Observer-based and computerized measures of the patient’s mentalization in psychotherapy: A scoping review

Figures & data

Figure 1. Flow diagram adopted from the PRISMA statement(Moher et al., 2009).

Table I. The different approaches to generate the total score for in-session RF.

	Publication	Assessment unit	Aggregation total score	RF total score (therapy start)
Single case studies	de la Cerda and Dagnino (2021)	Statement	No total score
	Josephs et al. (2004)	Blocks of 150 words	Mean score	0.75
	Kornhas et al. (2020)	3-minute segments	Mean score after exclusion of the lowest 20%	1.47
	Georg et al. (2019)	Blocks of 150 words	Mean score	2.63
	Markin and McCarthy (2020)	N/A	N/A	3
	Brockmann et al. (2017)	N/A	N/A	4
	Janusz et al. (2020)	Blocks of 150 words	Algorithm	1.5; 4.5
	Hörz-Sagstetter et al. (2015)	Blocks of 150 words	Algorithm	3; 5
5–160 patients	de la Cerda et al. (2019)	N/A	No total score
	Kalleklev and Karterud (2018)	Statement	No total score
	Kivity et al. (2021)	Statement	Algorithm	N/A
	Möller et al. (2017)	Statement	Mean score	1.83 (0.52)
	Danback (2006)	Blocks of 150 words	Mean score	2.16 (0.78)
	Zeeck et al. (2022)	3-minute segments	Mean score after exclusion of lowest 3 scores	3.06 (0.66)
			Mean score of highest 3 scores	4.1 (0.89)
	Talia et al. (2019)	Blocks of 150 words	Algorithm	3.5 (1.3)
	Goldstein (2015)	Statement	Algorithm	3.55 (0.74)
			Highest score	3.98 (0.79)
	Babl et al. (2022)	Blocks of 150 words	Mean score after exclusion of the lowest 2 blocks	3.56 (0.57)
	Bryant (2020)	Complete session	Highest score (averaged over 4 sessions)	4.29 (0.82)
	Karlsson and Kermott (2006)	Complete session	Highest score	4.52 (1.48)
	Karlsson and Kermott (2006)	Complete session	Highest score	4.62 (1.39)
	Bernbach (2001)	Thirds	Low	1.90 (1.20)
			Mode	4.56 (1.65)
			Peak	7.00 (1.76)
			Mean (low, mode, peak)	4.49 (1.46)

Table II. Frequency distribution and measurement time points of the measures.

Measure		Study (i)	Publication (j)	Measurement time points (per study)			Amount of collected Data Md (range)
				One	Two	Three +
RFS	AAI	16	40	18.8%	62.5%	18.8%	61.5 (2-236)
	BRFI, brief RF	5	8		60.0%	40.0%	52.0 (3-414)
	PRI-T, PT-AAI, TATI	3	6	66.7%		33.3%	10.0 (4-28)
	ORI	1	4			100%	308.0
	SSRF	4	10		50.0%	50.0%	82.5 (52-408)
	In-session RF^a	21	22	9.5%	14.3%	66.7%	36 (2-216)
CRF	AAI	2	2	100%			81.0 (49-113)
	session	2	2			100%	290.0 (40-540)
RFRS		2	2	100%			150.5 (49-252)
MIS		5	5	60%		40%	24 (15-400)
MMS		5	5	60%		40%	24 (15-400)

Note. RFS = Reflective Functioning Scale; AAI = Adult Attachment Interview; BRFI = Brief Reflective Functioning Interview; PRI-T = Patient Relationship Interview at Termination; PT-AAI = Patient-Therapist Adult Attachment Interview; TATI = Therapist Attachment Transference Interview; ORI = Object Relations Inventory; SSRF = symptom-specific reflective functioning; CRF = Computerized Reflective Functioning; RFRS = Reflective Function Rating Scale; MIS = Mentalization Imbalances Scale; MMS = Modes of Mentalization Scale.

^a Measurement time points for two studies were not included because they used only selected episodes from the therapy sessions instead of the entire session.

Table III. Factor structure and internal consistency.

	RFRS		MIS	MMS
	Meehan et al. (2009)	Kemps and Kooiman (2015)	Gagliardini et al. (2018)	Gagliardini and Colli (2019)
Factor 1	Defensive/Distorted	Adequate Mentalizing	Cognitive	Excessive Certainty
α	0.94	0.94	0.89	0.91
items	16	29	5	6
λ		0.44–0.72	0.65–0.90	0.47–0.91
Factor 2	Awareness of Mental States	Blocked Mentalizing	Affective	Concrete Thinking
α	0.95	0.81	0.83	0.79
items	14	13	4	6
λ		0.37–0.66	0.53–0.88	0.45–0.78
Factor 3	Developmental	Nonmentalizing Behavior	Others	Good Mentalization
α	0.92	0.59	0.81	0.83
items	13	5	3	5
λ		0.40–0.69	0.67–0.91	0.51–0.85
Factor 4			Self	Teleological Thought
α			0.78	0.77
items			4	3
λ			0.58–0.76	0.41–0.86
Factor 5			Automatic	Intrusive Pseudomentalization
α			0.70	0.67
items			3	4
λ			0.50–0.75	0.40–0.66
Factor 6			External
α			0.78
items			3
λ			0.55–0.87

Note. RFRS = Reflective Function Rating Scale; MIS = Mentalization Imbalances Scale; MMS = Modes of Mentalization Scale.

α = Cronbachs Alpha, λ = factor loadings.

Figure 2. Reported Correlations between different measures of RF.

Note. RFS = Reflective Functioning Scale; AAI = Adult Attachment Interview; CRF = Computerized Reflective Functioning; PRI-T = Patient Relationship Interview at Termination; PT-AAI = Patient-Therapist Adult Attachment Interview; RFRS = Reflective Function Rating Scale; BRFI = Brief Reflective Functioning Interview; DSRF = depression-specific reflective functioning; PSRF = panic-specific reflective functioning.

Figure 3. Effects of sensitivity to change sorted by the used measure and effect size.

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