The importance of reflective functioning to the diagnosis of psychic structure

OBJECTIVE: This pilot study examines the connection between the concept of Fonagy and Target's reflective functioning and the structure axis of operationalized psychodynamic diagnostics (OPD) and assesses the potential of both scales to predict therapy success. METHOD: In the study, 24 (female) patients of the psychotherapy ward of the Frankfurt University Hospital for psychosomatic medicine and psychotherapy aged 18 to 55 were assessed on the basis of a 90-minute, semi-structured interview with regard to their capability for reflective functioning as well as with regard to their structural level according to OPD. In addition, the SCL-90-R was administered at the beginning and end of the 3-month in-patient therapy. RESULTS: A significant correlation was found between reflective functioning and the structure axis of OPD. Reflective functioning also predicted improvement in overall mental condition through a 3-month in-patient therapy. This remained significant even when the influence of the overall assessment of structure according to OPD was removed. CONCLUSIONS: The independence of the concept of reflective functioning (RF) and its implications for the clinical stance are discussed.