Mentalizing in Clinical Practice

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.