The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression Inventory and the Reflective Functioning Questionnaire (RFQ). Data were analyzed using Latent Growth Curve (LGC) modeling with structured residuals. In the total sample, depressive symptoms improved on average from baseline to the end of treatment, while mentalizing skills did not. However, individual variations were observed in mentalizing skills, with some patients improving while others did not. Within-patient residual changes in mentalizing skills did not predict residual changes in depressive symptoms. Accordingly, the results did not support mentalizing as a mechanism of change at this level. Nonetheless, between-patient effects were found, showing that patients with higher levels of mentalizing at baseline and patients whose mentalizing skills improved over the course of therapy also had greater reductions in depressive symptoms. We suggest that the presence of relatively higher mentalizing skills might be a factor contributing to moderately depressed individuals' ability to benefit from treatment, while relatively poor or absent mentalizing capacity might be part of the dynamics underlying treatment resistance in individuals with severe depression. Public Significance StatementEmotional and relational changes related to psychodynamic therapy are likely to be followed by reductions in depressive symptoms over the course of therapy. Between-person improvements in mentalizing were related to reductions in depressive symptoms, but within-person change in mentalizing was not found to be a mechanism of change in depression. Further research is needed to examine the role of mentalizing skills as a factor contributing to the depressed individual's ability to profit from treatment.

One’s perceived relationship with God can be understood as an attachment or object relation, and this relationship can have clinical relevance, such as for depressive conditions. We investigated changes in attachment to God among participants in a 3-month inpatient psychodynamic therapy program. We then linked changes in the God relation to changes in depressive symptoms (N = 56). Attachment behavior to God generally increased in the treatment period and remained relatively stable with only slight decreases at the 1-year follow-up (FU). Higher initial levels of attachment behavior to God were linked to higher baseline levels of depressive symptoms. Additionally, increases in attachment behavior to God predicted increases in depressive symptoms during the first phase of therapy and then reductions in depressive symptoms during the last period of treatment—at the end of treatment, depression symptoms had decreased considerably from baseline. Our findings suggest that the God relation can be addressed in terms of existing theories about human relations and knowledge about therapeutic processes. The trained therapist can potentially offer individuals suffering from pathological conditions that incorporate patients’ representations of God.