Mentalization Based Treatment is centred on the scientific evidence that emotional regulation (anxiety, depression, anger outbursts, dissociation) is a developmental achievement which can be achieved (in childhood and/or adulthood) only by having an engaged caregiver who “holds mind in mind.” 

“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.  

Even holding an understanding of the misunderstandings is mentalizing.  

Mentalization provides the very important perspective of being able to see oneself from the outside and to see others from the inside.  

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.

Awareness of Reacting

  • Identifying the emotion: attentional focus; “pushing the pause button”.

Acting and Reacting:

  • 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])



Mentalization References

Psychotherapy for borderline personality disorder

mentalization-based treatment | A.W. Bateman et al., (2010) | World Psychiatry 9(1): 11–15 | doi: 10.1002/j.2051-5545.2010.tb00255.x

Affect regulation, mentalization, and the development of the self

P. Fonagy et al., (2002) | New York, NY: Other Press

Attachment Theory Expanded

Mentalization |

Mentalization-Based Treatment: A Common-Sense Approach to Borderline Personality Disorder

L. W. Choi-kai et al., (March 2016) |Psychiatric Times, Vol 33 No 3, Volume 33, Issue 3

Mentalization Books

Mentalizing in Clinical Practice

Jon G. Allen, Peter Fonagy, Anthony Bateman (2008) | American Psychiatric Pub. | ISBN 978-1-58562-306-8

Handbook of Mentalizing in Mental Health Practice

(2019) | American Psychiatric Association Publishing | ISBN 978-1-61537-140-2

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