Mentalization and couple relationships: A systematic review of associations and interventions.
Abstract
Background
Mentalization, the ability to understand one's own and another's thoughts and feelings, is considered important for couple functioning. Many couple-focused interventions aim to improve mentalization, either as the process through which change occurs or as a central goal of treatment. We aimed to examine (a) associations between mentalization and couple relationship processes and (b) the impact of interventions designed to enhance mentalization in couples.
Methods
We included studies of adult romantic couples that assessed associations between mentalization and relationship outcomes or evaluated interventions incorporating mentalization. We searched 6 databases (last search: 20th October 2025), identifying 72 publications to include. Sixty-four publications examined associations, of which 24 were included in a meta-analysis, and eight studies examined interventions. Risk of bias was assessed using CASP checklists.
Results
Higher mentalization was moderately associated with greater relationship satisfaction (k = 24, ρ = 0.31, 95% CI [0.24, 0.37]), although findings were significantly heterogeneous (I2 = 91.1%). Narrative synthesis indicated that higher mentalization was also associated with adaptive relational processes, whereas lower mentalization was associated with conflict and intimate partner violence. Intervention studies showed improvements in satisfaction, intimacy, empathy and conflict reduction, although effects were heterogeneous and constrained by small samples and inconsistent measures.
Discussion
Mentalization is a robust correlate of couple functioning and a promising but undertested intervention target. Causal mechanisms remain unclear, and the evidence base is limited by heterogeneity and modest methodological quality. More rigorous, diverse trials are needed to establish effectiveness, mechanisms and sustainability of mentalization-based interventions for couples.