On the concept of mentalization in theory and treatment technique of psychoses

Mentalization denotes the ability to perceive, represent and reflect one's own and also foreign mental states. It is developed within a secure attachment relationship and forms the basis for regulation of emotions and the self as well as for the development of metacognitive functions. In the field of psychoses mentalization disorders have received increasing attention over the last decades, whereby particularly the association with psychopathological core symptoms, such as delusions, as well as the effect on social functionality were investigated and often focused on cognitive aspects. Clearly less findings exist on the affective mentalization capability in psychoses and to the question of whether premorbid, subtle impairments in mentalization contribute to psychotic vulnerability. In contrast, completely different forms of disturbed mentalization can be present in acute psychoses, beginning with fundamental disorders of symbolic and verbal representation, perception and recognition of affects through "mind-blind" concretism or hyperreflexive forms of contemplation of mental states up to metacognitive distortion and difficulties to integrate experiences into a biographical narrative. This article attempts to provide a framework for the classification of mentalization disorders in psychotic patients from a clinical perspective and based on this, to present the principles and possibilities for application of mentalization-based therapeutic procedures for these patient groups. The importance of a general mentalization-promoting attitude as well as the individual and disease stage-adapted therapy approaches are illustrated by case examples.