In this study, we examined global treatment outcomes during 16 months of intensive, psychodynamic treatment for 77 inpatients suffering from treatment-refractory disorders. Hypotheses based on the phase model of treatment change (Howard, Lueger, Maling, & Martinovich, 1993; Howard, Moras, Brill, Martinovich, & Lutz, 1996) were supported in the study results. Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis V scales assessing behavioral functioning demonstrated large and medium effect size change, whereas stable, enduring personality functioning assessed by psychoanalytic Rorschach scales and the Social Cognition and Object Relations Scale (Westen, 1995) for the Thematic Apperception Test (Murray, 1943) demonstrated small and medium effect size change. We also report assessment of reliable change index and clinical significance. The ecological validity of Rorschach measures is supported by significant validity coefficients (in the hypothesized directions) between implicit measures of personality functioning and behavioral ratings.

The concept of mentalization – the ability to think about mental states (e.g., feelings, intentions, motivations) of self and others – has become increasingly influential in psychoanalysis ( Bateman & Fonagy, 2004 ; Fischer-Kern et al., 2010 ; Fonagy, 1991 ). Unfortunately, the clinical application and further exploration of the construct has been limited by the time-consuming and highly specialized methods used to assess it ( Choi-Kain & Gunderson, 2008 ; Meehan, Levy, Reynoso, Hill, & Clarkin, 2009 ). In that mentalization operates predominantly outside of conscious awareness and involves the assessment of mental representations of self and other, projective measures such as the Rorschach are possibly the most efficient to evaluate and further explore this construct. In this paper we present a conceptual framework for how texture responses (T) as they relate to the ability to form attachments, and human and human movement responses (M+/M–, GHR:PHR) as they relate to empathy, social understanding, and boundary formation, may be utilized in the assessment of mentalization.

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