Mentalization Based Treatment

Mentalizing refers to the sense we have of ourselves and others as persons whose actions and communications are based on mental states: desires, needs, feelings, reasons, and beliefs.  This sense allows us to respond to others, and is the basis of meaningful, sustaining relationships.

When we mentalize, we cannot help but empathize, that is, putting ourselves in the other person’s shoes and seeing things from their perspective. While empathizing, we retain self-awareness, a sense of where we are coming from. Such intuitive empathizing—with ourselves and with others—is the cornerstone of healthy relationships and ordinary human interactions. It makes possible the moment-to-moment adjustments we make effortlessly to the verbal and emotional signals we read in other people’s behavior.

At their most fulfilling, relationships involve a meeting of minds. We feel affirmed and validated when we sense that the other person has our mind in their mind. We are not alone. We not only feel heard and understood, we feel felt.

There is a growing body of evidence that points to mentalizing as the key to resilience—the ability to adapt successfully to adversity, challenges and stress. By promoting resilience, mentalizing facilitates coping with vulnerabilities, including genetic vulnerability problems such as depression, bipolar disorder, eating disorders, anxiety and addictive disorders, as well as autism spectrum disorders. Research is demonstrating, for example, that persons who can mentalize in the face of trauma—including childhood trauma—are less vulnerable to psychological disorders. Research is also demonstrating that adjustment and quality of life of people with various psychological difficulties is ultimately determined by abilities that result from mentalizing.

Problems like depression, anxiety, eating disorders, posttraumatic stress and personality disorders are ways of being stuck in repetitive patterns that are self-perpetuating, and illustrate problems with mentalizing.  These problems are also frequently related to troubled relationships. Acting out adolescents are often struggling with an impaired ability to mentalize, jumping to conclusions.

When we cannot mentalize flexibly, a psychotherapist can help. Being able to see things from different perspectives and to explore one’s own mind and the minds of others is essential in being able to manage feelings. Exploring can be frightening, as well as enticing. Psychotherapy offers a climate that enables exploring calmly and confidently: a sense of security and safety. If we are to explore our mind in of the mind another person, it is essential that the other person be accepting, interested and empathic.

Positive emotions—interest, enthusiasm, joyfulness and compassion—promote mentalizing. Positive emotions tend to broaden our attention and awareness, in contrast to emotions such as fear and anger, which tend to narrow our attention. Thus, in positive emotional states, our thinking is more flexible and creative. Anxiety and depression, for example, erode our capacity for positive emotion. Hence treatment interventions that restore the capacity for positive emotional states, often in the context of promoting a sense of connection with other persons, will also facilitate mentalizing.

Adapted from:

Mentalizing as a Compass for Treatment

Jon G. Allen, PhD, Efrain Bleiberg, MD, and Tobias Haslam-Hopwood, PsyD, The Menninger Clinic