Combining the framework of psychoanalytic theory, attachment theory and aspects of research on social-cognitive development, a relatively new frame of reference for psychopathology and psychotherapy has been proposed by a group of psychologists working in the United States and Europe.
The core idea, mentalization (or Mentalizing as many practitioners prefer), originates as a hybrid, and not essentially novel, idea from: Philosophy of Mind, Attachment studies, SystemsTheory, and Neuroscience, and describes a uniquely human capacity:
The imaginative activity of making sense of the actions of oneself and others on the basis of intentional mental states such as desires, feelings and beliefs.
Two short training videos
For most teams (short version - 10 mins):
For teams who want more academic detail (longer version - 20 mins):
Prof Peter Fonagy - interview: What is Mentalization?
Peter Fonagy here describes mentalizing and its applications in a 20 minute interview made at the Anna Freud Centre.
What is Mentalizing, and why does it matter?
A 70 minute illustrated talk describing Mentalizing, its origins, its value and what happens when it goes "offline":
Mentalization and AMBIT
This is film of a 40 minute talk on Mentalizing and how it is used in AMBIT, given at a conference by MAP in Norwich, November 2012.
A brief conversation about Mentalizing
Wih Dr Jon Allen, Menninger Clinic, USA
You can access teaching slides about mentalization - see Training slides. Remember these slides are all released for sharing under a Creative Commons Licence - you just need to not pretend they are yours, and share them on similar non-commercial terms!
Complexities in Mentalizing:
Mentalizing is a complex and uncertain process for a variety of reasons including:
A person can act according to a belief that is wrong.
Beliefs arise through a complicated interaction between sensory perceptions, memory, and motivation and so may change for many reasons, perhaps because the environment has changed, or because some hidden mental process has occurred.
Because beliefs are just representations of reality, people can have very different beliefs and feel very different emotions about apparently similar things.
We do not just mentalize at a conscious (or verbal) level, but also at a procedural level - which involves non-conscious and non-verbal affective (feeling-based), motor and perceptual strategies to grasp and convey mental states.
Mentalizing is central to understanding, regulating and communicating emotions, since emotions relate very directly to one’s desires or goals and, beliefs about whether they are being met, or frustrated or threatened. Reflecting on one’s own beliefs, desires, and feelings is also important for maintaining a healthy inner life.
Almost all aspects of social interaction entail the capacity to mentalize: to understand the other person's behaviour in terms of the activity that has taken place inside their minds - that may provide a good explanatory model of their actions.
Mentalizing emphasises the uniqueness and specificity of the human's subjective experience, and carries with it the implication that making sense of this in each other (or indeed at times within ourselves) is a complicated task at which we are only only ever partially successful.
See below a brief video of the famous scientist (and extraordinary communicator) Richard Feynman - describing how he came to understand that even the most basic mental functions (like counting, or reading) that we might take for granted as being the same for all of us, may in fact be conducted in extremely different ways:
Another way of making sense of Mentalizing, courtesy of Pixar:
Therefore, the ability of the clinician to mentalize is particularly important, especially when the behaviour of our clients does not make sense in obvious ways, or seems inexplicable. Our Theory tells us that Mentalizing is fragile, though - in therapists as well as clients (in this sense it is a great "leveller" in the power dynamics of the patient-therapist relationship.) This explains the strong emphasis on SupervisoryStructures in AMBIT - so that stimulating and sustaining our colleagues' mentalizing is as important as the work we do face to face with our clients.
Attachment in infancy is primarily a behavioural or procedural construct. According to Bowlby, at about the age of three, behaviours signifying a goal-corrected partnership begin to emerge. The central psychological processes for mediating goal-corrected partnerships are the Internal Working Models.
Meta-cognitive capacities, such as the capacity for psychological interpretation, are the product of the complex psychological processes engendered by close proximity in infancy to another human being, the attachment figure.
In order to develop mentalization, the individual needs:
To be able to selectively activate states of mind in line with particular intentions (attentional control).
When Attachment is Disrupted:
Early disruption of attachment relationships creates a developmental vulnerability for a failure of the complex meta-cognitive capacities referred to above.
The relationship between attachment and mentalization, however, is bidirectional.
The inability to represent the mental state of the self, attentional problems, and difficulties in reflecting on the mental states of others obviously disrupts attachment relationships which in turn undermines the natural emergence of mentalizing capacities. In this way, in some families, the very process that could lead to the child overcoming problems arising out of interpersonal challenges is undermined by the difficulties in the child’s attachment system.
When Mentalizing fails:
When the Attachment system is activated by stress/anxiety, etc, Attachment Behaviours are triggered. These behaviours function to adjust the individual's proximity to their Attachment Object. Whilst this process is active, Mentalization is effectively de-activated.
Another way of understanding this is that the prefrontal cortex (where mentalizing occurs) is a very sophisticated and recently-evolved part of the brain, that is easily 'drowned out' by the relatively much more primitive (and "louder") brain centres such as those dealing with Attachment and Stress-Arousal.
Crucially, this rapid (minute-by-minute) switching on and off of the mentalizing capacity occurs in both the client/patient as well as the Practitioner at times of high anxiety.
Clinical work of all kinds crucially depends on a focused endeavour to understand the seemingly anomalous actions that we construe as psychopathology in mental state terms, eg mistaken beliefs, inappropriate desires, conflicting motivations, incoherent thoughts, etc.
A broad range of psychopathology can be seen as involving one or another form of specific mentalizing dysfunction.
Three key concepts help to describe the “primitive” states of mind (Pre-mentalistic stances) that are adopted when mentalizing fails. These are: