Mentalization

Mentalization is the capacity to understand and interpret behavior in terms of underlying mental states—such as beliefs, desires, intentions, emotions, and thoughts—in oneself and in others. It involves attributing intentionality to actions, recognizing that people can hold different beliefs or feelings from one’s own, and using this understanding to predict and regulate behavior. The concept is closely related to theory of mind and to reflective functioning, a term used to describe the quality of mentalization.

Mentalization develops in childhood within caregiver–child relationships and is influenced by attachment security. Secure attachments support accurate inference about others’ mental states and management of one’s own emotions; adversity can impair mentalization, leading to misreads of others or excessive self-focus. The framework has been integrated into psychoanalytic and psychotherapeutic approaches, particularly through the work of Peter Fonagy and colleagues.

Clinically, mentalization-based treatment (MBT) aims to strengthen reflective functioning to improve affect regulation and interpersonal functioning. MBT has shown efficacy for borderline personality disorder and has been adapted for other mood and personality disorders. Assessment tools include the Reflective Functioning Scale applied to interviews and the Reflective Functioning Questionnaire, with roots in the Adult Attachment Interview.

Research distinguishes mentalization from basic theory of mind and from empathy, though they are related constructs. Limitations include measurement challenges, cultural variation in expressions of mental states, and debates about the universality of mentalization. In autism spectrum conditions, mentalizing deficits are a prominent focus, but the profile is heterogeneous. Ongoing work aims to clarify mechanisms and optimize clinical applications.