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The Reflective Functioning Questionnaire (RFQ)

General information

Mentalizing, or reflective functioning, refers to our capacity to understand ourselves and others in terms of intentional mental states, such as feelings, desires, wishes, goals and attitudes. Mentalizing is a quintessential human capacity that is needed to be able to successfully navigate the social world. Impairments in this capacity have been shown to be implicated in a wide variety of disorders and behavioural problems, ranging from psychosis to personality disorders, mood and anxiety disorders, eating disorders, and conduct disorder [1].

There is increasing evidence to support the effectiveness of intervention programmes that have been explicitly inspired by the mentalizing approach, and a focus on improving mentalizing may be a common factor in all effective psychosocial interventions [2].

The Reflective Functioning Questionnaire (RFQ) was developed as a brief, easy-to-administer screening measure of reflective functioning [3]. It is not aimed at capturing the different dimensions of mentalizing (for a detailed description of these dimensions, see [4]), nor is it aimed at capturing the process of mentalizing as it unfolds in social interactions. A wide range of measures are currently available that tap into these specific capacities, or that allow the assessment of ‘online’ (real-time) mentalizing. For a more extensive discussion of the assessment of mentalizing for clinical and research purposes, see [5].

We are currently in the process of developing a longer, multidimensional self-report and clinician-report measure of reflective functioning, as well as measures that assess different dimensions of mentalizing. These will be made available in the future.

Development of the RFQ

A detailed description of the development of the RFQ can be found in Fonagy et al. (2016) [3].

As described in this paper, in developing the RFQ, we first formulated 46 items that were scored using either a polar-scoring or a median-scoring method.

For polar-scored items (e.g., “I realise that I can sometimes misunderstand my best friends”), stronger agreement (or disagreement in case of inverted items) yielded higher reflective functioning scores.

Median-scored items were designed so that responses reflecting an awareness of the opaqueness of mental states (“disagree somewhat” or “agree somewhat”) received the highest scores, while extreme answers (“strongly agree” or “strongly disagree”) were scored so that they reflected lower reflective functioning. For example, the response to the item “I always know what I feel”, which was scored by the participant on a 6-point Likert-type scale ranging from 1 (completely disagree) to 6 (completely agree), was rescored as 1, 2, 3, 3, 2, 1, so that the more extreme the rating, the lower the score on reflective functioning.

Extensive analyses of both scoring methods using Principal Component Analysis and Confirmatory Factor Analysis in different community and clinical samples failed to yield evidence for their validity. The polar-scored items tended to suffer from ceiling or floor effects, and tended to load on two bipolar factors, reflecting the wording of items (i.e., positively and negatively formulated items),and tended to conflate hypomentalizing and hypermentalizing, as did the median-scored items.

This led us to focus on the originally median-scored items only, but to recode them, focusing on certainty versus uncertainty about mental states. Hence, we developed a scale assessing Certainty about Mental States (RFQ_C), focusing on the extent to which individuals disagree with statements such as “I don’t always know why I do what I do”, and rescoring them so that very low agreement on this scale reflected hypermentalizing, while some agreement with these items would purportedly reflect more genuine mentalizing, involving an acknowledgment of the opaqueness of mental states, while at the same time having some certainty about what oneself or others are experiencing. In the initial 46-item RFQ, we used a 6-point Likert-type scale so that items were rescored to 2, 1, 0, 0, 0, 0.

After initial pilot studies, we added 8 items in an attempt to better capture certainty/hypermentalizing, which led to the RFQ-54, and we changed the scale to a 7-point Likert-type scale to increase the possible range of scores, rescoring these items to 3, 2, 1, 0, 0, 0, 0.

Similarly, we developed a scale assessing Uncertainty about Mental States (RFQ_U), which in the extreme was expected to assess hypomentalizing. Responses to items such as “Sometimes I do things without really knowing why” were recoded to 0, 0, 0, 0, 1, 2 (6-point Likert-type scale) or 0, 0, 0, 0, 1, 2, 3 (7-point Likert-type scale), so that high scores reflect a stance characterized by an almost complete lack of knowledge about mental states, while lower scores reflect acknowledgment of the opaqueness of one’s own mental states and that of others, characteristic of genuine mentalizing.

Because we wanted to develop a brief screening measure of reflective functioning, we selected the six items that had the highest loading on their respective factor across a series of exploratory and confirmatory factor analyses across the samples used in the original validation studies [3] [6].

On this website, we make available the original 46-item version, the 54-item version and the final 8-item version.

The SPSS syntax for scoring the 17 (RFQ46) and 26 (RFQ54) median-scored items is also available on this website; this is provided for exploratory investigations only.

For researchers wishing to use the RFQ as a screening measure in research studies, we recommend using the 8-item version and the accompanying syntax.

Statistical analysis

For the purposes of statistical analysis, we recommend (multi-group) Confirmatory Factor Analysis with maximum likelihood estimation either on Pearson r correlation coefficients or on polychoric correlations, allowing error correlations only between items that are similar in formulation or meaning (e.g., item 17, “I don’t always know why I do what I do” and item 36, “Sometimes I do things without really knowing why”). For more details, see Fonagy et al. 2016 [3].

Availability

The RFQ is freely available to download for research purposes. The measure is not yet suited for clinical purposes.

Other language versions will be available soon. If you are interested in translating the RFQ, or if you have any other questions, please contact us:

Patrick Luyten: p.luyten@ucl.ac.uk

Peter Fonagy: p.fonagy@ucl.ac.uk

References

  1. Allen JG, Fonagy P, Bateman AW. Mentalizing in clinical practice. Washington, DC: American Psychiatric Press; 2008.
  2. Fonagy P, Luyten P, Allison E. Epistemic petrification and the restoration of epistemic trust: A new conceptualization of borderline personality disorder and its psychosocial treatment. Journal of Personality Disorders. 2015;29(5):575-609. doi: 10.1521/pedi.2015.29.5.575
  3. Fonagy P, Luyten P, Moulton-Perkins A, Lee YW, Warren F, Howard S, et al. Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire. PLOS ONE. 2016;11(7):e0158678. doi: 10.1371/journal.pone.0158678
  4. Luyten P, Fonagy P. The neurobiology of mentalizing. Personality Disorders: Theory, Research, and Treatment. 2015;6(4):366-79. doi: 10.1037/per0000117.
  5. Luyten P, Fonagy P, Lowyck B, Vermote R. Assessment of mentalization. In: Bateman AW, Fonagy P, editors. Handbook of mentalizing in mental health practice. Washington, DC: American Psychiatric Publishing; 2012. pp. 43-65.
  6. Badoud D, Luyten P, Fonseca-Pedrero E, Eliez S, Fonagy P, Debbane M. The French version of the Reflective Functioning Questionnaire: Validity data for adolescents and adults and its association with non-suicidal self-injury. PLOS ONE. 2015;10(12):e0145892. doi:10.1371/journal.pone.0145892