Measuring mentalization: An attempt using the Reflective Functioning Rating Scale

BACKGROUND The ability to mentalise or continue to mentalise is considered relevant for our understanding of the progenesis of various psychiatric disorders and is seen as a common factor in various forms of psychotherapy. Until now, however, there has not been any easy to handle instrument available which clinicians can use to measure the nature and degree of a patient's mentalisation ability. The Reflective Functioning Rating Scale (RFRS) is an instrument that is developed to meet the need for such measurements. AIM To investigate the scale structure, reliability, validity and usefulness of this new rating scale in a psychotherapeutic population. METHOD We conducted a cross-sectional study among psychotherapy patients and their therapists using the infrastructure of routine outcome monitoring for data sampling. RESULTS The items in the RFRS could be grouped in threeclinically meaningful dimensions: AdequateMentalising (AM), Blocked Mentalising (BM) and Non-Mentalised Behaviour (NMB). The first two dimensions had an excellent internal consistency, the third (NMB) fell short. The inter-rater reliability of all three scales was unsatisfactory. The construct and concurrent validity were disappointing. Finally, the usefulness of the instrument, as experienced by the therapists was below the required standard and needs to be upgraded. CONCLUSION In psychotherapeuticand psychiatric practice mentalising is a frequently used concept. Sofar.there is no instrument available which allows clinicians to measure the nature and degree of mentalisation. In its present form the RFRS is not up to the required standard.

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