mentalization saara salo, phd , psychologist, huch ...€¦ · what is mentalizing? mentalizing is...
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Mentalization
Saara Salo, PhD
, psychologist, HUCH/Helsinki
University Hospital, Pilke-Clinic
2014
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What is mentalizing?
Mentalizing is a form of
imaginative mental activity about
others and onseself, namely
perceiving and interpreting human
behaviour in terms of intentional
mental states (e.g., needs, desired,
feelings, beliefs, goals, purposes,
and reasons) Bateman & Fonagy, 2012
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What is going on..?
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Mentalization theory
• Intergrates essential features of human
existence and well-being
• Being ultimately socially and
interpersonally rooted
• How we understand ourselves and others is
determined by our past interpersonal
relationships
• Is central to psychological well-being
• And capability of interpersonal relations
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In reverse
• Dysfuntional mentalizing leads to disorders
of of self-experience
• Which is central in all forms of
psychopathologies
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Mentalizing as an
Integrative framework
CBT: The value of understanding the relationship between
my thoughts and feelings and my behaviour.
SYSTEMIC: The value of understanding the relationship
between the thoughts and feelings of family members and
their behaviours, and the impact of these on each other.
PSYCHODYNAMIC: The value of Understanding the nature of resistance
to therapy, and the dynamics of here-and-now in the therapeutic
relationship.
SOCIAL ECOLOGICAL: The value of understanding the impact of
context upon mental states; deprivation, hunger, fear, etc...
COMMON LANGUAGE
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Forewarning In advocating mentalization-based treatment we claim no innovation. On the contrary, mentalization-based treatment is the least novel therapeutic approach imaginable: it addresses the bedrock human capacity to apprehend mind as such. Holding mind in mind is as ancient as human relatedness and self-awareness.
—Allen & Fonagy (2006) Preface.
Chichester: J. Wiley, 2006
MBT is a technique
NOT a new theology!
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Mentalization based
interventions
• Based on mentalization principles
• Main aim is to enhance the very capacity of
mentalize (as opposed to social support,
reducing symptoms etc.)
• Developed over the past 10--15 years
• Original focus of BPD
• Various parenting programa
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Essential feature in human
relationships
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Markers of mentalization
• Curiosity
• Awareness of the impact of affects
• Perspective taking
• Capacity to trust
• Narrative continuity
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Features of good mentalizing
1. Is curious about own and other people’s perspectives
2. Being flexible – not stuck in one point of view
3. Can be playful - using humour to engage
4. Can solve problems using give and take between
different people’s views
5. Can differentiate one’s own experience from that of
others
6. Conveys ’ownership’ of own behaviour
7. Uses ’grounded’ imagination
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Dimensions
• Mentalization with regard to self and others
• Presecnce of egocentrism
• Liability of emotional contagion
• Cognitive vs affective mentalization
• Thinking about feeling and feeling about
thinking
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Mentalizing is a developmental
construct
• Acquisition of this capacity depends on the
quality of attachment relationships
• Especially the quality of early affect
mirroring
• Disruptions of early attachment and later
trauma have the potential to disrupt the
capacity of mentalizing
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Transmission Model
• Parental
internal
working models
• Parenting
behaviors
• Child-
parent
attachment
Berlin LJ. Interventions to enhance early
attachments. In Berlin L, Ziv Y, Amaya-
Jackson L, Greenberg M. Enhancing early
attachments. New York: Guildford Press
2005, s. 3–33.
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Developmental studies
• Mind-mindedness has been linked to
• Theory of Mind in 31 mo - 5 year old children
and attachment
• Prospective relationship from 6 mo to 48
• Social symbolic play (desire talk) at 3 years
• Executive functioning at 3 years
Meins, Fernyhough, Russell, & Clark-Carter,
1998; Meins et al., 2002; Osario et al, 2012;
Bernier et al., 2012)
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WHEN MENTALIZATION
GOES WRONG..
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Research
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The relationship between stress, trauma history and
capacity to mentalise (from Luyten et al., 2009)
Attachment - Arousal/Stress
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Midgley & Troupp, 2013
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Significance
• LOW mentalization leads to interpersonal
difficulties
• Errors in interpreting others intentions behind
overt behavior
• Child’s needs? Inability to give comfort? Or
structure?
• Difficulties in handling ones own feelings –
inability to cope with stress
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Why work with mentalization..?
In adults, there is accumulating evidence that mentalization
based therapies work with
BPD
Antisocial personality disorder (Bateman & Fonagy,
2012)
In parents, appropriate parental reflective funtioning (A.
Slade) predicts attachment security, adaptive social skills and
increased sense of self-efficacy
Minding the Baby
Adaptation for substance-abusing mothers in
residential treatment (Suchman et al., 2012)
Families First / Finnish national Program
BABY Magic / Pregnant Depressed Moms
With families (MBFT) developed at the Anna Freud Institute
/London
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Common features in mentalizing
interventions
Simple interventions
Affect focused
Focused on patients minds
Relate to current event or activity –
mental reality
Use of therapist’s mind as a model –
seek to mentalize the current
relationship
Identify non-mentalizing and recover
from it
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References
• Allen, J., Fonagy, P., & Bateman, A. (2008). Mentalizing in clinical practice. American
psychiatric publications.
• Bateman, A., & Fonagy, P. (2012). Handbook of mentalizing in mental health practice.
American Psychiatric Association.
• Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization
and the development of the self. Other Press.
• George, C, Kaplan, N., & Main, M. (1985). Adult Attachment Interview. Department of
Psychology, Uni- versity of California, Berkeley.
• Marvin R, Cooper G, Hoffman K, Powell B. The Circle of Security Project:
Attachment-based intervention with caregiver-preschool child dyads. Attachment and
Human Development 2002; 4, 107-124.
• Midgley, N., & Troupp, C. (2013). Core features: The mentalizing loop. Dia-materiaali
Mentalization Based Family Therapy Training, Helsinki.
• Midgley, N., Vrouva, I. (Eds.) (2012). Minding the Child: Mentalization-based
interventions with children, young people and families. London Routledge.
• Mäkelä J., Salo S. 2011. Theraplay - vanhemman ja lapsen välinen vuorovaikutushoito
lasten mielenterveysongelmissa. Duodecim 2011; 127: 327- 34.
• Stern, D. The present moment in psychotherapy and everyday life. Norton, 2004.