Psychosis and Recovery: what is the Role of Mentalising in Recovery from Psychosis? A Critical Interpretative Synthesis

Research on recovery from psychotic experience indicates that individuals often continue to experience a high level of distress and difficulties in coping with day-to-day life even after the strange phenomena associated with psychosis have ceased. Some researchers have suggested that this discrepancy can be explained by difficulties in mentalising, a process closely associated with attachment security. The present study set out to answer the question: ‘What is the role of mentalising in recovery from psychosis?’. A systematic search of four databases was carried out (Web of Science, SCOPUS, PsychInfo, and Medline ESCBO) to identify papers that could address the review question. After screening for relevance and quality, 15 articles remained. Critical interpretative synthesis (CIS), a systematic review method born from meta-ethnographical processes, 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, as well as from expert opinion papers and case studies. The results of the synthesis 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 positive 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. The study highlighted the need for research with a specific focus on first person accounts of mentalising and the importance of attachment in recovery processes.