How Mentalization and Reflective Functioning Could Add to Dyadic Health Science

Brenton Kirschner, M.MFT, LPC, LMFT

Introduction

Between the 1990s and early 2000s, the field of dyadic research was small, primarily focusing on studying family relationships using Actor-Partner Interdependence Models (APIMs). Now, in 2026, it has become an interdisciplinary field with comprehensive models (Lyons, Rauer, and Proulx, 2026). The field is growing so quickly that the demand for training and program development has outpaced what experts are able to create. However, Karen Lyons, Ph.D., FGSA, Amy Rauer, Ph.D., FGSA, and Christine M. Proulx, Ph.D., have provided an invaluable resource for those seeking to learn the theories and methods of Dyadic Health Science.

What is Dyadic Health Science?

Approximately 25% of adults in the United States serve in a caregiver capacity to one, sometimes multiple, long-term relationships. When a patient is diagnosed with cancer, the focus is on that individual. The highest priority is appropriately placed on medical treatment and outcomes. However, this individual focus misses seeing the patient in their primary relational context.

“The impact of a cancer diagnosis, and the resulting treatment, adverse events, financial burden, and fear of recurrence can cause substantial distress and anxiety, not just to the patient themselves but also to their caregivers. Most care for patients with cancer is provided by family caregivers, often by a spouse. Providing care for a person with cancer requires both emotional and physical commitment and can take a huge toll on mental and physical wellbeing in addition to causing financial hardship.” (The Lancet Oncology, 2024, p. 1387)

As a Marriage and Family Therapist, the dyadic perspective resonates with my systemic training. We were taught to view families through a cybernetic lens, focusing on patterns and feedback loops rather than linear causality. In mental health practice, systemic interventions often produce more enduring outcomes than approaches that target individuals alone.

The authors reference Wilson and Novak (2024) for three elements of the definition of Dyadic Health Science:

1. The focus is on dyads in close enduring relationships.

2. The goal is to optimize the health of the dyad.

3. The research is grounded in a dyadic theoretical framework.

(Lyons, Rauer, & Proulx, 2026; Wilson & Novak, 2024).

This differs from health behavior science, which focuses on how an individual experiences the disease process and treatment, instead highlighting the unique challenges of two people navigating health and illness together (Lyons, Rauer, and Proulx, 2026).

When I started reading about Dyadic Health Science, my mind went immediately to how medical trauma, chronic illness, and financial stress would impact a romantic relationship between a couple. While this is relevant, the authors establish that this book is not limited to couples but also addresses parent–adult child dyads. Additionally, the authors cover in depth caregiving research, nursing, the management of health and illness, and the science of behavior change.

Relevant Fields & Interview Methods

The authors highlight that currently the highest quality research for Dyadic Health Science comes from adult oncology, cardiovascular disease, early-stage ADRD, and obesity and smoking related illness (Lyons et al., 2026). However, these are not the only relevant fields, and there is a great need to expand research into other specialties.

In the hopes of creating a beachhead for unification of the field and launching new initiatives, the authors interviewed twenty-two dyadic researchers. Each interview included the following ten questions (Lyons, Rauer, and Proulx, 2026):

1. How would you define dyadic research?

2. What first started your interest in dyadic research?

3. Thinking about your work today, briefly, what is your focus/interest area in dyadic research?

4. What are the methods and theories that you find most helpful in examining your focus area?

5. What is the dyadic research you are most proud of that you have either led or been involved with?

6. What 2–3 things most excite you about current/emerging dyadic research?

7. Where do you think we need to go as a field?

8. What 2–3 pieces of advice would you have for someone who is just entering the field of dyadic research?

9. Who else should we try to talk to about dyadic research?

10. Is there anything else you think we should know or that you would like to share with us?

Expanding the Conversation

As I reflected on the rapid growth of Dyadic Health Science, I began considering how my own clinical and coaching experience intersects with this emerging field. While the book provides a strong foundation, I see several opportunities to deepen and expand the conversation:

How Mentalization and Reflective Functioning Could Add to Dyadic Health Science

The foundational work on mentalization and reflective functioning in the context of attachment and interpersonal relationships is attributed to Peter Fonagy, Mary Target, Howard Steele, Miriam Steele, and Jon G. Allen.

Mentalization refers to the capacity to understand one's own and others' mental states, such as thoughts, feelings, and intentions. This ability is crucial for navigating interpersonal relationships. Reflective functioning is the operationalization of mentalization, describing how well individuals can reflect on their own and their partner's internal experiences.

Integrating mentalization and reflective functioning into Dyadic Health Science would enrich the field in several ways:

1. Enhancing dyadic understanding. These concepts help partners interpret each other's behaviors and emotional responses, fostering empathy and reducing miscommunication.

2. Improving coping and support. High reflective functioning enables partners to respond more adaptively to stress and health challenges, supporting each other's psychological and physical well-being.

3. Facilitating secure attachment. Mentalization is closely linked to secure attachment. Interventions that boost reflective functioning may help shift dyadic patterns toward greater security and resilience.

4. Promoting mutual regulation. By understanding and reflecting on each other's mental states, dyads can better co-regulate emotions, which is vital for managing chronic illness, stress, and everyday challenges.

In summary, incorporating mentalization and reflective functioning into dyadic health models would provide a deeper, process-oriented understanding of how couples navigate health and stress. This approach complements the attachment-based frameworks already discussed in the book

Coaching as a Bridge to Dyadic Practice

A critical gap in current dyadic models is helping providers experientially learn attunement and presence to be more available to the subtle needs of dyads. Coaching for healthcare professionals offers a powerful solution by equipping providers with relational skills that extend beyond clinical protocols.

Through structured coaching, clinicians can learn to integrate dyadic principles into everyday practice, fostering collaborative care, improving communication with patients and caregivers, and sustaining relational well-being long after the medical intervention ends.

This approach not only enhances patient outcomes but also supports providers in embracing a holistic, relationship-centered model of health care.

Narrative and Meaning-Making in Illness

Finally, I believe narrative therapy and parts-based integration have untapped potential in dyadic health care. Helping dyads re-author their shared illness story fosters meaning-making, reduces relational strain, and promotes psychological flexibility, which are critical components of resilience.

Future Directions I Am Excited About

• How does reflective functioning/mentalization moderate the effectiveness of dyadic health interventions?

• Can emotional intelligence coaching reduce caregiver burnout and improve patient adherence?

• What role does physiological synchrony play in predicting dyadic resilience during chronic illness?

These questions reflect where I see the field heading and where my own work can contribute to advancing both theory and practice.

References

1. Lyons, K. S., Rauer, A. J., and Proulx, C. M. (2025). Dyadic health science: Theories, methods, and future directions. Cambridge University Press.

2. The Lancet Oncology. (2024, November). Caring for carers of people with cancer. The Lancet Oncology, 25(11), 1387. https://doi.org/10.1016/S1470-2045(24)00588-6