Mentalizing in Clinical Practice
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Mentalizing, the fundamental human capacity to understand behavior in relation to mental states such as thoughts and feelings, is the basis of healthy relationships and self-awareness. A growing evidence base supports the effectiveness of mentalizing-focused interventions in the treatment of borderline personality disorder. This volume explores wider applications, construing mentalizing as a core common factor in the effectiveness of psychotherapeutic interventions that cuts across treatment modalities and theoretical approaches ranging from psychodynamic to interpersonal and cognitive therapies.
This book distills the burgeoning literature on mentalizing for clinicians of diverse professional backgrounds. The book is divided into two parts: Understanding Mentalizing fully explicates the concept of mentalizing and its foundations in developmental research and social-cognitive neuroscience; Practicing Mentalizing presents the general principles of psychotherapeutic interventions that promote mentalizing as well as a range of current clinical applications.
- Mentalizing is multifaceted—for example, pertaining to self and others as well as explicit and implicit processes—and links to myriad overlapping concepts including empathy, metacognition, theory of mind, mindfulness, and psychological mindedness.
- Two sides of research on the development of mentalizing in attachment relationships have significant clinical implications: interactions in secure attachment relationships enhance mentalizing and illuminate the conditions of optimal psychotherapeutic relationships; conversely, trauma in attachment relationships undermines the development of mentalizing and eventuates in developmental psychopathology that poses special challenges for psychotherapy.
- Neuroimaging is illuminating diverse brain regions that contribute to mentalizing capacity, including a mentalizing region in the medial prefrontal cortex that is consistently activated in mentalizing tasks; concomitantly, research on autism and psychopathy attests to the neurobiological basis of psychopathologies in which stable impairments of mentalizing are most conspicuous.
- In development and in psychotherapy, mentalizing begets mentalizing, as exemplified by a mentalizing stance that fosters inquisitiveness and curiosity about mental states in oneself and others; basic principles and clinical examples, including the use of transference, demonstrate the spirit and technique of mentalizing, capped off by a patient's first-hand account of mentalization-based treatment for borderline personality disorder.
- Attachment trauma is the wellspring of disrupted mentalizing capacity, and a focus on mentalizing provides an integrative framework for psychodynamic and cognitive-behavioral treatment of trauma as well as for parenting, family, and social-systems interventions directed toward interrupting the perpetuation of trauma in relationships.
- Psychoeducational interventions, including patient education and structured exercises, are employed to cultivate a therapeutic alliance around mentalizing; the book includes a straightforward explanation clinicians can use with patients, What is Mentalizing and Why Do It?
In the chapter on mentalizing interventions, the authors propose to clinicians, You are already doing it. If the effectiveness of treatment depends on therapists mentalizing and helping their patients do so more consistently and skillfully, clinicians of all persuasions can benefit from the extensive knowledge now available to hone further their attention to this vital therapeutic process.
- About the Authors
- Chapter 1. Introduction
- PART I: Understanding Mentalizing
- Chapter 2. Mentalizing
- Chapter 3. Development
- Chapter 4. Neurobiology
- PART II: Practicing Mentalizing
- Chapter 5. The Art of Mentalizing
- Chapter 6. Mentalizing Interventions
- Chapter 7. Treating Attachment Trauma
- Chapter 8. Parenting and Family Therapy
- Chapter 9. Borderline Personality Disorder
- Chapter 10. Psychoeducation
- Appendix: What Is Mentalizing and Why Do It?
- Chapter 11. Social Systems
- Recommended Reading
About the Authors
Jon G. Allen, Ph.D., is the Helen Malsin Palley Chair in Mental Health Research; Professor of Psychiatry in the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine; and Senior Staff Psychologist in The Menninger Clinic, Houston, Texas.
Peter Fonagy, Ph.D., F.B.A., is Freud Memorial Professor of Psychoanalysis and Director of the Sub-Department of Clinical Health Psychology at University College London; Chief Executive of the Anna Freud Centre, London; and Consultant to the Child and Family Program at the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine.
Anthony W. Bateman, M.D., F.R.C.Psych., is Consultant Psychiatrist in Psychotherapy, Halliwick Unit, St. Ann's Hospital, Barnet, Enfield, and Haringey Mental Health Trust; Visiting Professor, University College London; and Visiting Consultant, The Menninger Clinic and the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine.
In their new volume Allen, Fonagy and Bateman expands the explanatory power and clinical utility of the mentalizing concept and argue convincingly for the thesis of mentalizing being the foundation of all psychotherapeutic treatments. Adding that to the capacity for uniting evolution, attachment, neurobiology, self development and psychopathology, we are probably witnessing a new paradigm for psychiatry. Superbly written, challenging and immensely integrative.—Sigmund Karterud, M.D., Ph.D., Professor of Psychiatry, University of Oslo, Norway
This timely and ambitious book helps clarify the meaning and clinical applications of the mentalization construct. The authors audaciously propose that mentalizing is the central corrective process of all effective psychotherapies and persuasively assert that this can be directly linked to failed early parent-child interactions. They could be right! And that makes this book essential reading for the next generation of psychotherapists.—John G. Gunderson, M.D., Director, Borderline Treatment and Research Center, McLean Hospital, Professor in Psychiatry, Harvard Medical School
How often in our field is one able to recommend a book written with wit and grace, expounded with clarity and scholarship, deftly structured, illustrated with memorable tables and diagrams, research- and clinically-oriented, and relevant across the range of psychotherapeutic disciplines? Here is a strong authorial voice on a vital psychotherapeutic theme. This exceptional volume helps therapists, from analytic to cognitive and beyond, to open minds and hearts to mentalizing as a meta-concept, underpinning—and often spearheading—all worthwhile psychotherapeutic enterprise.—Jeremy Holmes, M.D., Professor of Psychological Therapies, University of Exeter UK
This is an excellent book: well written, theoretically sophisticated but practical, clear, and provocative in its implications for reframing and enhancing treatment for a broad spectrum of disorders.This book is especially useful for those interested in the leading edge in psychotherapy integration; the common-factors approach to understanding psychotherapeutic effectiveness; and the integration of mind, brain, and interpersonal relations. I highly recommend it.—PsycCRITIQUES, 8/1/2008
The authors are superb teachers. It is refreshing to read this book that can heighten awareness of nuances in listening to and helping clients grow in recognizing and adapting the formulations of experience that shape their emotional responses.—Doody Enterprises, 8/1/2008
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