Reflective functioning in the Psychotic Spectrum: a longitudinal evaluation of Group MBT using the Reflective Functioning Scale

A growing body of evidence suggests that Reflective functioning (RF), the measurable expression of mentalization, is linked to vulnerabilities in psychotic spectrum disorders. Mentalization-Based Treatment (MBT), originally developed for borderline personality disorder, has recently been proposed as a promising intervention for this population. This work examines a longitudinal evolution of RF in young adults with psychotic spectrum diagnoses undergoing a 12-month Group MBT protocol within the Department of Mental Health of AULSS 6 Euganea (Padova). The study involves nine participants (aged 24–49), assessed through a mixed-method design. The Reflective Functioning Scale (RFS; Fonagy et al., 1998) applied to verbatim therapy transcripts was used as a process measure, while outcome measures include standardized clinician-rated and self-report scales evaluating symptomatology, social and occupational functioning, and mentalized affectivity. Assessments were conducted at baseline (T0), post-treatment (T1), and at a 12-month follow-up (T2). It was hypothesized that Group RF would improve over the course of treatment, with clinical-functional improvements expected on an individual level, supporting RF as a transdiagnostic mechanism of change in MBT.