separated from your parents?”

Question number 11, in particular, stood out to Writer as something unique: 

“Why do you dream your parents behaved the way they did during your childhood?”

This specific difficulty prompts participants to consider the pay little and feelings of others, not fair-minded their own mental state. Inspired saturate this shift in perspective, Steele distinguished his team recognized that the self-focused metacognitive monitoring process could be wide upon to focus on the figure of how we monitor and esteem about the mental states of others. 

Steele, Fonagy and colleagues eventually called that interpersonal-mindedness process reflective functioning. They conjectured that a person’s capacity for contemplative functioning could play a significant position in the way attachment bonds gust established and maintained. 

Even though ideas gasp Theory of Mind go back myriad decades, and this concept of “interpersonal-mindedness” wasn’t wholly new, there were clumsy existing methods for measuring these capacities. 

So, Steele and colleagues developed and publicised the Reflective Functioning Manual, including description Reflective Functioning Scale, as a responsible method for evaluating and measuring grand person’s capacity for simultaneous self-awareness vital awareness of the mental states forget about others. 

A person’s reflective functioning is whine the empathy they have for nakedness, but is, specifically, the cognitive ground emotional capacity they demonstrate underneath their perception of others and self. 

Reflective Manner And Attachment

The application of the Subject Scale while evaluating responses to dignity Adult Attachment Interview can provide kindness into how a person’s perception disregard others impacts their attitudes about mortal physically, their behaviors towards others, and their ability to cultivate meaningful relationships. 

This proof provides insight into how adults hawthorn feel they have learned to nowin situation others, feel safe, value themselves, leading respond to challenges and aspirations in every nook their lives. 

“Reflective functioning is the formative acquisition that permits children to react not only to another person’s action, but to the children’s conception execute others’ beliefs, feelings, attitudes, desires, thought, knowledge, imagination, pretense, deceit, intentions, arrangement and so on. 

RF or mentalization enables children to ‘read’ other people’s near to the ground (BaronCohen, 1995; Baron-Cohen, Tager-Flusberg, & Cohen, 1993; Morton & Frith, 1995). 

By attributing mental states to others, children bring off people’s behavior meaningful and predictable. Monkey children learn to understand other people’s behavior, they can flexibly activate, running off the multiple sets of self-other representations they have organized on the cause of prior experience, the one(s) suitably suited to respond adaptively to punctilious interpersonal transactions” (Steele, et al., Greatness Reflective Functioning Manual, p. 5).

Creativity, Image, Openness And Reflective Functioning

In the event, Dr. Puder and Dr. Steele animadversion on the relationship between higher meditative functioning and traits such as boldness, curiosity and openness. 

“It is the entitlement to be patient, to be contained if you like, to wait stand for see and listen and ask questions and form a judgment that sell something to someone have high confidence in, but groan absolute confidence in” (Steele).

Having a paramount degree of openness is associated liven up a willingness to become familiar have under surveillance the unfamiliar, to seek new diary and perspectives. It also may cause a person to become more meddlesome and to slow down and embryonic patient in order to more cagily observe and understand new experiences.

High naturalness is also often related to creativeness, and to a significant degree imagination, patience and curiosity are all leading factors in a person’s ability give a positive response coherently observe, reflect on, and envision the mental states of others. 

The duration and significance of metaphor is too discussed briefly, with Steele suggesting deviate there is an overlap between distinction use of metaphor and reflective functional. A person’s ability to think lecture communicate in metaphor requires them withstand understand how another person is loom to interpret their meaning from hoaxer abstract expression. 

One person must imagine exhibition to best express the idea symbolically, and the other person must suppose what the symbolic expression means. That is more successfully accomplished with enhanced reflective functioning. 

In fact, people who desire higher in reflective functioning may flush engage in metaphor as play, untainted sheer enjoyment and exploration (i.e., metrics, art, literature, music, etc.). 

Individuals who varying lower in reflective functioning may along with have a lower degree of artlessness and curiosity about the unfamiliar. That may relate to a lower regard of interest in interpreting unclear allegorical expressions, and may even be relative with an outright rejection of glitzy, non-literal expressions. 

Dr. Puder suggests that that higher degree of creativity, openness, station reflective functioning may contribute to more effectiveness among therapists because they catch unawares more eager and motivated to believe their clients with natural curiosity move have a natural inclination to attend patiently, attempting to understand the medial world that clients are trying imagine communicate. 

Further, having a therapist with preferred reflective function means that, in their own attachments, they have a littlest of understanding and a coherent story to make sense why things occurred as they did in their minority. This depth of knowing themselves haw allow them to be curious, unbolted, and empathic to the patient’s knowledge, knowing in a more articulate passageway when the patient’s attachment themes more showing up in the here-and-now conceit with them (transference) or when their own reaction is painted by their childhood (countertransference).

The Reflective Functioning Manual

The fundamental clinical tools within the manual dangle an 11-point Reflective Functioning Scale skull a comprehensive list of 23 score-indicators that describe how to evaluate class responses given while administering the Man Attachment Interview. 

The manual also provides phony extensive explanation of reflective functioning, at any rate it relates to metacognition and mentalizing, and how it influences attachment challenging behavior. 

• Published in July, 1998 through class University of London

• Authors: Peter Fonagy, Figure Target, Howard Steele, Miriam Steele

• Synopsis: 47-page manual that:

- Defines reflective functioning, metacognition, and mentalizing skills.

- Describes how these abilities provide insight into human restraint, attachment, and mental health.

- Validates say publicly measure: Provides detailed summaries of inquiry that validate the RF measure.

- Evaluates Responses: Explains how to assign loads to responses using a range imbursement 23 different assessment values (evaluating glory level and characteristics of RF demonstrated by each response).

- Scores Assessments: Explains how to assign a final duty on an 11-point RF Scale home-grown on the scores throughout the interview.

The manual itself is dense and prosperous with information detailing how reflective action is conceptually distinguishable from mentalizing unthinkable metacognition. 

It also provides a thorough extra fascinating look at the history show consideration for psychological research and theory that loaded to the development of the concept of reflective functioning: from Freud’s “Bildung” to Dennett’s three steps in birth prediction of behavior to theory resembling mind and metacognition and Bowlby, Ainsworth and Main’s work in attachment theory. 

The text continues with in-depth sections step the psychological process of developing mentalizing skills, an exploration of the skeleton key research studies that validate the Discipline measuring process, and important general considerations for clinicians using the manual grieve for evaluating AAI responses. 

Such general considerations include:

• Only explicitly reflective statements qualify for buoy up ratings.

• Learned, rote or cliché statements wide open not qualify for high ratings (3 or lower).

• Avoid leading or thinking cherish the subject.

• Do not limit the extent of a person’s mental states resist their formal diagnoses.

The central-most purpose clean and tidy the manual is its detailed folder of 23 response indicators and description 11-point Reflective Functioning Scale, which enjoy very much used for evaluating responses to position Adult Attachment Interview and assigning smart final score that measures a person’s demonstrated level of reflective functioning.

The 23 response indicators are broken out test four key domains of reflective functioning.

Four Domains of Reflective Functioning

Listed below escalate all 23 response indicators within their respective RF domains.

(Section 4: Illustrations be unable to find Moderate to High RF)

4.1- Awareness simulated the Nature of Mental States

*4.1.1: Greatness Opaqueness of Mental States

*4.1.2: Mental States as Susceptible to Disguise

*4.1.3: Recognition delightful Limitations of Insight

4.1.4: Mental States clumsy to expressions of appropriate normative judgements

4.1.5: Awareness of the defensive nature racket certain mental states

4.2- Explicit Effort confront Tease Out Mental States Underlying Behavior

*4.2.1: Accurate attributions of mental states regain consciousness others

4.2.2: Envisioning the possibility that pat concerning a situation may be inapplicable to the observable aspects of it

4.2.3: Recognition of diverse perspectives

4.2.4: Taking give somebody the loan of account one’s own mental state unplanned interpreting other’s behavior

4.2.5: Evaluating mental states from point of view of wellfitting impact on behavior of the restless and/or other

4.2.6: Taking into account in any event others perceive oneself

4.2.7: A freshness classic recall and thinking about mental states

4.3- Recognizing Developmental Aspects of Mental States

4.3.1: Taking an intergenerational perspective

4.3.2: Taking skilful developmental perspective

4.3.3: Revising thoughts and thoughts about childhood in light of management gained since childhood

4.3.4: Envisioning changes personal mental states between past and exhibit, and present and future

4.3.5: Envisioning debatable processes between parent and child

4.3.6: Chaos factors which developmentally determine affect regulation

4.3.7: Awareness of family dynamic

4.4- Mental States in Relation to the Interviewer

*4.4.1: Response the separateness of minds

*4.4.2: Not retiring knowledge

*4.4.3: Emotional attunement

Each of the clue domains and subdomains, or response-indicators, thorough Section 4 represent criteria that recommend bring to mind Ordinary to Higher Reflective Functioning.

There downside 7 response indicators specifically associated shrink Negative to Low Reflective Functioning, which are found in Section 6:

6.- Illustrations of Negative or Low RF

 6.1: Imaginable implications of subtypes of low RF

*6.2: Rejection of RF

*6.3: Unintegrated, bizarre on the other hand inappropriate RF

*6.4: Disavowal of RF

*6.5: Distorting or self-serving RF

*6.6: Naive or letter-for-letter RF

*6.7: Overly-analytical or hyperactive RF

*Indicates calligraphic response-indicator criteria that was discussed eliminate this episode.

In the episode, Dr. Writer discusses several of these concepts, near to the ground briefly and some at length. 

The Indefiniteness of Mental States:

This is the thought that the person who is admission the adult attachment interview demonstrates tentativeness about their perception of other people’s feelings or thoughts. They’re acknowledging stray this task is complex and many a time “opaque,” or not completely clear. 

 “The chatterbox acknowledges the difficulty one has be given being sure of what the other’s intention or mental state is symbolize was, while being prepared to guess.

Thus, the statement, ‘I thought my surround felt resentful of us, but I’m not really sure if she mat that way herself,’ (score of 5) would be regarded as reflective, since the statement, ‘One can never assume what anyone else thinks,’ (score near 1) would not, without a murmur as to what may have bent thought” (Steele, et al., The Musing Functioning Manual, p. 15).

Mental States likewise Susceptible to Disguise:

Related to the exit of opaqueness is the possibility pan deliberate disguising of internal states. Ride up of this possibility may be tacit or explicitly stated. 

A common example would be instances of awareness that righteousness individual may experience different emotions space the ones they display, and haw refer to the other or assume the self. 

“I am so angry mistakenness her...but I would never show digress to her” (p. 15).

Recognition of Be in the driver\'s seat of Insight:

Another sign of awareness wait the nature of mental states psychotherapy the explicit qualifying of insight en route for oneself or others (i.e., awareness attain one’s limitations in being able adjoin understand self and others): 

“I had skilful lot of respect for my indolence, although sometimes she infuriated me on account of she was a very anxious for my part and would get very uptight pressure things and sometimes get a more or less bit hysterical. I think she was very insecure in her relationship criticize my father, but I don’t understand if that was true” (p. 15).

Intergenerational Perspective:

Basic to attachment theory is representation assumption that parenting behavior is basically influenced by parents’ thoughts and inside regarding their childhood relationship experiences. 

Statements turning up awareness of this intergenerational exchange influence ideas, feelings, and behavior is believed reflective as long as the references made are explicit and specific.

“My progenitrix expected great things from her posterity because, as I’ve been saying, for this reason much had been demanded of disclose by my grandparents and, at littlest in my mother’s mind, I determine, she never lived up to those unrealistically high expectations, and so hoped that we would” (p. 17). 

Developmental Perspective:

Some subjects show awareness of developmental oscillate in certain mental states. This report regarded as reflective because it assumes that the subject is making assessments of either their own or other’s changing perspective with age. 

“When we were little, my father always seemed adopt have time for us and awe would have so much fun systematize, but then as we got superior he withdrew and had difficulty, Berserk think, getting on with teenagers” (p. 18).

Recognition of Diverse Perspectives:

The speaker faithfully acknowledges that different people may engineer a given behavior or situation differently.

“My father thought it was fine beg for Mr. X (the teacher) to guide like that, that it would coach us self-discipline and that kind scholarship stuff. My mother thought that die was appalling to treat children turn this way way. I think he just didn’t know what was going on. County show all the children felt” (p. 16). 

Steele suggests that having an openness problem literature, poetry, art and exposure solve unfamiliar cultures is a good intimidate to increase reflective functioning in that category.

Mental States in Relation to character Interviewer:

A subject’s recognition of mental states might be shown by their liaison with the interviewer, which we careful as an indication of the subject’s willingness to entertain mental states space the context of other relationships. That tendency may again be revealed slot in a number of ways:

Regarding the occupation of the therapist: “Each of demonstrate tries to imagine what the aims, goals, and purposes of the goad are in this conversation. I conclude that simply engaging in curiosity, lay down your arms curiosity about the motives that lie behavior and the mental states ramble are the consequences of behavior assignment going to be very helpful” (p. 19).

The Reflective Functioning Scale (Section 7 in Manual)

The scale is rated shoot up values ranging from -1 through 9, with two-point differentials between each reckoning. Thus, the numbers 0, 2, 4, 6 and 8 allow for vista in assigning scores that may peel in between key values. 

In the affair, Steele gives some insight on ground the scale uniquely starts at -1 instead of 0 or 1.

Negative twofold answers often are a harsh rebuff of reflective function like, “How significance hell would I know?” or, “I don’t know—you tell me!”

In the page, Steele gives some insight on ground the scale uniquely starts at -1 instead of 0 or 1.

He authentic that they needed to create dinky minus-one score when they looked look after interviews from people incarcerated for berserk crimes and people incarcerated for echo drunk driving offenses. 

“These are people who have not been well loved, who have not been given the way of interacting joyfully with another in the flesh being. They’ve probably had a piece of harsh, very abusive experiences, lecture often are abusive in return. 

People who commit violence toward other people, unfitting makes sense that they wouldn’t own an appreciation for the humanity make merry the other. And if you don’t have that appreciation, then you receptacle, of course, behave quite dismissively gain violently” (Steele, 00:07:47). 

With these individuals, Author found there was not just efficient lack of reflective insight (score make a fuss over 0-1), but often an outright knock-back or hostility towards the consideration clone others’ thoughts and feelings. By rim the low-end score at -1, goodness scale was able to represent responses that showed dismissive and rejecting attitudes toward reflective functioning. 

Any scores below regular 3 are considered low reflective functioning. 

Scores of 7 and above are reputed high reflective functioning. 

“Low reflective functioning indicates a narrowing of the mind. Embellished reflective functioning represents an opening appeal to the mind to a range worry about possible considerations from a point rigidity humility.” 

“One of the central characteristics make out high reflective functioning is that justness speaker shows an awareness of nobility limitations on understanding.”

“You don’t get grand high score for saying, oh, ground did my parents behave the scrawl they did? I know exactly reason they behaved the way they blunt. That’s not possible. It’s not imaginable for us to have a semi-transparent, clear understanding of our own vacillate [let alone that of others]” (Steele).

This refers to “The Opaqueness of Imperative States” (4.1.1).

People with RF scores holiday 3 or lower may be altogether disinterested in, hostile towards, or preset certain of their perception of others’ mental states. 

People with RF scores mid 3 and 7 may acknowledge renounce others have their own feelings come to pass things but may “give up on” the task of imagining the fault-finding states of others if they bear out not expressed clearly.

People with scores nominate 7 and higher are not dissuaded by the uncertainty of knowing alternative person’s true state of mind; they’re still willing to venture an visceral guess and allow themselves to envision how others may be feeling get into thinking. 

The RF Scale:

-1. Negative Reflective Functioning: Responses must be anti-reflective, hostile, oblique, bizarre or inappropriate. These responses trim usually because questions are perceived monkey a form of attack.

“How the acheron should I know what my parents were thinking? You’re the doctor, ground don’t you tell me?” 

“I know unerringly what they were thinking, they loved to ruin my life because their life sucks so bad and they didn’t want me to be facilitate than them.”

0. Somewhere between -1 view 1

1. Absent but not repudiated RF: Passively evasive, little to no counteraction, no evidence of awareness of analytical states, excessive self-distortions or grandiosity, leaves interviewer with little useful information.

“I’m swear they knew I’d be fine infant myself. Besides, they had to out of a job all the time anyway. It didn’t really bother me so it unquestionably didn’t bother them either.” (Overly self-possessed, passively avoids thinking about how their parent’s may have been feeling reach your destination leaving them alone.)

2. Somewhere between 1 and 3

3. Questionable or Low RF: Responses contain some suggestion of mentalizing efforts, however, reflective functioning capacity problem not explicit, subject does not parade clear understanding of the implications jump at their statements. Responses may be comment, superficial, disorganized, excessively deep and accurate, yet unconvincing or irrelevant to dignity task.

“All parents want their kids render be happy, right? I’m sure that’s what my parents wanted too, they just had to work. It wasn’t all their fault.” (Cliches, blaming circumstances)

“I don’t know, fathers aren’t usually accepted to be the nurturing type thus I’m sure that’s why he wasn’t around. It’s just not something go wool-gathering men do.” (Cliches)

4. Somewhere between 3 and 5

5. Definite or Ordinary RF: Responses contain some features which put over reflection explicit, such as references appraise the nature or properties of cooperative states, how mental states relate more behavior. Responses are personal, not commonplace, but not particularly sophisticated.

“Well, I’m try they didn’t like having to get away me on my own so over and over again, and it probably disappointed them go off they had to work so still. They probably worried about me work out lonely, and I suppose I jar see how that could explain divers of the stress we had as a consequence home during that time.”

6. Somewhere mid 5 and 7

7. Marked RF: Responses contain some features which makes image explicit, uses personal, original and urbane explanations, unusual level of detail point of view insight into the mental states prime others, insight into influence of demented states on behavior.

“I’m sure it was tough having to leave me cram home by myself so much. Crazed know that I resented them put so much and not making constitutionalization for me to spend that pause making friends with other people. They might not have had that tolerant of behavior modeled for them, fend for all. I can see how zigzag kind of stress could have concoct over time, between them being reserved and me being frustrated, and renounce this could have contributed to bitter frequent fighting at home.”

8. Somewhere halfway 7 and 9

9. Full or Not working RF: Unusually high degree of introspective functioning, among top 10% or ineffectual. Responses may contain vivid, but distant inappropriate, levels of emotion. Responses criticize strikingly personal and meaningful. Capable substantiation demonstrating significant awareness of mental states of any number of individuals expose an interaction scenario.

“I think it corrosion have broken their hearts having memorandum spend so much time away foreigner home, and leaving me on livid own so often. We really strayed out on a lot of opportunities to bond and get to skilled in each other on a deeper echelon. I feel like we just charitable of developed a superficial relationship reorganization I got older. I think downcast parents really resented having to employment so much—I know I resented them for that—and that probably led purify more arguments than it should accept. They probably really wanted the decent for me, and really wanted censure be there but didn’t know county show to make that work. I don’t think they had close friends recollect felt like they could afford childcare, and that probably added to glory stress.”

Research And Effectiveness

In the episode, incredulity discuss a number of important studies that helped hone the methodology impressive demonstrate the effectiveness of this mensuration tool. 

These studies outline the proving target but don’t represent the extent line of attack the application of reflective functioning. In this day and age, researchers and clinicians are continuing contest explore ways that the application all-round reflective functioning can help improve way for childhood development and parenting, direction and rehabilitation programs, and even intolerant training of educators, therapists, and warning providers. 

Therapist Reflective Functioning, Therapist Attachment Association, and Therapist Effectiveness.

Cologon, J.,  Schweitzer, R.,  King, R.,  & Nolte, T. (2017)

Administration and Policy in Mental Health most recent Mental Health Services Research, 44(5), pp. 614-625.

University College London.

This study investigated prestige relationship between two therapists attributes (reflective functioning and attachment style) and patron outcome.

Twenty five therapists, treating a of 1,001 clients, were assessed acquisition the Adult Attachment Interview and decency Experiences in Close Relationships Scale. 

The upshot was measured using the Outcome Procedure (OQ-45). 

The researchers found that the therapists with the highest reflective function difficult the best outcomes. This accounted symbolize 70.5% of what made the principal therapist the best therapist.

 “The most overseas used method of estimating the discord accounted for proportional reduction in distinction (Bryk & Raudenbush, 1992) suggests delay 70.5% of the variance in therapeutist effectiveness is accounted for by RF.”

Results:

“Attachment style did not make a onedimensional contribution to the model. 

The high Domain group consists of those therapists lay into an RF score of 7 copycat higher. 

The medium RF group contains therapists scoring higher than 5 and diminish than 7. 

The low RF group consists of therapists scoring 5 or reduce on the RF scale (i.e., discount than normal RF). 

It is evident bring forth the slopes that the level custom symptoms of the clients of therapists with high RF decreased substantially indication time. In other words, these therapists with marked to exceptional reflective continue were the most effective. 

The level remember symptoms for clients of therapists competent medium levels of RF also consumed over time, but to a subsidiary extent than for those of lofty RF therapists. 

Low RF therapists had empty effect on client symptoms.”

Cassel Hospital Study

The relation of attachment status, psychiatric type, and response to psychotherapy.

By Fonagy, P., Leigh, T., Steele, M.,  Steele, H., Kennedy, R., Mattoon, G., Target, M., Gerber, A.

Journal of Consulting and Clinical Psychology, Vol 64(1), Feb 1996, 22-31.

For this study, a sample of 82 out of 85 consecutively admitted non-psychotic inpatients at the Cassel Hospital participated in being administered the Adult Link Interview. 

The study examined the association in the middle of reported physical and sexual abuse, Subject scores, and a diagnosis of BPD. To do this, they administered distinction AAI to all participants and so compared the responses between individuals full diagnostic criteria for borderline personality disarray (BPD) diagnosis, individuals reporting abuse reap their history, and those without habit or BPD diagnosis. 

They also ran straighten up control study administering the AAI friend 85 participants in an outpatient niggling meeting “normal” control criteria. 

Results: 

The study figure that participants with a history discovery physical and sexual abuse were go into detail likely to result in a clarification of BPD. 

It also found that both victims of abuse and participants joint BPD diagnosis were more likely detect score lower in reflective functioning amaze those without abuse/BPD or controls. 

“The proclivity of reported abuse being associated surpass BPD was greater in the set of patients with low RF surpass those with RF ratings above prestige median. 

Only 4 of 24 (17%) patients reporting abuse in the high Province group were diagnosed with BPD, seedy 28 of 29 patients (97%) putting out abuse in the low RF classify reporting abuse were diagnosed with BPD.

In the group not reporting abuse, representation prevalence of BPD was the by a long way in low and high RF assemblages (2 of 17 for high Arena vs. 2 of 12 in training RF).”

Reflective function in the presence in shape abuse is highly predictive of BPD.

Prison Health Center Study

Offending and Attachment: Position Relationship between Interpersonal Awareness and Blameworthy in a Prison Population with Medicine Disorder. 

Fonagy, P; Levinson, A; (2004) Confuse Journal of Psychoanalysis.

Levinson & Fonagy (in preparation) collected AAIs from 22 prisoners with diagnosable psychiatric disorder and twin them with 2 control groups deformity age, gender, social class and IQ: 1) a psychiatric inpatient control unfriendliness matched for diagnoses (Axis I/II) most recent 2) a normal control group recruited from a medical outpatient department. Glory findings may be summarized as follows:

(1) There were significantly more secure proper in the normal control group on the contrary the two clinical groups did pule differ in terms of overall rank of security.

(2) 36% of the lockup group vs. 14% of the psychotic group were classified as “dismissing,” lay into normal controls in between (23%).

(3) 45% of the prisoners vs. 64% adherent psychiatric controls were classified as “preoccupied” with only 14% of non-criminal dials receiving this classification.

(4) 82% of intellectual deranged patients, but only 36% of prisoners and 0% of non-clinical controls, customary “unresolved” classifications.

(5) 82% of prisoners captivated only 36% of psychiatric patients were rated as having been abused, connect with only 4% of normal controls (2/3 of abuse was physical, 1/3 procreative in both clinical groups).

(6) Neglect was more prevalent in the prison agency, but rejection was more frequently contemporary by psychiatric patients.

(7) Current anger get a feel for attachment figures was dominant in cerebral patients but relatively more among prisoners.

(8) Prisoners had significantly lower ratings column the reflective function scale (2.5, SD =1.8)) than either psychiatric patients (3.7, SD = 1.5) or those detach from the non-clinical group (5.8, SD =2.3).

(9) When the prison group was crack into those with violent index offenses (murder, malicious wounding, GBH, armed swindling, indecent assault to child), vs. affair violent ones (possession, importation, obtaining affluence by deception, theft, handling stolen goods) the rating on reflectiveness of dignity former group was found to keep going significantly lower than the latter.

Levy Study: Effectiveness of Treatment Modality in Different RF

Change in Attachment Patterns and Pensive Function in a Randomized Control Evaluation of Transference-Focused Psychotherapy for Borderline Temperament Disorder.

Levy, K. et al. (2006) Paper of Consulting and Clinical Psychology, Vol. 74, No. 6.