Search

The last couple of decades have seen a significant increase in the fields of research and clinical practice inspired by the theory of mentalising. Mentalisation, the capacity to understand one's own and others' behaviour in terms of mental states, is considered to be a "defining human social and psychological achievement" (Fonagy & Allison, 2014). The dialogue between mentalising theory and other fields such as developmental psychopathology or the neurosciences has added complexity and nuance to the understanding of this mental capacity. However, there is a gap in the research literature concerning the assessment of mentalising during therapeutic sessions. This assessment has often been done at the beginning and end of the treatment, missing session-to-session variations and the possibility to inquire about a mentalising style and its outcome in psychotherapy. This thesis describes the development and preliminary validation of the Mentalising Profile Q-set (MQS), an observer-rated measure that aims to bridge the gap between scientific research and clinical observations by describing the mentalising process of patients undergoing psychotherapy in a jargon-free language. The MQS focuses on the patient and provides a picture of the mentalising process in relation to its four polarities and pre-mentalising modes of experience. The data used in this research was derived from the Randomised Evaluation Study of Dynamic Interpersonal Therapy (REDIT) and the Tavistock Adult Depression Study (TADS), two trials that worked with depressed patients, although with differences in clinical characteristics. The preliminary results suggest that the MQS is an instrument that can differentiate groups of individual mentalising profiles and their likely effect on therapeutic outcomes, as assessed by the HRSD-17, at the beginning of treatment. The MQS contributes to the extant literature on assessment instruments and, at the same time, expands on the role of the capacity to mentalise in the therapeutic outcome.

Individuals with long-term and relapsing forms of depression are at a serious disadvantage due to the shortage of research evidence guiding their clinical management. Moreover, differences in responsiveness to treatment might result as a function of the interactions between patients' pre-treatment personality characteristics and various aspects of the therapeutic process. This PhD takes the Two-Configurations model developed by Blatt and collaborators as its starting point. In order to circumvent well-known biases of self-report questionnaires as well as difficulties of available instruments to assess issues of dependency and self-criticism at different developmental levels reliably, the aim was to develop a viable alternative following a person-centred approach. After introducing the conceptualisation of treatment-resistant depression from four angles (the psychiatric, the psychoanalytic, the private, and Blatt's integrative approach), the development and preliminary validation of the Anaclitic Introjective Depression Assessment (AIDA) is presented. This observer-rated measure was developed using expert consensus rating and Q-methodology. Psychometric properties, preliminary reliability, and validity were established using a sample of 128 patients diagnosed with treatment-resistant depression from a randomised controlled trial investigating the effectives of psychoanalytic psychotherapy (the TADS study). Using Q-Factor analysis, four naturally occurring clusters of patients representing concerns with relatedness and self-definition were identified. Anaclitic and introjective issues of severe depression appear to be expressed at different developmental levels. Whether and to what extent the four factors of depressed patients differed was investigated by testing their relations to expert anaclitic/introjective prototypes, developmental adversity, and various functioning indices. Finally, using multi-level modelling, their differential response to psychoanalytic treatment compared with treatment-as-usual was investigated. Overall, findings provide preliminary evidence for the reliability and validity of the new measure and evidence that anaclitic and introjective concerns are hierarchically organised among individuals with severe depression. Limitations, and implications for future research and clinical practice are discussed.

This thesis focuses on the Implicit Associations Test (IAT), as a measure of implicit cognition aiming to tap distortions of cognitive processing by unconsciously held personal and interpersonal attitudes and beliefs. Classically, IAT had revealed delays in processing of information when dissonant attitudes were activated, even when the participant denied these attitudes. It is a popular measure, but there is little scientific consensus about its value and reliably to detect individual differences across a number of domains. This thesis examined the validity if the IAT in a number of clinical contexts attempting to test its clinical relevance and practical usefulness as a psychometric instrument. The thesis contains 5 empirical studies: 1) Attachment transmission: The test is administered to a sample of mothers with infants of 1 year of age. IAT was used to measure the mother's implicit attitudes towards attachment relationships and parenting in general and its capacity accurately to predict other measures of attachment, parenting, and psychopathology. In this context, the IAT resulted to be of little value. 2) A newly developed version of the IAT with the potential to measure implicit self-esteem was administered to a large sample of adolescents (14-24 y-o) to test the prediction that implicit self-esteem measured with the IAT is robust to age and gender of the sample. 3, and 5) Depression: Three studies aimed to validate the SE-IAT in the context of depression. The first assessed the ability of the SE-IAT to discriminate between depressed and non-depressed patients. The second study, cross-validated the SE-IAT against several other psychometric instruments in this depressed sample. The third study aimed to assess the value of the SE-IAT to predict and monitor individual gains in the psychotherapy for depression. The SE-IAT is useful at calculating discrepancies between explicit and implicit self-esteem to predict internalizing disorders.