Is Mentalization a Common Process Factor in Transference-Focused Psychotherapy and Dialectical Behavior Therapy Sessions?

Transference-focused psychotherapy (TFP) and dialectical behavior therapy (DBT) are 2 treatment models designed to treat patients with borderline personality disorder (BPD). Although originating in separate theoretical orientations, TFP and DBT have been effective in treating BPD patients. Reflective functioning (RF), defined as interpreting the behaviors of self and others as motivated by the underlying mental states of self and others, has been suggested as an effective therapeutic process common to all BPD treatment models. Expert raters provided TFP and DBT prototypes as well as a prototype of RF process using the Psychotherapy Process Q-Set. Three hypotheses were tested: (1) The TFP prototype would be positively correlated with a previously constructed psychodynamic therapy (PDT) prototype and not with a previously constructed cognitive-behavioral therapy (CBT) prototype or the DBT prototype, (2) the DBT prototype would be positively correlated with the CBT prototype and not with the PDT prototype, and (3) the RF process prototype would be positively correlated with both the TFP and DBT prototypes. The TFP and DBT prototypes loaded onto 2 independent factors. The RF process prototype loaded onto both factors. The TFP prototype was positively correlated with the PDT prototype and not with the CBT or DBT prototypes. The DBT prototype was positively correlated with both the CBT and PDT prototypes. The RF process prototype was highly correlated with all prototypes. It is argued that enhancing RF in BPD patients is an implicit process inherent to TFP and DBT and should be explicitly acknowledged.