Introduction to Mentalization. What is Mentalization. It is the capacity to reflect on one’s own mental states (thoughts, feelings, beliefs, desires etc.) and to attribute mental states to others, as an explanation of their behaviour.
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It is the capacity to reflect on one’s own mental states (thoughts, feelings, beliefs, desires etc.) and to attribute mental states to others, as an explanation of their behaviour.
Mentalization involves being able to recognise, tolerate and respond to one’s own, and others’, mental states.
Mentalization is dependent on whether primary attachment figures recognise, tolerate and respond empathically to the infant. Deficits in care will impact on how an infant represents their own mental states, and also how they represent the thoughts, feelings, wishes and motives of an abusive, neglectful or poorly attuned primary attachment figure.
The overall aim of MBT is to develop a therapeutic process in which the mind of the patient becomes the focus of treatment. The objective is for the patient to find out more about how he thinks and feels about himself and others, how that dictates his responses to others and how ‘errors’ in understanding himself and others lead to actions in an attempt to retain stability and to make sense of incomprehensible feelings.
There are three main phases to the trajectory of treatment.
Looking back, can you think a bit about what made her behave like that?
How do you explain his action?
Is that something that has happened before?
Is there any other explanation?
What do other people think about it?
I can see that you must have wanted to end the relationship but somehow you stuck it out. Tell me what made you carry on.
You must have been so excited when the relationship started and felt so let down when he was unreliable. How did you manage those feelings?
complete lack of integration
complete lack of explanation
complete non-sequiturs (no relation to what has gone before)
gross assumptions about the interviewer
literal meaning of words
Generalised lack of mentalizing
Looks like mentalizing but missing essential features
Others’ minds understood and thought about, but used to hurt, manipulate, control or undermine
Therapist continually questions his and patient’s internal mental state:
Highlighting alternative perspectives
Using questioning comments to promote exploration
Affective experience and its representation
Suicide Attempt and Self Harm
Intervention should be simple and short, affect focused, refer to current context and address conscious or near-conscious contact.
The pathway for intervention moves from affect identification to interpersonal context to meaning.
The therapist should not assume responsibility for the patients actions and a comment early in treatment defining the extent of his responsibility is necessary.
(e.g.) “I can’t stop you harming yourself or even killing yourself, but I might be able to help you understand what makes you try to do it and to find other ways of managing things”.
The primary purpose of self harm and other actions is to maintain self structure following sudden de-stabilization.
To maintain the self-structure
I won’t come because they don’t want me there’.
During a typical non-mentalizing interaction in a group or individual session.