Working alliance, attachment and mentalization as relational indexes for a systemic manualization of psychotherapy.

Evidence-based research have confirmed that various models of psychotherapy produce very positive results, but no particular psychotherapeutic technique has shown a significant superiority compared to the others. A factor significantly related to patient or family satisfaction and to the final result of psychotherapy seems to be the quality of the therapeutic alliance or Working Alliance (WA), and the attachment paradigm has been used as a key for interpretation and assessment of this dimension. Another relational factor that seems to be a common goal for most therapies is to increase mentalization of patients and their families, but how can this factor be measured within therapeutic relationships? Following a systemic perspective that takes this evidence into account and pursues a biopsychosocial vision, in the manualization of a psychotherapeutic protocol, relational indexes as working alliance, attachment and mentalization can be considered. Different models of assessment of WA, attachment and mentalization in psychotherapy will be described. Unfortunately, most of them assess these dimensions as individual characteristics. Reflective Function in the Family (RFF) will be described, one of the few tools to evaluate mentalization in family therapy following a systemic perspective. Its integration in the manualization of a therapeutic protocol is suggested.