The role of mentalising in recovery from psychosis: A qualitative interpretive synthesis

Purpose
Research on recovery from psychosis indicates that individuals often continue to experience high levels of distress in coping with day-to-day life, even after the psychotic phenomena have ceased. Researchers have suggested that this discrepancy can be explained by difficulties in mentalising, a process closely associated with attachment security. This review focuses on psychotic experiences insofar as they intersect with trauma, attachment disturbances and dissociative processes, while acknowledging that psychosis is heterogeneous and may also be understood through other frameworks. The present review aimed to answer the question: ‘What is the role of mentalising in recovery from psychosis?’.

Methods
A search, following systematic principles, of four databases was performed (Web of Science, SCOPUS, PsycINFO, Medline EBSCO). After screening for relevance and quality, 15 articles remained. Critical interpretative synthesis (CIS), a review methodology born from meta-ethnography, was used to allow inclusion of data across a range of sources. This enabled the synthesis of information drawn from both qualitative and quantitative studies, alongside expert opinion papers and case studies.

Results
The results indicated that mentalising capacity underpinned reciprocal processes of developing sense of self (through self-reflection and developing complex self-narratives) and adaptation to the social environment (through attachment security and the ability to think about interaction). This in turn afforded agency in communicating self-states, accessing social connection and support, navigating social interaction, and a return to meaningful activities. Mentalising in recovery also influenced subjective experience, including feeling connected, reduced self-stigma, an integrating recovery style, a reduction in unusual experiences, and a sense of self continuity.

Conclusions
The original contribution of this review is the development of a conceptual model linking mentalising to recovery through two reciprocal pathways: re-development of a sense of self and adaptation to social environments. The proposed model should be regarded as a clinician- and literature-derived framework based on a heterogeneous corpus, requiring validation through further study centred on first-person accounts.