Mentalization and its importance in the therapeutic context

Mentalization, also called reflective function, is a mental activity involved in the interpretation of human behavior and its underlying mental states (Fonagy and Target, 2006).

According to Viloria Rodriguez and Ballespí Sola (2016) “it is a skill that allows us to understand our own mental states (emotions, feelings, thoughts, desires, beliefs, etc.) as well as those of the people around us”.

What is mentalization for?

From the mentalizing model, it is proposed that dysfunction in the attachment system can inhibit affective regulation skills as well as mentalizing capacity (Bateman & Fonagy, 2016).

This ability to interpret it begins to be forged in the intimate relationship of an attachment figure during the first years of life. The baby expresses his emotions and the attachment figure reacts to these manifestations.

When the adult interprets what the baby may need, he mentalizes and reacts. This response, if it is contingent, produces a certain regulation in the baby. It is in this dyadic regulation that the baby gradually learns, throughout his development, to recognize and regulate his own mental and emotional states, just as he learns to observe and interpret those of others.

Therefore, the mother’s response gives rise to the symbolic representation of this inner state. And, in this way, it shapes and gives meaning to the emotional states of the child. These representations gradually shape the baby’s sense of Self, as a differentiated being.

In this line, a secure attachment is a necessary prerequisite for develop the ability to regulate affections and reflect on the emotional functioning of self and others (Fonagy, 2001). Thus, there is evidence for the relationship between insecure attachment, emotional dysregulation, and metacognitive functions (Fonagy and Target 2006).

Thus, the mentalization it is necessary for the regulation of our emotions and requires the subject to be able to maintain a balance between their different dimensions and to use them according to the context. These dimensions of mentalizing refer to whether it occurs in a controlled or automatic way, on others or on oneself, on internal or external states, on cognition or affection. Mentalizing means flexibility to realize that mental states organize our behaviors and bring them coherence, allowing us to differentiate ourselves from others. Moreover, it involves assuming that it is not stable, homogeneous or one-dimensional (Bateman and Fonagy, 2016).

The ability to mentalize includes a reflective component and an interpersonal component. It requires cognitive ability to focus attention and manage interpersonal relationships. Context evaluation is filtered by internal attachment models. These are composed of mental representations, many of which are unconscious, which produce a subjective perception of the situation. This, in turn, causes the behavioral response to context, being more rigid or flexible depending on mentalizing ability. In other words, the more mentalization there is, the more flexibility there is. This allows us to recognize that the inner world is different from the outer reality, even if it is related to it.

Characteristics of mentalization

According to Bateman and Fonagy (2016), mentalization has the following characteristics:

  • It is about being able to perceive and interpret the behavior of others and one’s own in terms of intentional mental states, which influence behavior.
  • It involves the ability to understand the actions of others and oneself in terms of thoughts, feelings, desires and expectations.
  • Without mentalizing, there can be no strong self-understanding, constructive social interactions, reciprocity in relationships, or sense of security.

Its benefits in everyday life and in psychotherapy

Mentalizing is closely related to concepts such as metacognition, empathy and interpersonal sensitivity.

Thus, a person sensitive to interpersonal relations is able to detect signals about the mental and emotional states of another person. At the same time empathy somehow takes over these states of the other, which involves balancing the ability to reason about what is going on with the ability to understand the associated affections and emotions, as well as to agree to it. .

In addition, there is a certain degree of metacognition insofar as the person is able to perceive and reflect on own mental states, representations and thoughts.

When a person is unable to mentalize, what Fonagy calls prementalizing states (of psychic, purposive, and simulation equivalence) resurface, which are activated by Internal Operating Models.

These states constitute the evolutionary antechamber of mentalization. And, in mature individuals, they involve modes of activation in which the ability to mentalize is diminished. It usually happens to people with a precarious attachment in interpersonal relationships and, above all, in situations of psychological closeness, intimacy. This fact is supported from a neuropsychological perspective, as states of high emotional intensity have been shown to inhibit the capacity for cognitive mentalizing (Bateman & Fonagy, 2016).

These latter aspects are particularly interesting in therapy, since the therapeutic space is characterized by psychological closeness and there are often pre-mentalising modes. Thus, by working from this perspective, it is possible to overcome certain resistances, to explain certain defense mechanisms and to provide the patient with tools for regulation, by exploring and identifying emotions and mental patterns in various situations. In addition, the modes of activation in patients are a good guide to develop reflective function and increase therapeutic understanding (Martínez Ibáñez, 2016).

Just as mentalization is a very useful psychotherapeutic tool, the therapist’s own ability to mentalize is presupposed, who needs it to accompany and guide the patient in the relationship of intimacy offered by the therapeutic framework. Mentalizing the patient facilitates the process from the moment of the psychological evaluation and is reinforced in the creation of the link and the therapeutic alliance.

Author: Borja Luque, general health psychologist and sexologist in vitalizing health psychology.

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