Clinical Evaluation and Intervention of Emerging Psychosis: A Mentalization-Informed Perspective

The practice of clinical evaluation and intervention for schizophrenia spectrum and other psychotic disorders (SSPDs) is progressively integrating a developmental perspective, targeting premorbid, clinical high-risk, and early phases along the continuum of symptom severity. Notwithstanding important progress in early intervention, clinical challenges remain in SSPDs, most notably the chronic functional disabilities which impede recovery. In this chapter, we review the evidence suggesting that mentalizing, or the developmentally acquired capacity to think about mental states, may represent a resilience-strengthening intervention target along the different stages of unfolding SSPDs. This leads us to consider evaluation and intervention informed by mentalization-based therapy (MBT), as applied along the clinical continuum of symptom expression. A clinical vignette illustrates the challenges encountered in the different periods of unfolding psychotic psychopathology, and some of the therapeutic benefits yielded by mentalization-informed clinical practice.