Dr. Mike Dadson Discusses Mentalization Counselling
Mentalization is a robust construct that has given rise to mentalizing based therapy (MBT). MBT is directly related to and arose from attachment research and attachment theory.
Dr. Mike Dadson clarifies:
One of our primary survival mechanisms, especially for infants, is our attachment to our caregivers. These attachment relationships are optimal when they are secure and safe because children have little chance of survival in the world without caregivers. If these attachments are disrupted or at worst damaged, or there is trauma or violence or neglect, and abuse, those attachment relationships, and the biological mechanism of attachment, can be injured or impaired. This is how a child at a young age is traumatized by the people who are responsible for their safety and care. These children can grow up with a traumatized sense of the world, and ridged working models of others, and themselves. They may learn how to survive but do not leave childhood with a sense of how to thrive.
MBT is very effective approach within this kind of developmental presentation. MBT arose directly from of the observation that imbedded within a securely based attachment relationships, is the parents’ ability to effectively mentalize or reflect, hold in mind, and reflect understandings of the inner thoughts, feelings, sensations, in a child in a moment and to help them understand themselves in the world and that they are caring for.
A good mentalizing based therapist is looking to actively hold in mind and reflect congruent understanding the inner world of their client. In that place, they put the client’s inner world in reflective language. This congruent, in the moment reflective shared space helps the client organize their inner selves while simultaneously regulating previously overwhelming imbedded emotions. The MBT therapist has also simultaneously, aware of themselves in the relationship and holds their own mind as an important part of the therapeutic process. MBT is a wonderful jewel of a treatment method. I personally have really enjoy working from mentalizing perspective while also holding a trauma informed practice.
“Holding mind in mind” means imaginatively perceiving and accurately interpreting the behaviour of oneself and others as they are conjoined with a person’s intentional mental state.
Holding and attending to the internal mental states of oneself and others simultaneously provides the psychological space to make sense of oneself and the another.
Holding states like emotions, thoughts, motives, desires, needs, beliefs, fantasies, and dreams is mentalizing.
Holding pathological processes such as panic attacks, dissociative states, hallucinations, and delusions is also mentalizing.
Mentalization provides the very important perspective of being able to see oneself from the outside and to see others from the inside.
Holding pathological processes such as panic attacks, dissociative states, hallucinations, and delusions is also mentalizing.
It is this shared perspective with another which is transformative.
This shared psychological space enables the developing person to shift from the reactive self, which is yet unregulated by the reflective function, to the “teleological stance” – the self which is experienced as intentional and recognized as a representational agent.
Mentalizing cultivates the emergence of the “agentive self.” This can only be developmentally achieved in the context of a highly reflective, non-judgmental, and empathetic relationship with someone who is able to hold one’s mind in their mind, while they hold their own mind.
What non-mentalizing actions look like:
- Excessive detail to the exclusion of motivations, feelings or thoughts
- Focus on physical or structural labels (tired, depressed, etc.)
- Preoccupation with rules, “shoulds” and “should nots”
- Denial of involvement in problem
- Blaming or fault finding
- Expressions of absolute certainty about thoughts or feelings of others
What disregulation looks like:
- Depression
- Anxiety
- Anger outbursts
- Hyper alert
- Shut down
- Numb
- Failure to identify emotions and other inertial states
- “Mind Blind” – only enough room for one mind in the room
The main focus of therapy is to help clients recover normal mental functions, particularly the capacity to reflect on their own internal states, and those of others, with congruence and accuracy.
In short this is to mentalize. The beneficial result is that a person can develop a more coherent representation of self and others. This increases one’s capacity to tolerate differences and thus engage in effective communication, emotional experiences, conflict resolution and intimacy.
To effectively mentalize is not to eliminate suffering – which would be a fantasy – but rather to gain the interpersonal skills needed to tolerate one’s suffering, see the suffering of others and to engage in a new and empowered position that addresses life challenges in a way that leads to more satisfaction, fulfillment, purpose, and maturity.
Stages of treatment:
Mentalizing Proper
- Symbolic, imaginative, and interpretive thinking about self and other; representational and autobiographical agency.
Empathy and Realistic Attunement
- Psychological mindedness; mentalized affectivity; thinking while feeling.
Reflective and Flexible Thinking
- Affect regulation; attentional control; thinking about thinking and feeling.
- Identifying the emotion: attentional focus; “pushing the pause button”.
- Rigid and stereotypical thinking: high emotional arousal (hyper- and hypo-arousal).
Psychic Equivalence
- Information about reality is experienced as reality. The experience becomes the self. (“Embeddedness” [Wallin 2007])