Mentalization as a predictor of psychoanalytic outcome. An empirical study of transcribed psychoanalytic sessions through the lenses of a computerized text analysis measure of reflective functioning

The Reflective Functioning Scale (Fonagy, Target, Steele, & Steele, 1998) was developed to empirically assess the capacity to mentalize thoughts, intentions, feelings and beliefs of oneself and others in the context of attachment relationships (Jurist & Meehan, 2009). To overcome the complexity of the RF scale scoring, the Computerized Text Analysis measure of Reflective Functioning (CRF) was created by Fertuck, Mergenthaler, Target, Levy, and Clarkin (2012). We report the results of a preliminary study applying the CRF to a sample of 540 sessions comprising 27 psychoanalytic treatments. Results show that patients' reflective functioning (RF), as measured at the beginning of treatment, was positively correlated with two global measures of healthy personality functioning-the Global Assessment of Functioning (GAF; American Psychiatric Association, 2000) and the Personality Health Index (PHI; Waldron et al., 2011)-as measured at the end of treatment. Even when the PHI and GAF levels at the beginning of treatment, the length of the treatments, and the average number of sessions per week were controlled for, these correlations remained significant. At the same time, the RF of patients did not increase throughout treatment. The implications of these results and the validity of CRF as an outcome predictor of long-term psychoanalytic treatment are discussed.