This is an example of Pause and Review, that moves into the process of trying to "Notice and Name" common breaks in mentalizing:

Noticing

A statement about an interaction (preferably in the ‘here and now’, but it can also be a reported event or sequence) between two or more family members (if there is family present), or between the client and therapist, is the starting point.

Here the therapist focuses on an emerging pattern of how family members relate to each other or how this young person relates to others (or me). Keeping in mind that it is possible to make many different observations of what might seem just one event and that therefore any observational statement is highly selective, the therapist voices this and immediately follows it up by checking for CONSENSUS between family members...

“I notice that when Sally does x (cry), David it looks as if you find it very hard to understand what exactly she is feeling and why, and without this understanding her behaviour doesn’t seem to make sense (Noticing). Have I got this right or am I totally off the mark? (Checking) Can you see what I am talking about? Well, let me continue… to me it looks that when Sally does x (cry), this makes you feel (or act) really y (confused), and so you do z (cut off) or respond in y (confused) way. Likewise, Sally, when David then does this (y), it seems like you find it hard to understand exactly what he is feeling that makes him behave like this. And then to me it looks that this makes you feel (or act) z (irritated) and it goes round in circles. (Noticing) I don’t think anyone is to blame here because everyone is finding it hard and doesn’t quite understand where everyone else is coming from…I’m not sure I’ve got this right (Checking) … what do you think Sally?”

In this example the therapist first identifies and highlights an interaction which (to him) appears to be related to some mentalization difficulty (Noticing).

The therapist then offers more Checking of her observation by inviting the family and its individual members to connect with and perhaps share this observation, but also giving them the chance to dismiss it.

It is possible that some or all family members might, for example, state that they had ‘no idea what the therapist was going on about'. This would then lead the therapist to reflect (in his own mind, without necessarily sharing this with the family at this stage) on the validity of his observation in view of the feedback obtained and himself dismiss the observation as insignificant and / or speculate about the possibility of – and potential reasons for - family members defending themselves again what has been observed. In either case it is unwise to just keep repeating the same.

If the observation (Noticing) and related comments resonate with some (or all) of the family members (Checking) then the therapist goes on to question the problem; in doing this, the therapist is looking for

• Shared experiences of how this pattern of relating to one another is a problem for family members
• A common language with which to name or label it.

“Do you feel all right about the way this is…this kind of ‘going round in circles’ (are you happy with that)? If not, why or how does it bother you? Is that the way you want it? Is that something you want to change? Does it ever cause you a problem? Do you sometimes get stuck? If you kept this going what might be the outcome?”

This line of questioning aims to elicit whether the family and its individual members regard the highlighted interaction pattern as something that causes them dis-ease (is experienced as ‘dysfunctional’), or as something that they regard as a non-issue (however ‘pathological’ it may seem to the therapist).

When to focus in on an identified issue:

It is only if or when at least one family member perceives the observed interaction as being problematic, that the therapist can focus on this issue.

Naming

Once a problematic interaction has been noticed and focussed upon, the family are invited to find ways to NAME it.

In order to maximise the phase of emotional brainstorming introduced in the second step (Mentalize the Moment) the family can use Pause and Review techniques, playing with images of a video or DVD of the "action" which can be paused to allow time and space for mentalization to be recovered.

Family members are encouraged to form a ‘working party’ to think about interactions, from a meta-level, as it were. They are also encouraged to find some buzz words to mark the interaction sequence and the associated feeling states.

“So what word or sentence comes to mind when you think about this?”

The aim is to find a word or phrase that becomes some form of ‘mantra’ which family members can recall after sessions, when similar stuck interactions evolve. Examples are ‘tango’, ‘malignant clinch’, ‘top-dog’, ‘door mat’, ‘playing first fiddle’, ‘the knight in shining armour’, ‘playing the fool’, 'hot potato', etc