Therapy based on mentalization, what does it consist of?

Mentalization-based therapy is a fairly new therapeutic approach. Its objective, however, is the same as that which integrates many other types of clinical strategies: to help us better understand emotions and thoughts to link them with our behaviors. It is, in essence, about focusing attention on mental processes to use them to our advantage and thus achieve a greater sense of control over everything we do.

In clinical psychology, these integrative currents are always as interesting as they are useful. This specific therapy, which emerged at the beginning of the second millennium, is one of those examples. In this case, in it They integrate from the cognitive-behavioral school to the psychodynamic, through the systemic and the ecological. All of this makes up a resource that is as valid as it is interesting, designed at the time by psychologists Peter Fonagy and Anthony Bateman.

Initially, this therapy was created to provide a more effective response to patients with borderline personality disorder. Now, today It stands as an equally valid tool to treat various disorders such as depression, anxiety, eating disorders and trauma.. Likewise, it is also frequently used in patients with addictions.

Characteristics of therapy based on mentalization

Before delving into this type of therapy, it is advisable to first stop at a term: mentalization.. What do we mean when we talk about this specific dimension? Basically, it refers to our ability to understand ourselves in depth, unpacking those internal processes that sometimes lead us to act impulsively.

“Mentalizing” can be understood as perceiving and interpreting behavior as related to intentional mental states. This ability is based on the assumption that our mental states influence our behavior. Broadly speaking, mentalization is a capacity that allows us to have a representation of ourselves, of our self, as an “agent”, that is, it allows us to feel like owners of our behaviors and thoughts.

For his part, Anthony Bateman, creator of this therapy, defined mentalization as that process by which we can understand others, but, above all, ourselves by becoming fully aware of what happens in our mind. To understand it better, let’s take a simple example.

Today, when I got home after work, I responded badly to my partner and this caused an argument. In therapy based on mentalization they would help me understand why this has happened: my mood, my worries and stress have caused me to choose the wrong words to communicate. Furthermore, I have projected my anger that originated at work onto my partner.

As we see, This type of resource can be very suitable for regulating emotions and helping us improve our relationships. Let us learn, therefore, more aspects of therapy based on mentalization.

Mentalization and Bowlby’s attachment theory

Therapy based on mentalization is largely nourished by that psychodynamic line that It follows from attachment theory John Bowlby. According to this approach, people manage to develop good mentalization, that is, good control and understanding over our thoughts, emotions and mental representations thanks to a secure attachment.

If our parents provide us with a loving environment where we can validate emotions, meet needs and help us build our identity, label feelings, desires and thoughts, everything will progress in a healthy way. We will develop, little by little, that coherence and self-control between acts and thoughts, between behaviors and emotions.Thus, something that the creators of mentalization-based therapy point out to us is that In borderline personality disorder, there is a sense of self disintegratedThese people are defined by impulsive behavior, by the clear difficulty in regulating emotions and by having many difficulties in managing their interpersonal relationships. In them, mentalization fails, they do not understand what is going on in their mind, because in many cases they were raised in an environment based on a disorganized and insecure attachment (Bateman and Fonagy, 2006).

What are the objectives of therapy based on mentalization?

Therapy based on mentalization is based on the following idea: not having adequately developed the mentalization process leads the human being to a series of very specific realities.

Interpersonal and social problems.Problems of emotional instability. Impulsivity.Stress disorders, anxiety, depression, etc.Self-destructive and violent behaviors.

Therefore, the objectives of therapy based on mentalization require, above all, having a well-trained professional in the following dimensions:

Achieve the patient to have a better understanding of their mental states.Promote emotional and behavioral regulation. Impulse control.Improve social skills to make relationships more rewarding.Clarify and establish vital purposes. Promote a rich, secure and motivated internal reality, where the person feels not only that they have control, but also the illusion of building a balanced and happy life. Build continuity in their autobiography. Often, going through certain traumas, problems or addictive behaviors creates a kind of wall in the person. The purpose of this therapy is to tear down those barbed wire fences and create new perspectives for the future.

The therapist’s position

The treatment’s emphasis on the therapist’s position is one of the basic components of mentalization-based therapy. The mentalizing therapeutic position should include:

Humility derived from a sense of not knowing. Patience in taking time to identify differences in perspectives. Legitimize and accept different perspectives. Actively ask the patient about their experience. Ask for detailed descriptions of the experience (what questions) rather than explanations (why questions). Avoid the need to offer understanding to things that do not make immediate sense.

The therapist’s attitude is essential. Its task is to stimulate a mentalizing process and turn it into an essential feature of the interaction. The act of thinking about oneself and others is developed, in part, through a process of identification: the therapist’s ability to use his or her mind and to show a change of mind when presented with alternative views is internalized by the patient. Progressively, the patient becomes more curious about his own mind and that of others.

The crucial aspect of the therapist’s attitude is assuming the position of not knowing the position. This is necessary to ensure that the therapist remains curious about his or her patient’s mental states. So, he must accept that both he and his patient experience things only partially and that neither of them has the primacy of knowledge over the other.

Basic interventions

The therapist’s interventions are organized around a series of steps:

Demonstrate empathy for the patient’s subjective state. Exploration, clarification and, if appropriate, challenge. Identify the affect and establish a focus of affect. Mentalize the relationship.

Is mentalization-based therapy effective?

As we have seen and intuited, this approach is undoubtedly very interesting. Now, what does the evidence say about its effectiveness?

Studies such as the one carried out in the Department of Psychology at the University of Aarhus, in Denmark, for example, tell us that Therapy based on mentalization is the one with the highest success rate in patients with borderline personality disorder; hence, it is the most recommended in mental health services.

To conclude, we are faced with one more resource that is worth taking into account for a certain type of clinical needs.

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