Mentalization-Based Theory & Interventions

Hi everybody oh let me close the door hi everybody Welcome to the mentalization workshop I appreciate you all being here since if you were already here today that means that this is a very long day for you and if you weren't already here that means you came just for this so I'm very grateful that you did that if that's the case I know I think every single person in here so that's good intimate group oh no I don't know you sir what's your name Conrad Conrad nice to meet you Conrad um so today's the mentalization

Bas interventions workshop and the reason I decided I wanted to do this Workshop was that first of all there's not enough in my opinion events just helping students get kind of free skills and additional training so I thought that was a really good idea um some people who' have been working with me for a long time wanted us to start hosting more events and were willing to help and this is event is really kind of the the proof that people are really willing to help and um the other reason is that I'm not going to

be teaching the psycho analytics Series in this next coming Academic Year and so When I thought about not teaching the psychoanalytic series that I've been teaching for so many years now I realized that the greatest loss I felt about that series was um not being able to teach students attachment Theory and um mentalization interventions um in addition to a effect regulation therapy which I'll say just a few words about today so we've never run this Workshop before so we don't know how long it's really going to take and there may be a few glitches so

please be patient with us if that happens um and we don't know if we're going to finish really early or if we're going to be running out of time at the end so we'll see how it goes um we've got several things planned the objectives for today are to introduce you to some critical theory about mentalization I will talk about what it is what are we even talking about um and then some back background for that and some basic details and some literature about why it matters um then uh the other two speakers which I'll

introduce in a little while will be doing two other pieces of the theory um um Andy Woodall will be doing the presentation on the theories of Polls the polls of mentalization um and then um Kat rosovich will be presenting on um basics for understanding intervention in mentalization and then after those presentations I will pick up and say a couple more things um getting you ready for the workshop piece which is where you're going to actually have to do something we will stop videotaping so you don't you know that you won't be on videotape nor will

the videotape have to watch us just going through the tedious process of trying to figure um these things out and I will be asking people to please come up and participate in trying to imp Implement these things actually try to do this practice so we're going to ask people to do that but we'll set you up so that by the time you get there you'll know um more or less what you're going to do and how you're going to do it and we'll do it in a kind of a peer consultation approach where you'll get

to ask people how do you think I should do this how should I say this okay so it'll all build on itself we will be doing some role playing um the people who helped me um Ryan ma my ta this year um the other presenters um and I will all be doing a role play you however will be doing the intervention side of the role play later once we get There okay the role plays were written by Sarah Alton bassac who's here and she wrote These role plays and I kind of edited them tweak them

a little bit all the way to the last minute where I changed you know one sentence in them but we um were very grateful for her to do that and I think everybody learned a lot in the process of kind of getting ready for um this presentation which is the first of its kind um that I do okay um so any questions or comments before I jump in with what we're going to do oh goals what what's the objectives I think I said I was going to get there but I didn't I want you to

know some of the theory I want you to know how to assess for these kinds of things at least in a basic way kind of an introductory way of assessing for mentalization skills or non- skills um and then I want you to be able by the end to design some basic interventions that are delivered in the way that the the founders of mentalization-based therapy um model have expected to be delivered and we'll teach you how to do that and you should be able to then deliver them okay so that's those are my goals that's a

pretty hefty series of goals but I think we should be able to get there at least for for most of us Okay any comments or questions before we jump in all right so we'll start as I often do with some quotes uh this quote is from um foni and Target who have been working on mentalization B based um therapy for a very long time and I really like this quote you may have heard it before if you've taken my classes if the attachment relationship is indeed a major organizer of brain development as many have accepted

and suggested then the determinants of attachment relationships are important far beyond the provision of a fundamental sense of safety and security and there's a lot in this quote and um that I think is important but I will highlight a few pieces of this quote that I think are really crucial first attachment is for a fundamental sense of Safety and Security okay so there is the primary reason that the attachment um system exists in our species and the attachment system exists in our species first and foremost from what we understand for providing safety um sorry security

safety and a sense of Security this comes from um Alan st's um statement that one of the outcomes of a strong attachment relationship is a sense of felt security and that is a subjective sense that things are going to be okay it's not necessarily true that they will be always but a sense that generally speaking things will be okay now attachment is first and foremost about this safety and a sense of safety actual safety of course because attachment relationship leads one to um seek proximity to a caregiver therefore ensuring that someone is watching out for

the child and able to protect the child we are a precocious species we are born very very um immature and so we definitely need our caregiver our attachment system goes far beyond the length of time that anyone else's any other um species attachment system um goes now other than that what foni is also saying here is that there's something about the attachment relationship lasting so long in humans as opposed to other important developmental processes that emerge and Sometimes go away such as a prominent sucking reflex a prominent grasping reflex so we have other systems that

come in manifest for some purpose developmentally and then um deteriorate or disappear the attachment system comes in helps us secure um the relationship with the caregiver in some way or the other and then it remains it definitely does not remain as prominently as it um existed in the first two5 years of life but it remains and it remains lifelong to some extent or the other with the consequences of of it being um the consequences of it being problematic reducing over time but we also know the Romantic relationships um are associated also with attachment style so

that you have often attachment Styles related to your romantic Partners as well that seem to be um uh stable a stable continuation of your infantile attachment style which has stabilized by the age of two so what foni is saying here is that there's something important about attachment lasting so long for in humans it wouldn't have if it didn't serve some Additional functions and that's a very important piece of his quote the suggestions nowadays for why attachment has lasted so long coming from interpersonal neurobiology people like Alan Shore who was in Chicago recently and Peter fonie

is that besides the sense of Safety and Security that comes from um the attachment relationship you also have a couple of other critical um needs that the attachment relationship seems to serve the first need that the attachment relationship seems to serve that is so centrally associated with infantile security is affect regulation and affect regulation is crucial Alan Shore doesn't himself say this but affect regulation is crucial it seems to me not because emotions inherently have to be regulated but because an animal that is as social as we are probably needs to have their a effects

regulated to a great extent in order for the social system to work as relatively seamlessly as it tends to do for humans so that we we have abnormal states of Affect expression um on both sides on the high end and the low end and the attachment caregiver seems to provide a lot of support for regulating um the infant's um affect States well we won't talk about that as much today but it's a very interesting topic we could have another event on that and how to use that in your therapy which is so crucial actually to

design a whole therapy around maintaining arousal States at a level that's therapeutic very useful avoiding too much comfort and avoiding too much discomfort um very important work now we're going to focus on mentalization Peter foni says of course related to affect regulation of course as well is the ability the ability of the caregiver to help a child develop something that is innately available to them which is this thing called mentalization let me say that again just to be clear about what I'm saying because I might have confused it a little bit it's very important that

an attachment Figure be available to help a child develop an innate capacity an innate potential that they carry within themselves as part of the species to develop this thing that we call mental Iz ation however like every other um innate um possibility in US it often has to find an environment in which it is altered um um uh in which it is altered or it is um developed appropriately aided supported and mentalization is the same way we need a caregiver who's who possesses the ability to ment Mize to help the child mentalize and they do

that in a series of steps um that we won't go into um in great detail here so these three things attachment related to Safety and Security attachment related to affect regulation and attachment related to mentalization are all um critical there's also a really interesting area of Investigation around attachment in adolescence where attachment then begins to shift and change maybe even change in males and females differentially depending on what um the the now the new problems are having to do with mating short-term long-term mating and such so there's a lot of interesting stuff Happening in the

world of understanding how attachment then changes and transforms but nevertheless remains in adolescence and on through adulthood too interesting things okay here's another quote from Peter fonie an evolutionary function of Earth early relationships is to equip the very young child with an environment within which the understanding of mental States in others and the self can fully develop Evolution has placed particular value on developing mental structures for interpreting interpersonal actions okay so this is where foni introduces his interest in evolution he's not an evolutionary psychologist or an evolutionary scientist he um comes from the world of

psychoanalysis and then attachment later but he's obviously interested in evolution and he poses um he frames his model of mentalization within Evolution which I think is critical of course um it's critical that he say what's this For what is this about and what he says is that what it's about out is we need to have the capacity to develop the ability to interpret interpersonal actions we need the mechanisms for which to do that and then we need a context in which that will be facilitated and he's saying that um the attachment relationship is that um

the context of facilitation for that process Evolution has placed a particular value on developing mental structures and that's an interesting statement that probably is quite true which is this seems to have helped us I'll talk a little bit more about Evolution but it seems that this has helped us and we know that because of the the extent to which we have a very welldeveloped um capacity for mentalization so if you do not know the the basic principles of evolutionary theory what this also means is that this capacity wherever it emerged and the to the extent

that it emerged was retained so those who possessed whatever beginning capacities for mentalizing or Theory of mind I'll use that I'll explain that term in a second um that was retained meaning that these individuals who possess some kind of beginning capacity for this were able to survive to reproductive age and some of them were able to reproduce and those who reproduced created more individuals with a capacity to develop um this skill mentalizing okay and another quote this is from David Borland and he I just discovered his work recently he has a great book called origins

of human nature that I'm um currently studying right now and this is from evolutionary developmental psychology which um I think is very meaningful because it starts to add some some of the nuances and details especially around development that I think are really um would be very useful to add to evolutionary psychology that does kind of broad more sweeping kind of Investigations into some of the capacities in our species and then the evolutionary developmental psychology field seems to kind of come in and say yes but this is how it happens and this is why it happens

this way rather than that way and the details get filled in and so here's a quote from that book To successfully maneuver the often Stormy Waters within small groups of long lived conspecifics other humans adult humans must be able to represent the knowledge desires and intentions of others if they are to succeed they must learn how to cooperate how to compete and which general social strategy is in their best interest this requires what has been termed social cognition we'll use other terms for it cognition about social relationships and social phenomenon and we're going to focus

today on mentalizing or theory of mind and I'm using those synonymously even though that's not exactly synonymous but we'll use them that way today there are other forms of social cognition like cheater detection social cheater detection um being able to uh detect infidelity mate guarding behavior all kinds of things that we do to kind of work with each other cooperate and compete as we need to and then theory of Mind Of course being a very important one um in many of our opinions okay so what is all this for this social cognition this subset of

social cognition we call theory of minor Mentalizing is particularly important to help small groups function with each other to cooperate compete and understand each other and it's particularly important for a species like us who has survived really because of our ability to cooperate with each other so those who could cooperate were the ones that really were leading the species helping the species move forward and we really needed it because we lived in small bands of maybe 50 to on the high end maybe 120 people people and we lived a really long time like 40 and

now of course we live you know I think the new stat is like 78 or something like that so we live a long time in small groups of people yet we interact with other bands of people and so there's all kinds of things that we need to be able to do in order to make all that possible and the only reason we survive despite the fact that we're such a weak animal scavengers for meat um slow gangly standing on you know two legs instead of running on four so the way we survived was through probably

cooperation we're Social Animal we'll Talk about about what that means too so so attachment is not an end in itself rather it exists in order to produce a representational system in the mind that has evolved to Aid human survival this evolved representational system is mentalizing there are other evolved um representational systems but one of them is called mentalizing to help us understand interpret and predict the behavior of self and others especially for social cooperation here you have um social brain you could hear a social brain Theory here um someone named Dunbar philosoph philosopher evolutionary philosopher

so very important um capacity that we have let me give you a little example of how easy this stuff is for us if I'm standing here talking to you and all of a sudden I start looking to the door a lot immediately what comes to your mind about what's going on someone you want to escape or you're Looking for someone I what was the first part you want to escape or you're looking You're Expecting someone to come I want to escape I'm looking for a door so possibly looking for an out or maybe I'm looking

for someone what else there's actually no right answer here what else might be going on something outside has reoriented your attention something has reoriented my attention maybe something happened over there maybe there are some stimulus and what might those be Anno what annoys her people annoys people campus shooter we had a training on that recently um what else might be going on for me if I'm going like [Music] this trigger to past trigger to the Past okay light flashing doing something to me okay our ability to just guess based on me doing something like this

what might be going on that right there what you just did and all the many probably hundreds of things that ran through your head as possibilities that's what's so special about mentalization the ability to make sense of me a behavior of mine based on things That you imagine might have been going on for me inside of my mind and in my world or that I might have been perceiving we do this thing so seamlessly that it almost is impossible to know notice it and yet it's so crucial because compared to all other species of animals

we do it so much better than any other we know that there's some limited capacity for some of these things in other species predictably in other Apes but no ape has the capacity that we have and what capacity they have depends on how we look at it and how we're interpreting some of the basic lower level capacities for mentalization so we do it amazingly well and it's very useful for us we know it's useful for us because we do it so well this if you remember Renee deart when he did his um radical doubt trying

to find a solid ground for his philosophizing for his work he wanted to find a solid ground on which his thinking can be built and what he did is he of course had his radical doubt he said I'm going to doubt everything that I possibly can doubt and see if I landed anything that Is beyond doubt right and one of the things that happened for decart when he finally landed on kogito osum I think therefore I am um is that he had arrived at his Solid Ground he knew one thing for sure that he couldn't

doubt that he was a doubter a person who was doubting so doubt was certain okay so he did that the other thing is he painted himself into a corner because his philosophy ended up in his mind and just his mind right this is called solipsism this is the problem of finding yourself only in your own mind with your own mind as the only thing that you're certain of but you'll see that most of us kind of think like what a strange thing deart is doing right it sounds like such a strange thing to land on

the Solid Ground of only only my mind exists for sure and the reason that that's strange for us is because we have such an intuitive sense that other people have Minds how do we know that other people have Minds it's a presumption you don't actually know it at all you don't know that someone else has a mind you only know as Dart said that you have a mind but you're very confident that other people have Minds right and their mental state is most certain because you know You have one and they are at least somewhat

like you right using oneself as kind of a basic prototype as the foundation for making sense of other people's mind is the way that this generally works and we know that other people have Minds because we know so much about them and we know so much about other people's minds deart tried working his philosophy out of his own mind and into the minds of others but it was very difficult for him to do but biologically it's not hard for us to do biologically we can all do it quite easily so in the 70s they came

up with this concept called theory of mind it was the first time that anyone had had such a clear insight into this thing that we now are calling here mentalizing based in fonag theory but at the time it was really um the Insight was that every single person seems to have the capacity as it says here to varying degrees to make sense of our own and others behavior on the basis of underlying mental States including Beliefs emotions and motives okay we all have to varying degrees the capacity to make sense of others people's behavior and

our own on the basis of mental States mental states that we have never SE seen that we cannot see no matter how many thought logs you do you've never seen a thought they're just presumed to be there usually on the basis of the fact that you have confidence that you have them now you should know that that puts us in a very precarious position to imagine mental States in other people we're probably feeling relatively comfortable with that but I should also tell you that there are some people who believe that this is um a very

bold presumption to make because they do not believe that mental states are real most of us in the room are going to presume that mental states are real and if I have them some other people have them you should also know that assuming that a computer has a mind when you're playing a chess game with it also helps you function socially in terms of of Competition you compete better with the chess game the computer chess game if you imagine it has mental States rather than trying to imagine all the rules that the computer is following

if we simply say it wants my queen we have a greater chance of beating the game so one way or the other whether people have mental States or not something about the ability to attribute mental states to the other seems to be very useful to us it becomes a very rapid way of making sense of complex systems and the social systems are complex systems functioning in a group of even three people is so complex that if we want to anticipate what's going to happen if we want to work well with this one but then compete

with this one then we really have to have some very rapid fire ways of assuming what it is that we think is going on and that should be relatively good it shouldn't be relatively bad we should have a relatively good sense of what other people are wanting anticipating thinking Feeling affects are emotions cognitions or thoughts and motives or desires okay so beginning in childhood we develop a theory this is one model of this there are several models of how this all works but anyways we'll go with this beginning in childhood we develop a theory that

enables us to understand and to some extent predict what others will do in light of what we think is going on in their mind we're able to make good predictions or form good theories in our minds about what they will do based on what we think is in their mind or what we hypothesize is in their mind and we'll talk today when Andy starts talking to to us a little bit about the polls of mentalizing we'll talk about the sources of information that we use for doing this but we do it now mentalization is the

clinical model based in all this research that's been being done for 40 years now called theory of Mind research theory of Mind comes out of philosophy that it enters into the cognitive Sciences it becomes part of the evolutionary cognitive Sciences doesn't really hit the clinical World until foni coming out of psychoanalysis and into attachment Theory and through reflective functioning scale of the adult attachment interview he then comes Online to his theory of mentalizing which is the clinical version of this it's not the only way of thinking about how we understand other people's minds but it

is Fig's way of doing it and it has always been about helping people psychotherapeutically which is what's so uh which is what's so useful about doing it here and which is why I bring this model rather than some other more philosophical model to this Workshop so mentalizing from the very beginning was about helping us understand a new dimension of human mental functioning that probably at the time probably was associated with certain forms of function and dysfunction and it turned out that after tons of Investigation it's turning out to be true functioning dysfunctioning will often have

something to do with the capacity to mentalize or the incapacity to mentalize or in other research domains strong theory of Mind versus weak theory of mind and you can read studies in Clinical Psychology around the different disorders and what has been shown to be The capacity or incapacity for mentalization with autism often being kind of the prototypical version of what it would be like to be a fully functioning human with the absence of mentalization or theory of mind the autistic individual can sometimes be just as intelligent as as um a non-autistic individual but what they're

often whe they're always lacking to some extent or the other is mentalization skill or theory of mind this is can be found in a in the work of Simon Baron Cohen the cousin of Sasha Baron Cohen and Simon Baron Cohen wrote a wonderful book called Mind blindness where he talks about autism as a kind of example of what humans would probably be like if just the theory of Mind modules were not working very interesting stuff and then there's Research into all other fields but I'll talk about the disorders in just a second so what did

they find out they started in 1987 with a study that showed several interesting things parents with a strong reflective capacity which what they were calling it At the time mentalization were three to four times more likely to have secure attached children this was very important because at the time attachment Theory had a strong empirical base but what we often didn't know or what we didn't know at the time was some of the factors that mediated secure versus insecure attachment in fact some of that's still a bit of a mystery but one thing was for sure

this one aspect of the mental functioning which in the adult attachment interview was actually a very weak scale this reflective capacity once that got bulked up put into a new scale reflective functioning scale by fonie and Howard steel they discovered that those who had the strong strong reflective capacity we're more likely to have secure children so this is at least one important contributing factor to Security in the attachment relationship now security isn't the be all and end all of attachment turns out that or it seems like it's going to turn out that security and the

two forms of insecurity are probably all adaptive evolutionary psychology is starting to realize that Um all three of the secure and insecure attachment styles are probably quite adaptive in different contexts and we started getting a hint of that in Clinical Psychology when we started realizing that despite the fact that we didn't love the idea of insecure attachment these people didn't seem to be significantly more vulnerable to mental illness so in other words we didn't like the idea but it didn't seem to cause any Global problems in functioning it just was kind of an unpleasant thing

minor problems in terms of relationships and such but nothing major so these are probably all adaptive security is not the most important thing in the world um but nevertheless if we want it reflective capacity is one of the ways to get it reflective capacity in the parent leading to reflective capacity in the child reflective capacity in the parent leading to a improved likelihood of security in the attachment relationship with the child so because we know that the attachment relationship seems to be intergenerational and because we know that uh that the way we the our capacity

To reflect as parents is going to impact the relationship with our children we also began to study how reflective functioning in the parent leads to reflective functioning in the child these things were all Associated so now we know that the mentalizing or theory of mind is is a potential in every human person for the most part unless there's some kind of um anatomical dysfunction or genetic dysfunction that could lead to anatomical dysfunction it's a potential for all of us but it must be facilitated by the environment this is the case with everything that has to

do with our genetics and our Evolution for the most part it always has to meet a world in which it is facilitated or hindered how vulnerable it is to being impacted is always uh dependent upon what we're talking about reflective capacity is very vulnerable to the world in which we find ourselves as children with a parents reflective capacity being crucial for our reflective capacity fondi gives us a strong sense of why that is but I've already hinted at it it has to do with Renee dickart and the foundation of all mind and mental States being

my own without a strong sense of one's own mind we will not be able to build any Theories about others Minds we need to have a strong sense of our own mind and how does a baby and young toddler and young child get a sense of their own mind from the caregiver the caregiver gives the child a sense of their own mind the stronger the sense of their own mind that the caregiver is able to provide the child the more layered that sense of self is as it becomes represented in the child's own mind the

more capable the child seems to be later as a theory of Mind capacity begins to develop into new facets the more likely is this child now to be able to build theories with themselves as the basis with the ability to hypothesize fantasize imagine contrast with themselves or from themselves so having a sense of one's own mind becomes very important okay strong reflective capacity also seems to be able to break the cycle of disadvantage that ordinarily LED parents With adverse attachment histories to raise insecure children this bullet point or this number two is very important to

me I had a challenging childhood and my attachment style was not secure it was preoccupied and my many many sessions of psychoanalysis on the couch um resulted in something that I think was quite obvious to me even before I knew mentalization Theory or theory of mind it helped me develop my analysis helped me develop a sense of my own mental States based on my analyst's capacity to know my mind to know my thoughts and emotions and feelings and her ability to reflect those back to me after many sessions about a thousand it could be done

more efficiently which is what we're here to learn to do but about a thousand sessions I developed this reflective capacity on the basis of her reflective capacity and that broke a cycle of disadvantage which also wasn't my mother's fault or my father's fault but an intergenerational problem that cannot be blamed on anyone because that's the nature of intergenerational transmission Who can you pin it on it's an infinite regress but I think it broke the cycle and I know that because I know my own attachment style now is an earned security and that comes really from

reflective capacity in my opinion it's not invulnerable it's still vulnerable but it's nevertheless significantly improved by reflective capacity and that's what they're saying here they found that this might break the cycle of the expectable cycle of intergenerational transmission of insecurity and probably disorganization which is much worse in terms of attachment style if you don't know attachment Theory very important topic disorganization unresolved status or the cannot classify group in terms of attachment okay analizing also turned out to be a protective factor that buffered the impact of difficult early experience and diminished intergenerational transmission of insecurity or

to put it in another way in the clinical world one of the things that we know now is that attachment security and therefore mentalization as well seems to kind of become a buffer between your vulnerability your kind of built In vulnerability towards mental illness endogenous vulnerability to mental illness that could be genetic but that could be early infantile experiences it could be um toxins there are lots of things that can cause us to become vulnerable to Mental Illness but security and reflective capacity associated with security seems to be a buffer it doesn't eliminate vulnerability but

it does buffer the vulnerability from expression of later um pathology it's not perfect but it has an effect a positive effect same way that unresolved status or disorganization see seems to be an increased vulnerability when you have disorganization or unresolved status now you have the opposite of security you have now an increased vulnerability for mental illness it's not the cause of it it's just an increased vulnerability factor and some of most of us probably don't need an additional vulnerability Factor so I say the things to focus on the most are how to achieve security and

reflective capacity and how to avoid um disorganization unresolved attachment and and breakdown of mentalizing so that mentalizing now becomes this amazing thing that we can encourage and help everybody With everyone can benefit from having their the limitations of their mentalizing improved and balanced which is what we're going to um help you learn how to do today everyone can benefit from that and we may not always see the effect of it but that might be good it might be good to just assume that based on the knowledge we have that it seems to serve as a

buffer it is a good thing to have there what do speak of the possibility the mentalization capacity itself might actually bring someone clinical to a subclinical level and I'll talk about that okay here here you have just a beginning just a kind of a dipping into the literature that's um that's um been put out there over the last several years mentalization therapy was developed first and foremost as a treatment for borderline personality disorder which is such a chronic problem in our field almost no one wants to work with this population because they're so difficult it

was my favorite area of um in my Psychotherapy practice when I had one but most people don't want to work with population they're very difficult and they're very difficult to help and we really didn't know how to help them despite Decades of trying to Make sense of this category of person now we have a couple of different therapies that seem to be useful for borderline personality disorder we have the conversational method out of Australia you have um DBT um linahan right her model um very effective in borderline personality disorder but other than that not a

lot until mentalization based therapy came and also seems to have been very effective um as well and you have tons of literature here on borderline personality disorder and the things that it helps even severe forms of hospitalized borderline personality disorder which is a very big deal seems to be helped and of course longitudinal studies into whether the effects of mentalizing based therapies um whether there's long-term effects to mentalization based therapy and sure enough at least um one study or yeah one study that I found today shows that 5 years after discharge these populations continue to

show clinical and statistical superiority to treatment um ra over treatment as usual that's often how it's done treatment as usual versus this kind of therapy with an improvement in Suicidality diagnostic status if you look at those percentages that's pretty dramatic by the way five years later service use use of medication um Global functioning vocational status okay so really significant Improvement now this was done on two-year treatments of twice a week treatment and mentalization based therapy but long-term effec in borderline personality disorders very important thing for us to develop very important thing so we know that

that um the ideology or the cause of borderline personality disorder is at least in part related to the loss of mentalizing or the non-development of mentalizing we know that this seems to be one crucial Factor in borderline personality disorder borderline personality disorder probably a complex relational trauma and maybe sexual trauma based kind of disorder but one thing that gets lost in the midst of all that is the capacity to mentalize you recover it and this individual all of a sudden doesn't seem to be the same kind of diagnostic category that they were for the rest

of Their for the rest of their life very interesting but they've done studies in other things too it's been hypothesized sorry it's been researched mentalization has been researched in other pathologies too there's some work on schizophrenia and um mentalization or theory of Mind definitely on autism um some stuff on eating disorders antisocial personality traits which is also one of those areas that we just think throw your hands up put people in prison if you can if not we don't know what to do with them we can't reach them so effects have been found with people

who have an overlapping borderline and antisocial traits significant improvements in real important things such as hostility anger paranoia so really great stuff not those traits the reduction of those traits Eating Disorders one preliminary study that said there seems to be some effect here for eating disorders but it was just preliminary um clinical trials for schizophrenia as well to see if we can make any improvements there particular kinds of dysfunction in schizophrenia now and if you're going to work in clinical populations or with any particular clinical population it will Be important to know what are the

particular kinds of deficits in mentalizing today we're going to do just kind of a global kind of a broad stroke understanding of mental mentalization assessment and intervention but you probably if you're going to if you're going to work with population such as schizophrenics and try to do any of this work you need to know what kind of deficits deficits do those different populations have that would be very important okay I'm saying there's two modes of of making sense of experience it's not entirely true F he actually says three modes but somewhere else he says four

modes I'm just going to for the sake of this this Workshop to not overwhelm you with too many Theory details because you're already going to get so many I'm going to say two pre mentalizing or non-mentalizing we could say and okay in the pre metalizing there's kind of these subdomains but don't worry so much about it and then there's hypermentalizing which we don't know exactly where to put it except for we know that it's not really mentalizing proper it's not effective mentalizing so They call it hyper mentalization and I'll talk more about what that means

but it often involves making multiple errors or exhibiting deficiency at that pole of mentalizing so trying to make sense of let's say what someone else is feeling and you're working really hard to do it but you're just making error over error over error despite what seems like a strong effort to make sense of someone's mind and they call that hypermentalizing so what we really want to know in Broad Strokes for you is mentalizing versus not mentalizing when not mentalizing what do we need to do to get them to do more mentalizing izing and that is

the clinical issue that is a clinical issue number one and we'll go through lots of details to focus on that if they're mentalizing if they're not mentalizing how to get them to mentalize in Vivo right now and then if they are mentalizing is their mentalization balanced okay mentalization here is the ability to recognize that the internal world is separate from but also related to external reality so that there is a mind that mediates the person from the world so it's their mind makes sense of their world and that's an important sub Defition for it we

can reflect upon we can reflect on the ways in which our thoughts emotions and motives both affect and are affected by what actually happens to us okay so the Mind itself internal mental States as a mediation between us and the world okay in when wot's language kind of the Mind becomes the transitional space or the transitional phenomenon if you want to use kind of wot's language for that subjective experiences subjective experien is felt to have interpretive depth interpretive depth and we can grasp the difference between events and our reactions to them okay interpretive depth means

we really can have a a rich relationship with our own sense of our self our world and the people around us a rich sense a layered sense of oh it's so interesting and complex and you're like this but you're also like that and sometimes you're like this and and my world is really like that it's gray and black and white and sometimes blue it's all these layers to reality and so this is interpretive depth you can make sense of things on multiple layers multiple Levels and in terms of um and and we can tell the

difference between reality and appearance which is such an important distinction to be able to make can I tell the difference between what happened and what it seems like to me what happened and how those things might be both and that happened and this is what it was like for me that it happened and was it more like this or was it more like that or was it a plan okay there you have the interpretive depth and the sense of appearance and reality the ability to distinguish and yet interplay appearance and reality right that's mentalizing proper

give you more details about that okay so we're going to um transition now a little bit um because we're going to have to get some details but I'll repeat one last thing here and then I'll move forward to the next part of the presentation we're looking for mentalizing and non-mentalizing or M mizing and hypermentalizing okay the non- mentalized to become a Mentalz but even the mentalize needs help often in having balanced mentalization okay and we'll talk a little bit about what that is now I'm going to introduce um the next presenter who's going to talk

about um the polls of mentalization okay hi everybody oh let me close the door hi everybody Welcome to the mentalization workshop I appreciate you all being here since if you were already here today that means that this is a very long day for you and if you weren't already here that means you came just for this so I'm very grateful that you did that if that's the case I know I think every single person in here so that's good intimate group oh no I don't know you sir what's your name Conrad Conrad nice to meet

you Conrad um so today's the mentalization Bas interventions workshop and the reason I decided I wanted to do this Workshop was that first of all there's not enough in my opinion events just helping students get kind of free skills and additional training so I Thought that was a really good idea um some people who' have been working with me for a long time wanted us to start hosting more events and were willing to help and this is event is really kind of the the proof that people are really willing to help and um the other

reason is that I'm not going to be teaching the psycho analytics Series in this next coming Academic Year and so when I thought about not teaching the psychoanalytic series that I've been teaching for so many years now I realized that the greatest loss I felt about that series was um not being able to teach students attachment Theory and um mentalization interventions um in addition to a effect regulation therapy which I'll say just a few words about today so we've never run this Workshop before so we don't know how long it's really going to take and

there may be a few glitches so please be patient with us if that happens um and we don't know if we're going to finish really early or if we're going to be running out of time at the end so we'll see how it goes um we've got several things planned the objectives for today are to introduce you to some critical theory about mentalization I Will talk about what it is what are we even talking about um and then some back background for that and some basic details and some literature about why it matters um then

uh the other two speakers which I'll introduce in a little while will be doing two other pieces of the theory um um Andy Woodall will be doing the presentation on the theories of polls the polls of mentalization um and then um Kat rosovich will be presenting on um basics for understanding intervention in mentalization and then after those presentations I will pick up and say a couple more things um getting you ready for the workshop piece which is where you're going to actually have to do something we will stop videotaping so you don't you know that

you won't be on videotape nor will the videotape have to watch us just going through the tedious process of trying to figure um these things out and I will be asking people to please come up and participate in trying to imp Implement these things actually try to do this practice so we're going to ask people to do that but we'll set you up so that by the time you get there you'll know um more or less what you're going to do and how you're Going to do it and we'll do it in a kind of

a peer consultation approach where you'll get to ask people how do you think I should do this how should I say this okay so it'll all build on itself we will be doing some role playing um the people who helped me um Ryan ma my ta this year um the other presenters um and I will all be doing a role play you however will be doing the intervention side of the role play later once we get there okay the role plays were written by Sarah Alton bassac who's here and she wrote These role plays and

I kind of edited them tweak them a little bit all the way to the last minute where I changed you know one sentence in them but we um were very grateful for her to do that and I think everybody learned a lot in the process of kind of getting ready for um this presentation which is the first of its kind um that I do okay um so any questions or comments before I jump in with what we're going to do oh goals what what's the objectives I think I said I was going to get there

but I didn't I want you to know some of the theory I want you to know how to assess for these kinds of things at least in a basic way kind of an introductory way of assessing for mentalization skills or non- skills um And then I want you to be able by the end to design some basic interventions that are delivered in the way that the the founders of mentalization-based therapy um model have expected to be delivered and we'll teach you how to do that and you should be able to then deliver them okay so

that's those are my goals that's a pretty hefty series of goals but I think we should be able to get there at least for for most of us okay any comments or questions before we jump in all right so we'll start as I often do with some quotes uh this quote is from um foni and Target who have been working on mentalization B based um therapy for a very long time and I really like this quote you may have heard it before if you've taken my classes if the attachment relationship is indeed a major organizer

of brain development as many have accepted and suggested then the determinants of attachment relationships are important far beyond the provision of a fundamental sense of safety and security and there's a lot in this quote and um that I think is important but I will highlight a few pieces of this quote that I think are really Crucial first attachment is for a fundamental sense of Safety and Security okay so there is the primary reason that the attachment um system exists in our species and the attachment system exists in our species first and foremost from what we

understand for providing safety um sorry security safety and a sense of security this comes from um Alan st's um statement that one of the outcomes of a strong attachment relationship is a sense of felt security and that is a subjective sense that things are going to be okay it's not necessarily true that they will be always but a sense that generally speaking things will be okay now attachment is first and foremost about this safety and a sense of safety actual safety of course because attachment relationship leads one to um seek proximity to a caregiver therefore

ensuring that someone is watching out for the child and able to protect the child we are a precocious species we are born very very um immature and so we definitely need our caregiver our Attachment system goes far beyond the length of time that anyone else's any other um species attachment system um goes now other than that what foni is also saying here is that there's something about the attachment relationship lasting so long in humans as opposed to other important developmental processes that emerge and sometimes go away such as a prominent sucking reflex a prominent grasping

reflex so we have other systems that come in manifest for some purpose developmentally and then um deteriorate or disappear the attachment system comes in helps us secure um the relationship with the caregiver in some way or the other and then it remains it definitely does not remain as prominently as it um existed in the first two5 years of life but it remains and it remains lifelong to some extent or the other with the consequences of of it being um the consequences of it being problematic reducing over time but we also know the Romantic relationships um

Are associated also with attachment style so that you have often attachment Styles related to your romantic Partners as well that seem to be um uh stable a stable continuation of your infantile attachment style which has stabilized by the age of two so what foni is saying here is that there's something important about attachment lasting so long for in humans it wouldn't have if it didn't serve some additional functions and that's a very important piece of his quote the suggestions nowadays for why attachment has lasted so long coming from interpersonal neurobiology people like Alan Shore who

was in Chicago recently and Peter fonie is that besides the sense of Safety and Security that comes from um the attachment relationship you also have a couple of other critical um needs that the attachment relationship seems to serve the first need that the attachment relationship seems to serve that is so centrally associated with infantile security is affect regulation and affect regulation is crucial Alan Shore doesn't himself say this but affect regulation is Crucial it seems to me not because emotions inherently have to be regulated but because an animal that is as social as we are

probably needs to have their a effects regulated to a great extent in order for the social system to work as relatively seamlessly as it tends to do for humans so that we we have abnormal states of affect expression um on both sides on the high end and the low end and the attachment caregiver seems to provide a lot of support for regulating um the infant's um affect States well we won't talk about that as much today but it's a very interesting topic we could have another event on that and how to use that in your

therapy which is so crucial actually to design a whole therapy around maintaining arousal States at a level that's therapeutic very useful avoiding too much comfort and avoiding too much discomfort um very important work now we're going to focus on mentalization Peter foni says of course related to affect regulation of course as well is the Ability the ability of the caregiver to help a child develop something that is innately available to them which is this thing called mentalization let me say that again just to be clear about what I'm saying because I might have confused it

a little bit it's very important that an attachment figure be available to help a child develop an innate capacity an innate potential that they carry within themselves as part of the species to develop this thing that we call mental Iz ation however like every other um innate um possibility in US it often has to find an environment in which it is altered um um uh in which it is altered or it is um developed appropriately aided supported and mentalization is the same way we need a caregiver who's who possesses the ability to ment Mize to

help the child mentalize and they do that in a series of steps um that we won't go into um in great detail here so these three things attachment related to Safety and Security attachment related to affect regulation and attachment related to mentalization are all um critical there's also a really interesting area of Investigation around attachment in adolescence where attachment then begins to shift and change maybe even change in males and females differentially depending on what um the the now the new problems are having to do with mating short-term long-term mating and such so there's a

lot of interesting stuff happening in the world of understanding how attachment then changes and transforms but nevertheless remains in adolescence and on through adulthood too interesting things okay here's another quote from Peter fonie an evolutionary function of Earth early relationships is to equip the very young child with an environment within which the understanding of mental States in others and the self can fully develop Evolution has placed particular value on developing mental structures for interpreting interpersonal actions okay so this is where foni introduces his interest in evolution He's not an evolutionary psychologist or an evolutionary scientist

he um comes from the world of psychoanalysis and then attachment later but he's obviously interested in evolution and he poses um he frames his model of mentalization within Evolution which I think is critical of course um it's critical that he say what's this for what is this about and what he says is that what it's about out is we need to have the capacity to develop the ability to interpret interpersonal actions we need the mechanisms for which to do that and then we need a context in which that will be facilitated and he's saying that

um the attachment relationship is that um the context of facilitation for that process Evolution has placed a particular value on developing mental structures and that's an interesting statement that probably is quite true which is this seems to have helped us I'll talk a little bit more about Evolution but it seems that this has helped us and we know that because of the the extent to which we have a very Welldeveloped um capacity for mentalization so if you do not know the the basic principles of evolutionary theory what this also means is that this capacity wherever

it emerged and the to the extent that it emerged was retained so those who possessed whatever beginning capacities for mentalizing or theory of mind I'll use that I'll explain that term in a second um that was retained meaning that these individuals who possess some kind of beginning capacity for this were able to survive to reproductive age and some of them were able to reproduce and those who reproduced created more individuals with a capacity to develop um this skill mentalizing okay and another quote this is from David Borland and he I just discovered his work recently

he has a great book called origins of human nature that I'm um currently studying right now and this is from evolutionary developmental psychology which um I think is very meaningful because it starts to add some some of the nuances and details especially around development that I think are really um Would be very useful to add to evolutionary psychology that does kind of broad more sweeping kind of Investigations into some of the capacities in our species and then the evolutionary developmental psychology field seems to kind of come in and say yes but this is how it

happens and this is why it happens this way rather than that way and the details get filled in and so here's a quote from that book to successfully maneuver the often Stormy Waters within small groups of long lived conspecifics other humans adult humans must be able to represent the knowledge desires and intentions of others if they are to succeed they must learn how to cooperate how to compete and which general social strategy is in their best interest this requires what has been termed social cognition we'll use other terms for it cognition about social relationships and

social phenomenon and we're going to focus today on mentalizing or theory of mind and I'm using those synonymously even though that's not exactly synonymous but we'll use them that way today there are other forms of social cognition like cheater detection social Cheater detection um being able to uh detect infidelity mate guarding behavior all kinds of things that we do to kind of work with each other cooperate and compete as we need to and then theory of Mind Of course being a very important one um in many of our opinions okay so what is all this

for this social cognition this subset of social cognition we call theory of minor mentalizing is particularly important to help small groups function with each other to cooperate compete and understand each other and it's particularly important for a species like us who has survived really because of our ability to cooperate with each other so those who could cooperate were the ones that really were leading the species helping the species move forward and we really needed it because we lived in small bands of maybe 50 to on the high end maybe 120 people people and we lived

a really long time like 40 and now of course we live you know I think the new stat is like 78 or something like that so we live a long time in small groups of people yet we Interact with other bands of people and so there's all kinds of things that we need to be able to do in order to make all that possible and the only reason we survive despite the fact that we're such a weak animal scavengers for meat um slow gangly standing on you know two legs instead of running on four so

the way we survived was through probably cooperation we're Social Animal we'll talk about about what that means too so so attachment is not an end in itself rather it exists in order to produce a representational system in the mind that has evolved to Aid human survival this evolved representational system is mentalizing there are other evolved um representational systems but one of them is called mentalizing to help us understand interpret and predict the behavior of self and others especially for social cooperation here you have um social brain you could hear a social brain Theory here um

someone named Dunbar philosoph philosopher evolutionary philosopher so Very important um capacity that we have let me give you a little example of how easy this stuff is for us if I'm standing here talking to you and all of a sudden I start looking to the door a lot immediately what comes to your mind about what's going on someone you want to escape or you're looking for someone I what was the first part you want to escape or you're looking You're Expecting someone to come I want to escape I'm looking for a door so possibly looking

for an out or maybe I'm looking for someone what else there's actually no right answer here what else might be going on something outside has reoriented your attention something has reoriented my attention maybe something happened over there maybe there are some stimulus and what might those be Anno what annoys her people annoys people campus shooter we had a training on that recently um what else might be going on for me if I'm going like [Music] this trigger to past trigger to the Past Okay light flashing doing something to me okay our ability to just guess

based on me doing something like this what might be going on that right there what you just did and all the many probably hundreds of things that ran through your head as possibilities that's what's so special about mentalization the ability to make sense of me a behavior of mine based on things that you imagine might have been going on for me inside of my mind and in my world or that I might have been perceiving we do this thing so seamlessly that it almost is impossible to know notice it and yet it's so crucial because

compared to all other species of animals we do it so much better than any other we know that there's some limited capacity for some of these things in other species predictably in other Apes but no ape has the capacity that we have and what capacity they have depends on how we look at it and how we're interpreting some of the basic lower level capacities for mentalization so we do it amazingly well and it's very useful for us we know it's useful for us because we do it so Well this if you remember Renee deart when

he did his um radical doubt trying to find a solid ground for his philosophizing for his work he wanted to find a solid ground on which his thinking can be built and what he did is he of course had his radical doubt he said I'm going to doubt everything that I possibly can doubt and see if I landed anything that is beyond doubt right and one of the things that happened for decart when he finally landed on kogito osum I think therefore I am um is that he had arrived at his Solid Ground he knew

one thing for sure that he couldn't doubt that he was a doubter a person who was doubting so doubt was certain okay so he did that the other thing is he painted himself into a corner because his philosophy ended up in his mind and just his mind right this is called solipsism this is the problem of finding yourself only in your own mind with your own mind as the only thing that you're certain of but you'll see that most of us kind of think like what a strange thing deart is doing right it sounds like

such a strange thing to land on the Solid Ground of only only my mind exists for Sure and the reason that that's strange for us is because we have such an intuitive sense that other people have Minds how do we know that other people have Minds it's a presumption you don't actually know it at all you don't know that someone else has a mind you only know as Dart said that you have a mind but you're very confident that other people have Minds right and their mental state is most certain because you know you have

one and they are at least somewhat like you right using oneself as kind of a basic prototype as the foundation for making sense of other people's mind is the way that this generally works and we know that other people have Minds because we know so much about them and we know so much about other people's minds deart tried working his philosophy out of his own mind and into the minds of others but it was very difficult for him to do but biologically it's not hard for us to do biologically we can all do it quite

easily so in the 70s they came up with this concept called theory of mind it was the first time that anyone had had such a clear insight into this thing That we now are calling here mentalizing based in fonag theory but at the time it was really um the Insight was that every single person seems to have the capacity as it says here to varying degrees to make sense of our own and others behavior on the basis of underlying mental States including beliefs emotions and motives okay we all have to varying degrees the capacity to

make sense of others people's behavior and our own on the basis of mental States mental states that we have never SE seen that we cannot see no matter how many thought logs you do you've never seen a thought they're just presumed to be there usually on the basis of the fact that you have confidence that you have them now you should know that that puts us in a very precarious position to imagine mental States in other people we're probably feeling relatively comfortable with that but I should also tell you that there are some people who

believe that this is um a very bold presumption to make because they do not Believe that mental states are real most of us in the room are going to presume that mental states are real and if I have them some other people have them you should also know that assuming that a computer has a mind when you're playing a chess game with it also helps you function socially in terms of of competition you compete better with the chess game the computer chess game if you imagine it has mental States rather than trying to imagine all

the rules that the computer is following if we simply say it wants my queen we have a greater chance of beating the game so one way or the other whether people have mental States or not something about the ability to attribute mental states to the other seems to be very useful to us it becomes a very rapid way of making sense of complex systems and the social systems are complex systems functioning in a group of even three people is so complex that if we want to anticipate what's going to Happen if we want to work

well with this one but then compete with this one then we really have to have some very rapid fire ways of assuming what it is that we think is going on and that should be relatively good it shouldn't be relatively bad we should have a relatively good sense of what other people are wanting anticipating thinking feeling affects are emotions cognitions or thoughts and motives or desires okay so beginning in childhood we develop a theory this is one model of this there are several models of how this all works but anyways we'll go with this beginning

in childhood we develop a theory that enables us to understand and to some extent predict what others will do in light of what we think is going on in their mind we're able to make good predictions or form good theories in our minds about what they will do based on what we think is in their mind or what we hypothesize is in their mind and we'll talk today when Andy starts talking to to us a little bit about the polls of mentalizing we'll talk about the sources of information that we use for doing this but

we do it now mentalization is the clinical Model based in all this research that's been being done for 40 years now called theory of Mind research theory of Mind comes out of philosophy that it enters into the cognitive Sciences it becomes part of the evolutionary cognitive Sciences doesn't really hit the clinical World until foni coming out of psychoanalysis and into attachment Theory and through reflective functioning scale of the adult attachment interview he then comes online to his theory of mentalizing which is the clinical version of this it's not the only way of thinking about how

we understand other people's minds but it is Fig's way of doing it and it has always been about helping people psychotherapeutically which is what's so uh which is what's so useful about doing it here and which is why I bring this model rather than some other more philosophical model to this Workshop so mentalizing from the very beginning was about helping us understand a new dimension of human mental functioning that probably at the time probably was associated with certain forms of function and dysfunction and it turned out that after tons of Investigation it's turning out to

be true functioning dysfunctioning will often have something to do with the capacity to mentalize or the incapacity to mentalize or in other research domains strong theory of Mind versus weak theory of mind and you can read studies in Clinical Psychology around the different disorders and what has been shown to be the capacity or incapacity for mentalization with autism often being kind of the prototypical version of what it would be like to be a fully functioning human with the absence of mentalization or theory of mind the autistic individual can sometimes be just as intelligent as as

um a non-autistic individual but what they're often whe they're always lacking to some extent or the other is mentalization skill or theory of mind this is can be found in a in the work of Simon Baron Cohen the cousin of Sasha Baron Cohen and Simon Baron Cohen wrote a wonderful book called Mind blindness where he talks about autism as a kind of example of what humans would Probably be like if just the theory of Mind modules were not working very interesting stuff and then there's Research into all other fields but I'll talk about the disorders

in just a second so what did they find out they started in 1987 with a study that showed several interesting things parents with a strong reflective capacity which what they were calling it at the time mentalization were three to four times more likely to have secure attached children this was very important because at the time attachment Theory had a strong empirical base but what we often didn't know or what we didn't know at the time was some of the factors that mediated secure versus insecure attachment in fact some of that's still a bit of a

mystery but one thing was for sure this one aspect of the mental functioning which in the adult attachment interview was actually a very weak scale this reflective capacity once that got bulked up put into a new scale reflective functioning scale by fonie and Howard steel they discovered that those who had the strong strong reflective capacity we're more likely to have secure Children so this is at least one important contributing factor to Security in the attachment relationship now security isn't the be all and end all of attachment turns out that or it seems like it's going

to turn out that security and the two forms of insecurity are probably all adaptive evolutionary psychology is starting to realize that um all three of the secure and insecure attachment styles are probably quite adaptive in different contexts and we started getting a hint of that in Clinical Psychology when we started realizing that despite the fact that we didn't love the idea of insecure attachment these people didn't seem to be significantly more vulnerable to mental illness so in other words we didn't like the idea but it didn't seem to cause any Global problems in functioning it

just was kind of an unpleasant thing minor problems in terms of relationships and such but nothing major so these are probably all adaptive security is not the most important thing in the world um but nevertheless if we want it reflective capacity is one of the ways to get it reflective capacity in the parent leading to reflective capacity in the Child reflective capacity in the parent leading to a improved likelihood of security in the attachment relationship with the child so because we know that the attachment relationship seems to be intergenerational and because we know that uh

that the way we the our capacity to reflect as parents is going to impact the relationship with our children we also began to study how reflective functioning in the parent leads to reflective functioning in the child these things were all Associated so now we know that the mentalizing or theory of mind is is a potential in every human person for the most part unless there's some kind of um anatomical dysfunction or genetic dysfunction that could lead to anatomical dysfunction it's a potential for all of us but it must be facilitated by the environment this is

the case with everything that has to do with our genetics and our Evolution for the most part it always has to meet a world in which it is facilitated or hindered how vulnerable it is to being impacted is always uh dependent upon what we're talking about reflective capacity is very vulnerable to the world in which we find ourselves as children With a parents reflective capacity being crucial for our reflective capacity fondi gives us a strong sense of why that is but I've already hinted at it it has to do with Renee dickart and the foundation

of all mind and mental States being my own without a strong sense of one's own mind we will not be able to build any theories about others Minds we need to have a strong sense of our own mind and how does a baby and young toddler and young child get a sense of their own mind from the caregiver the caregiver gives the child a sense of their own mind the stronger the sense of their own mind that the caregiver is able to provide the child the more layered that sense of self is as it becomes

represented in the child's own mind the more capable the child seems to be later as a theory of Mind capacity begins to develop into new facets the more likely is this child now to be able to build theories with themselves as the Basis with the ability to hypothesize fantasize imagine contrast with themselves or from themselves so having a sense of one's own mind becomes very important okay strong reflective capacity also seems to be able to break the cycle of disadvantage that ordinarily LED parents with adverse attachment histories to raise insecure children this bullet point or

this number two is very important to me I had a challenging childhood and my attachment style was not secure it was preoccupied and my many many sessions of psychoanalysis on the couch um resulted in something that I think was quite obvious to me even before I knew mentalization Theory or theory of mind it helped me develop my analysis helped me develop a sense of my own mental States based on my analyst's capacity to know my mind to know my thoughts and emotions and feelings and her ability to reflect those back to me after many sessions

about a thousand it could be Done more efficiently which is what we're here to learn to do but about a thousand sessions I developed this reflective capacity on the basis of her reflective capacity and that broke a cycle of disadvantage which also wasn't my mother's fault or my father's fault but an intergenerational problem that cannot be blamed on anyone because that's the nature of intergenerational transmission who can you pin it on it's an infinite regress but I think it broke the cycle and I know that because I know my own attachment style now is an

earned security and that comes really from reflective capacity in my opinion it's not invulnerable it's still vulnerable but it's nevertheless significantly improved by reflective capacity and that's what they're saying here they found that this might break the cycle of the expectable cycle of intergenerational transmission of insecurity and probably disorganization which is much worse in terms of attachment style if you don't know attachment Theory very important topic disorganization unresolved status or the cannot classify group in terms of attachment okay analizing also turned Out to be a protective factor that buffered the impact of difficult early experience

and diminished intergenerational transmission of insecurity or to put it in another way in the clinical world one of the things that we know now is that attachment security and therefore mentalization as well seems to kind of become a buffer between your vulnerability your kind of built in vulnerability towards mental illness endogenous vulnerability to mental illness that could be genetic but that could be early infantile experiences it could be um toxins there are lots of things that can cause us to become vulnerable to Mental Illness but security and reflective capacity associated with security seems to be

a buffer it doesn't eliminate vulnerability but it does buffer the vulnerability from expression of later um pathology it's not perfect but it has an effect a positive effect same way that unresolved status or disorganization see seems to be an increased vulnerability when you have disorganization or unresolved status now you have the opposite of security you have now an increased vulnerability for mental illness it's not the cause of it it's just an increased vulnerability Factor and some of most of us probably don't need an additional vulnerability Factor so I say the things to focus on the

most are how to achieve security and reflective capacity and how to avoid um disorganization unresolved attachment and and breakdown of mentalizing so that mentalizing now becomes this amazing thing that we can encourage and help everybody with everyone can benefit from having their the limitations of their mentalizing improved and balanced which is what we're going to um help you learn how to do today everyone can benefit from that and we may not always see the effect of it but that might be good it might be good to just assume that based on the knowledge we have

that it seems to serve as a buffer it is a good thing to have there what do speak of the possibility the mentalization capacity itself might actually bring someone clinical to a subclinical level and I'll talk about that okay here here you have just a beginning just a kind of a dipping into the literature that's um that's um been put out there over the last several years mentalization therapy was developed first and foremost as a treatment for Borderline personality disorder which is such a chronic problem in our field almost no one wants to work with

this population because they're so difficult it was my favorite area of um in my Psychotherapy practice when I had one but most people don't want to work with population they're very difficult and they're very difficult to help and we really didn't know how to help them despite Decades of trying to make sense of this category of person now we have a couple of different therapies that seem to be useful for borderline personality disorder we have the conversational method out of Australia you have um DBT um linahan right her model um very effective in borderline personality

disorder but other than that not a lot until mentalization based therapy came and also seems to have been very effective um as well and you have tons of literature here on borderline personality disorder and the things that it helps even severe forms of hospitalized borderline personality disorder which is a very big deal seems to be helped and of course longitudinal studies into whether the effects of mentalizing based Therapies um whether there's long-term effects to mentalization based therapy and sure enough at least um one study or yeah one study that I found today shows that 5

years after discharge these populations continue to show clinical and statistical superiority to treatment um ra over treatment as usual that's often how it's done treatment as usual versus this kind of therapy with an improvement in suicidality diagnostic status if you look at those percentages that's pretty dramatic by the way five years later service use use of medication um Global functioning vocational status okay so really significant Improvement now this was done on two-year treatments of twice a week treatment and mentalization based therapy but long-term effec in borderline personality disorders very important thing for us to develop

very important thing so we know that that um the ideology or the cause of borderline personality disorder is at least in part related to the loss of mentalizing or the non-development of mentalizing we know that this seems to be one crucial Factor in borderline personality Disorder borderline personality disorder probably a complex relational trauma and maybe sexual trauma based kind of disorder but one thing that gets lost in the midst of all that is the capacity to mentalize you recover it and this individual all of a sudden doesn't seem to be the same kind of diagnostic

category that they were for the rest of their for the rest of their life very interesting but they've done studies in other things too it's been hypothesized sorry it's been researched mentalization has been researched in other pathologies too there's some work on schizophrenia and um mentalization or theory of Mind definitely on autism um some stuff on eating disorders antisocial personality traits which is also one of those areas that we just think throw your hands up put people in prison if you can if not we don't know what to do with them we can't reach them

so effects have been found with people who have an overlapping borderline and antisocial traits significant improvements in real important things such as hostility anger paranoia so really great Stuff not those traits the reduction of those traits Eating Disorders one preliminary study that said there seems to be some effect here for eating disorders but it was just preliminary um clinical trials for schizophrenia as well to see if we can make any improvements there particular kinds of dysfunction in schizophrenia now and if you're going to work in clinical populations or with any particular clinical population it will

be important to know what are the particular kinds of deficits in mentalizing today we're going to do just kind of a global kind of a broad stroke understanding of mental mentalization assessment and intervention but you probably if you're going to if you're going to work with population such as schizophrenics and try to do any of this work you need to know what kind of deficits deficits do those different populations have that would be very important okay I'm saying there's two modes of of making sense of experience it's not entirely true F he actually says three

modes but somewhere else he says four modes I'm just going to for the sake of this this Workshop to not overwhelm you with too many Theory details because you're already going to get so Many I'm going to say two pre mentalizing or non-mentalizing we could say and okay in the pre metalizing there's kind of these subdomains but don't worry so much about it and then there's hypermentalizing which we don't know exactly where to put it except for we know that it's not really mentalizing proper it's not effective mentalizing so they call it hyper mentalization and

I'll talk more about what that means but it often involves making multiple errors or exhibiting deficiency at that pole of mentalizing so trying to make sense of let's say what someone else is feeling and you're working really hard to do it but you're just making error over error over error despite what seems like a strong effort to make sense of someone's mind and they call that hypermentalizing so what we really want to know in Broad Strokes for you is mentalizing versus not mentalizing when not mentalizing what do we need to do to get them to

do more mentalizing izing and that is the clinical issue that is a clinical issue number one and we'll go through lots of details to focus on that if they're Mentalizing if they're not mentalizing how to get them to mentalize in Vivo right now and then if they are mentalizing is their mentalization balanced okay mentalization here is the ability to recognize that the internal world is separate from but also related to external reality so that there is a mind that mediates the person from the world so it's their mind makes sense of their world and that's

an important sub defition for it we can reflect upon we can reflect on the ways in which our thoughts emotions and motives both affect and are affected by what actually happens to us okay so the Mind itself internal mental States as a mediation between us and the world okay in when wot's language kind of the Mind becomes the transitional space or the transitional phenomenon if you want to use kind of wot's language for that subjective experiences subjective experien is felt to have interpretive depth interpretive depth and we can grasp the difference between events and our

reactions to them okay interpretive depth means we really can have a a rich relationship with our own sense of our Self our world and the people around us a rich sense a layered sense of oh it's so interesting and complex and you're like this but you're also like that and sometimes you're like this and and my world is really like that it's gray and black and white and sometimes blue it's all these layers to reality and so this is interpretive depth you can make sense of things on multiple layers multiple levels and in terms of

um and and we can tell the difference between reality and appearance which is such an important distinction to be able to make can I tell the difference between what happened and what it seems like to me what happened and how those things might be both and that happened and this is what it was like for me that it happened and was it more like this or was it more like that or was it a plan okay there you have the interpretive depth and the sense of appearance and reality the ability to distinguish and yet interplay

appearance and reality right that's mentalizing proper give you more details about that okay so we're going to um transition now a Little bit um because we're going to have to get some details but I'll repeat one last thing here and then I'll move forward to the next part of the presentation we're looking for mentalizing and non-mentalizing or M mizing and hypermentalizing okay the non- mentalized to become a mentalz but even the mentalize needs help often in having balanced mentalization okay and we'll talk a little bit about what that is now I'm going to introduce um

the next presenter who's going to talk about um the polls of mentalization okay