Psychoanalysis, in its purist mainstream sense, tends to be considered as an isolationist discipline that steers clear of interdisciplinary connections with other psychotherapies. Its drive for purity does not open up to influences that cast as alien and a threat to its core principles. We refer to Hegelian dialectics in an attempt to offer an alternative approach to interdisciplinarity in clinical psychoanalysis. Psychoanalysis entertains a complex dialectical relationship with the major theories it opposes. In this dynamic, psychoanalysis begins by negating (...) the non-psychoanalytic theory as a part of self-negation (Hegel calls this phase self-alienation). But in its own process of growth, it negates this negation and reabsorbs the alienated self part. Reabsorbing the negated component, psychoanalysis does not revert to its original identity but becomes sublated into a different, more complex idea. In this epistemological process, psychoanalysis deals with its own practical and theoretical anomalies and lacunas. The paper illustrates this process using three central developments in the history of psychoanalysis: empathy in self psychology (connection with Rogers' humanist psychology), short-term dynamic psychotherapy (connection with short, intensive therapies), and mentalization-based psychotherapy (connection with cognitive-behavioral therapies). In all of these cases, psychoanalysis integrates components it previously opposed and changes these components to their own, specific characteristics. We address the epistemological shifts in the scientific status of psychoanalysis and show their connection to dialectics. Finally, we conclude that dialectical development is what allows psychoanalysis to remain relevant and up to date, to be open to interdisciplinary influences without its identity and tradition coming under threat. (shrink)

Eating disorders can be viewed as “embodied acts” that help to cope with internal and external demands that are perceived as overwhelming. The maintenance of EDs affects the entire identity of the person; the lack of a defined; or valid sense of self is expressed in terms of both physical body and personal identity. According to attachment theory, primary relationships characterized by insecurity, traumatic experiences, poor mirroring, and emotional attunement lead to the development of dysfunctional regulatory strategies. Although the literature (...) shows an association between attachment style or states of mind, trauma, behavioral strategies, and various EDs, the debate is still ongoing and the results are still conflicting. Therefore, we believe it is important to examine and treat EDs by understanding which narrative trajectory intercepts distress in relation to narrative and embodied self-concept. Drawing on clinical observation and a narrative review of the literature, we focus on the construction and organization of bodily and narrative identity. Because bodily representations are the primary tools for generating meaning, organizing experience, and shaping social identity from the earliest stages of life, we focus on the role that bodily interactions and sensorimotor and proprioceptive patterns have played in the development of EDs. We consider the role that lack of attunement, insecure attachment, and relational trauma play in mentalizing, affecting self-representation and emotion regulation strategies. The paper also considers a semantic mode of trauma in EDs that involves a top-down pathway through beliefs and narratives about oneself based on lack of amiability, on devaluation, and on humiliation memories. Finally, we would like to highlight the proposal of an integrated model with multiple access model to psychotherapy that takes into account the complexity of ED patients in whom aspects related to dysregulation, body image disintegration, and post-traumatic symptoms are associated with a suffering sense of self and a retraumatizing narrative. (shrink)

Alterations in consciousness are among the most common transdiagnostic psychopathological symptoms. Therefore clinical practice would benefit from a clear conceptual framework that guides the recognition, comprehension, and treatment of consciousness disorders. However, contemporary psychopathology lacks such a framework. We describe how pathology of consciousness is currently being addressed in clinical psychology and psychiatry so far, and how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, Tenth Edition (ICD-10) refer to this subject. A (...) brief review of the literature on consciousness is then given. After describing psychological perspectives on consciousness and discussing theoretical issues involved in exploring consciousness, we offer a practical clinical working definition of consciousness and we illustrate its connections with a variety of diagnoses. Making use of Jean-Paul Sartre’s distinctions among: states, functions, qualities, and structure, provide a conceptual framework to understand consciousness, to refine diagnostics and to guide the development of therapeutic possibilities in clinical practice. (shrink)

Mentalization is a process of social cognition that involves making inferences about one’s own behavior and the behavior of other people on the basis of unobservable mental states. Particularly in psychodynamic approaches, mentalization is conceptualized in the context of activation of internal representation of emotional relationship. In this study, we checked whether mentalization constitutes a predictor of relational satisfaction in the context of one’s own and the partner’s specific attachment. The research sample was composed of 32 heterosexual couples living together (...) for at least two years. Three tools were applied: the Mental State Task, Experiences in Close Relationships-Relationship Structures, and the Relationship Assessment Scale. The results indicate a strong negative effect of one’s own attachment anxiety and avoidance, and a strong effect of the partner’s attachment anxiety on the relationship satisfaction for both men and women. In women, the incremental validity of mentalization in predicting satisfaction in the relationship beyond the attachment of their partners has been observed. The results are discussed in the context of the intrapsychic and interpersonal aspects of mentalization and attachment. (shrink)

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs.Method: A sample of patients with eating disorders completed a battery of measures assessing mentalization and related variables, including the Reflective (...) Functioning Questionnaire, the Difficulties in Emotion Regulation Strategies, the Interpersonal Reactivity Index. Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale, and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation, empathy, and adequate and impairments in mentalizing.Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: affective/self/automatic imbalances, external imbalance, cognitive/self/automatic imbalances, and cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients.Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis. (shrink)

This paper is a critical analysis and overview of body image conceptualization and its scope and limits within the field of eating disorders up to the present day. In addition, a concept ofemotional bodily experienceis advanced in an attempt to shift towards a more comprehensive and multidimensional perspective for thelived bodyof these patients. It mainly considers contributions from phenomenology, embodiment theories and a review of the empirical findings that shed light on the emotional bodily experience in eating disorders. It proposes (...) an ‘embodied defense’ that leads patients to experiencing their own bodies as objects. This proposal highlights the need for new psychotherapeutic tools in the treatment ofeds that take into account the bodily resonance of emotions and their use for improving adaptive responses to the environment: it calls for helping patients to recover the subjective experience of their bodies. (shrink)

Current theories of social cognition are mainly based on a representationalist view. Moreover, they focus on a rather sophisticated and limited aspect of understanding others, i.e. on how we predict and explain others’ behaviours through representing their mental states. Research into the ‘social brain’ has also favoured a third-person paradigm of social cognition as a passive observation of others’ behaviour, attributing it to an inferential, simulative or projective process in the individual brain. In this paper, we present a concept of (...) social understanding as an ongoing, dynamical process of participatory sense-making and mutual incorporation. This process may be described (1) from a dynamical agentive systems point of view as an interaction and coordination of two embodied agents; (2) from a phenomenological approach as a mutual incorporation, i.e. a process in which the lived bodies of both participants extend and form a common intercorporality. Intersubjectivity, it is argued, is not a solitary task of deciphering or simulating the movements of others but means entering a process of embodied interaction and generating common meaning through it. This approach will be further illustrated by an analysis of primary dyadic interaction in early childhood. (shrink)

Mentalization is a form of social cognition that enables to perceive and interpret human behaviour in terms of intentional mental states and is influenced by social context. Hence, we examined mentalization related to specific attachment relationships. This study involved 115 participants who reported their relationship-specific and global attachment styles, and perspective-taking tendency towards their attachment figures. Reading the Mind in the Eyes Task-Revised was used as a proxy for mentalization disregarding relationships. The results showed that perspective-taking was associated with relationship-specific (...) attachment avoidance whereas global characteristics of mentalization were not related to attachment quality. Our findings indicate that the link between attachment quality and mentalization is relationship-specific. (shrink)

Theory of Mind is a mental process which can be critical to the understanding of the maintenance of psychic disorders and can have implications for their treatment. The idea of a conceptual organisation of the Theory of Mind is supported by current research from Developmental Psychology. We could show that Theory of Mind seems to develop with the understanding of identity and is based on a common conceptual basis: the understanding of the relationship between reference and representation. Theory of Mind (...) means the ability to ascribe and reflect own mental states and mental states of others. The concept "Theory of Mind" is used very heterogeneousl and is defined very broadly in the research with adults. The aim of this work is to describe the theoretical and conceptual basis of the Theory of Mind and to show its importance for the Posttraumatic Stress Disorder and Chronic Depression with regards to aetiology concept as well as for its implications in the specific therapy methods [Dialectic Trauma Therapy of and the Cognitive Behavioral Analysis System for Psychotherapy ]. I will take into account the attachment theory, the ability of perspective-taking and the integration of paradoxical information as well as the meaning of trauma as a determining factor in the organisation of the Theory of Mind. The differentiation between reference and representation forms the basis of the ability of perspective-taking as well as understanding identity. This work shows related concepts as well as established assumptions about the organisation of the Theory of Mind and Mentalizing and introduces a meta-representational concept to distinguish between reference and representation. The environment is seen as an external source of supply to the formation of mental representation. This work intends a systematic processing of the conceptual fundament of the Theory of Mind as a basis for the use in the clinical-therapeutic area. (shrink)