Mentalization

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Mentalization is a technical term from psychology and psychoanalysis . It stands for the ability to "interpret one's own behavior or the behavior of other people by ascribing mental states". Here, not only the behavior of the other person is dealt with, but also one's own ideas about their beliefs , feelings , attitudes and desires , Mentalization means, so to speak, “being able to read from behavior what is going on in the minds of others.” It is also possible to reflexively grasp one's own experiences and actions .

The concept of mentalization is based on theory of mind research. It was coined by Peter Fonagy and Mary Target , who prefer the term ' mentalizing' for it because it is a psychological activity. Mentalization presupposes an understanding of the nature of the mental. This includes the knowledge that reality is only represented (mapped) in the mind - the thoughts of the real world in general, but not exactly correspond.

The ability to mentalize is developed from the first months of life: Social exchange takes place in a secure attachment relationship with the main reference person . This enables the child to increasingly differentiate, understand and control emotional movements and to control their own attention. The basic ability to mentalize is often developed from the age of four.

The concepts of mentalization and mindfulness are very similar, with many authors referring to a comparison between Choi-Kain and Gunderson's 2008 concepts.

Basics of mentalization

The psychoanalyst Peter Fonagy is one of the originators of the concept of mentalization and mentalization-based psychotherapy .

Mentalization is a scientific construct for the normal visualization of mental processes in everyday psychology . So it means to distinguish affective and mental states of activity and at the same time to recognize them as the cause. Mentalization means having an idea of ​​the intellectual , mental, i.e. intellectual reasons for a person's behavior. It includes the ability to suspect desires, thoughts and beliefs in other people as well as in oneself , i.e. to see mental, spiritual processes that underlie action. It is also possible to mentalize yourself, i.e. to grasp reflexively which circumstances and experiences in the past and present have led to the current wishes, thoughts and convictions. In order to develop this ability it is necessary to have a basic idea of ​​the mental.

Many people take it for granted that their own actions and those of others are based on the wishes, needs, intentions, expectations and opinions of others, but also of themselves. For example, if a person opens a window, he does so because he wants fresh air; she smiles because she is happy; or it points to an object as it the attention would draw on this. It is part of everyday life to view these mental states as the cause of actions in others.

The ability to mentalize can be seen as unique to humans. It appears to be the foundation of the "social species" human, and possibly the basis for accumulating and maintaining cultural knowledge. Because of their “social conscience”, humans are a species that shows altruism even towards unrelated conspecifics and is able to provide assistance in the event of a conflict. This is also attributed to the ability to mentalize.

In principle, it is not decisive here whether the suspected mental (spiritual) states are actually there. It seems important for the social attitude of the individual to know that the mentalized thoughts are merely representations of reality. For example, it is not crucial whether an object actually poses a danger, but whether someone else believes that it is so in order to be able to foresee how he will act. However, the ability to mentalize correctly offers a clear selection advantage in the sense of Charles Darwin's theory of evolution . The more often a person succeeds in understanding their counterpart, the more likely they will be able to adjust to the respective social environment. Being able to correctly interpret other people's desires, thoughts, and beliefs often makes them more adaptable. Effective mentalization serves

  • " Of orientation and control in every type of interpersonal communication and relationship building
  • of one's own emotion and self-regulation
  • the acquisition of greater emotional and social skills. "( Sic )

The starting point for research on the ability to mentalize was the Theory of Mind (ToM). This cognitive concept researches, among other things, at what point in time children discover that they themselves and others can have distinguishable mental (spiritual) states. This knowledge occurs around the same time in all cultures. For this reason, research assumes that this ability is genetically based. In contrast to mentalization, the theory of mind only describes the knowledge that other people also have mental (spiritual) states.

The mentalization concept of Peter Fonagy and Mary Target and their colleagues differs from theory-of-mind research through its connections with attachment theory and developmental psychology as well as psychoanalysis . Fonagy and Target criticize the Theory of Mind as there are indications of a socialization-dependent development. So z. B. Children who grow up with older siblings are more likely to understand that other people have incorrect beliefs. Knowing about misconceptions in others is seen as a skill which, when acquired, can be referred to as a theory of mind. Fonagy and co-workers assume that the ability to mentalize does not simply come about as a maturation characteristic. They assume that the ability to mentalize has to be developed in the first years of life in exchange with the main reference person.

To this end, the scientists have launched a research program that examines both the development of the basic developmental steps up to the ability to mentalize and the effects of mentalization on an adult. In doing so, they investigated the extent to which disorders in this development can lead to mental disorders.

See also: mentalization-based psychotherapy .

Theoretical foundations

Daniel Dennett
Jerry Fodor

In the past few decades, scientists have asked about the origin of people's ability to see their own mental states in relation to the mental states of other people. These include philosophers like Daniel Dennett or Jerry Fodor, as well as some cognitive developmental psychologists . In the cognitive sciences, the term for this unique human ability is called Theory of Mind , i.e. having a theory of the mental that every person can develop. The term Theory of Mind (ToM) in psychology and the other cognitive sciences describes the ability to make an assumption about consciousness processes in other people, i.e. to suspect feelings, needs, intentions, expectations and opinions in other people.

The philosopher Daniel Dennett saw this ability as an enormous evolutionary adjustment. The ability to understand the actions of others as intentional and mind-controlled makes it possible to foresee the actions of others. By assuming an intention, i.e. an intention, to the action of another person, the behavior becomes predictable. A very simple example of this would be for a person to be angry or sad about the loss of an item. The person would then rather go looking for this item than if they were completely unemotional or indifferent about the loss.

Requirements for developing the ability to mentalize

In particular, Fonagy and Target present the ability to interpret psychological states as a significant social development in human beings. They describe these developing functions as interpersonal interpretation function (IIF). They regard the interpersonal interpretation function as an instrument for processing new experiences. In order to use this function, more complex psychological functions like

  • Regulation of emotions,
  • Attention control and
  • mentalizing skills

work together. In order to actually use the ability to mentalize, according to the researchers, a complex interplay of other psychological functions is required. The development of these functions is mutually dependent. Is z. For example, if the attention control function is not sufficiently developed, a person fails to use the IIF in stressful situations. Negative emotional reactions to the actions of others cannot be traced back to the mental state of the counterpart. In such a situation there is a lack of reflective distance. For example, it is not possible for a person to attribute supposedly hostile behavior on the part of a counterpart to their own actions or statements. There is no reflection on previous causes.

The researchers regard the ability to understand one's own and other people's behavior on the basis of intentional mental states to be the highest expression in the development of the interpersonal interpretation function. A mismatched attachment prevents the development of such an interpersonal interpretation function. In particular, people who suffer from a personality disorder do not have this function.

In order to be able to examine the mentalization ability of adults, the researchers have operationalized this mentalistic interpretation strategy as a "reflection function". This term describes "the ability to plausibly interpret one's own behavior as well as the actions of other people as the result of underlying psychological states."

Developmental Psychology of Mentalization

People are capable of social exchange processes shortly after birth.

Peter Fonagy and Mary Target, and their research group at University College London, have linked these fundamentals to infant psychoanalytic research and academic developmental psychology and attachment theory . They created a theory that describes the development of this understanding of human beings to assume similar mental states in others as in oneself. The pathological undesirable developments in this ability were also brought into connection with early human development.

Fonagy and Target assume that a theory of mind does not simply emerge from a certain age; they assume that this ability first has to be acquired in a sensitive development process that begins in early childhood.

The self as author

According to Peter Fonagy and György Gergely, normal development shows different, early phases in the development of the self and its understanding of its possibilities of being the originator of changes in its physical and social environment. The child must first understand what things it can trigger in its physical environment, before it understands that it can also influence the knowledge of another person. Development becomes more complex with age. Five phases of authorship, which are the basic condition for the ability to mentalize, can be distinguished:

  • the physical level: From birth, the child recognizes what effects it can have on the bodies in the room. It can move things as a creator;
  • the social level: the interaction process between children and their caregivers, which begins from birth, is expressed in early childhood in the understanding that the child can be the originator of social exchange processes;
  • the teleological level: this is where the child begins to understand how he can achieve goals through various possibilities. It can (around eight to nine months old) think about different ways of achieving a goal (getting to a place or moving an object into the correct position). This early form is again a matter of a self-understanding of authorship limited to physical space;
  • the intentional level: This is where an understanding of actions begins, which already understands intentions as the originator. In doing so, both one's own intentions and those of others are recognized. This developmental step takes place in the course of the second year of life;
  • the representational level: Around the age of four, another step in understanding authorship takes place. From this age onwards, children can include in their considerations that there is knowledge about something (e.g. beliefs). So one can say that they can now understand themselves as the originators of representational , i.e. mental states. A typical study of this developmental achievement is the age at which children are able to understand that other people may have incorrect knowledge about something.

In addition, a further development step is significant: From around the age of six, the child is able to organize his memories of his own intentional activities and experiences in a coherent , causal and temporal manner. This means that they have a common understanding of their past experiences. For example, it is able to understand actions that relate to its own past. Fonagy speaks in this context of an autobiographical self .

The child's increasing ability to see himself as the originator shows a clear tendency to perceive mental states in a more differentiated manner. It is a basic requirement to explain social interactions, i.e. to explain yourself and others from the point of view of emotions, desires and convictions of both parties. This process of understanding begins with the child developing concepts about the internal states. For example, it can only think about another person's fear if it has a representation of fear as physiological , cognitive, and behavioral (behavioral) experience. This complex concept is called secondary representation in psychoanalysis (see below).

Bonding as a prerequisite for development

Fonagy and Target see a secure bond between the child and the caregiver as a necessary condition for this development . "We have to start from a dialectical model of the development of the self (...), according to which the child's ability to develop a coherent idea of ​​the psyche depends crucially on the child's feeling of being perceived as psyche by his attachment figure." The attachment theory According to John Bowlby , it is assumed that there is an evolutionary advantage if the child is able to emotionally bond with his parents, who can protect him and are able to respond appropriately. Through the attachment relationship, the child tries to ensure the closeness of the caregiver. The quality of the attachment to the important attachment figures leads to a certain attachment style of the child, which affects the behavior as well as the soul of the person and makes the behavior of the attachment figure predictable for the child. The psychological effects described Bowlby as internal working models , that internal working models . These working models, which include early relationship experiences with the caregiver, are viewed as the basis for people to adapt to their social environment. The effect of early attachment experiences can also be demonstrated in adults. Fonagy and Target start from the assumption of attachment theory that attachment not only has an impact on social behavior, but that certain psychological functions and the perception of relationships are also influenced by the attachment relationship with an early caregiver.

These complex functions do not only develop, as originally described in attachment theory, through the proximity of the caregiver. Rather, both the existing closeness to the attachment person and the processes of exchange in the attachment are relevant.

In order to explain the origin of these complex psychological functions, Fonagy and Target resort to empirical research on babies . They assume that the basic emotions and affects are still undifferentiated in the first months of life.

Affect regulation and self development

Some developmental psychologists assume that infants in the first year of life experience their own affects or emotions as positive or negative states without really being able to assign them. In doing so, they experience the typical physical changes associated with an emotion in a passive and undifferentiated manner. You cannot consciously assign the physical conditions that typically accompany the various emotions. The basic emotions (joy, anger, fear, sadness, disgust and surprise; see also emotion theories ) are experienced without a reflective meaning being ascribed to them. So infants can feel uncomfortable caused by a frightening event. However, they cannot determine that they are "fearful" themselves. Neither do they have the skills to associate fear with a person or event that caused the fearful state.

The child must first develop this ability to distinguish between different emotional states. The research group around Fonagy attaches great importance to the ability to distinguish between emotional states. They believe that this ability is a prerequisite for recognizing one's own for what it is. This, in turn, is the basis for being able to ascribe to other people that they have such mental states.

Affect mirroring

To explain how children develop this ability, Fonagy and Target use the developmental psychological model of affect mirroring developed by the Hungarian György Gergely and the Canadian John Watson. Gergely and Watson describe the affect regulation of infants that arises in interaction with their caregivers. This is also a basis for developing the ability to regulate affects .

Gergely and Watson also assume that infants perceive the physical feelings that accompany their emotions in an undifferentiated and unreflected - vague - manner (primary awareness) . They only become more aware of their own feeling and emotional states through the caregiver's reaction to their expressions of emotions; H. through a corresponding response from the caregiver, which corresponds to the infant's emotional expression. The researchers speak of affect reflection in this context .

This affect mirroring is to be understood as a non-verbal response in facial expressions and voices that corresponds to the infant's emotional state. Parents usually give an exaggerated, strongly accentuated answer. The researchers call these highly accentuated, affective parental responses marking . This behavior seems to be innate in humans and an evolutionary peculiarity. This intuitive behavior is also evident in the cross-cultural baby language that people in many cultures automatically use when addressing infants and toddlers. Parents clearly exaggerate the children's expressions of affect.

mark

According to Gergely and Watson, exaggerating or marking the affects of infants is crucial. Caregivers may experience similar feelings when looking at the emotional expression of their children, but they do not react in the same way in facial expressions and vocalizations or with the expression of “real” feelings as they would in communication with adults or older children. They show a similar but exaggerated (marked) affective facial expression and sound accordingly.

From around the third month of life, children no longer prefer contingent, i.e. exactly the same, movements that they see in the mirror, for example, but prefer strong similarities or overlaps with the leg movements of other babies. From this point on, you show more interest in similarities and no longer in exact correspondences. Gergely and Watson conclude from this that they also develop a willingness to perceive these similarities in their parents or even to expect them.

Beginning of affect regulation

Another significance for the development of the perception of one's own emotional states arises from the fact that the affects of the infants can be changed through this face-to-face interaction , i.e. the facial interplay with their parents. The infant is only able to do this to a very limited extent. In the best case, the caregiver regulates the affective states of the child intuitively and unintentionally by adapting them to the infant's affect expressions and minor variations of these through their own facial expression. The caregiver adapts to the infant's expressions of affect and sequentially weakens or reinforces them in a face-to-face interaction. These individual sequences take place in a time frame of less than a second. This also seems to weaken or intensify the child's affect state accordingly.

In this way, over time, the infant will understand that their caregivers are responding to their own condition. He understands that the caregivers reflect his own condition. The affect shown by the carers is marked, an exaggeration of the child's expression. It is precisely through the exaggeration (marking) that the infant has the opportunity to recognize that his parents “represent” something that does not exactly correspond to his own feelings. But it has so much similarity that the infant can establish a connection between his own affect expression and that of his parents. If the parents were to react to the child's expression as they would to another adult's expression (unmarked) , the infant would be confronted with a real adult emotional state. The marking enables the infant to understand that the caregivers are imitating their own affective state.

Formation of "secondary representative offices"

The researchers refer to the infant's recognition of the reflection as referential decoupling . The infant understands that the state that the caregiver reflects is not real, that is, it does not correspond to the real state of the carer. He understands the expression as a game, as an as-if quality . As a next step, the infant realizes that the expression decoupled from the wearer (the face) relates to him and that it is a reflection of his own affect expression. This process is called referential anchoring by Gergely and Watson .

Biofeedback can be used as an example . In this method, physical conditions or processes (e.g. pulse, blood pressure or swallowing processes) are usually represented in imaging processes. The patient knows that this is a pictorial representation of his own body processes and is not a process on the screen or the apparatus on which these processes are displayed. For example, he can see on a screen how his blood pressure is changing. This enables him to learn that muscle contraction affects his blood pressure. If he can perceive this connection, it is possible for him to consciously regulate his blood pressure, since he becomes aware of a physical process that is otherwise not conscious, but arbitrary.

“So the primary attachment relationship can move from a primary awareness of inner states to a functional awareness. As soon as this has developed, a concept that corresponds to the feeling of anger (not the experience of anger, but the idea of ​​anger) can be used to simulate the corresponding mental state of the other and in this way to develop it. "

In this way the infant learns to understand the marked affect expressions of his caregivers as representations of his own affective expression. In this way he receives a first conscious idea - a picture - of his own condition, which he previously only experienced in an undifferentiated manner.

Then one speaks of the affect that now spiritually-mentally or psychologically represents is. The affect is no longer only vaguely perceived, now a certain thought is assigned to the physical feeling. A spiritual equivalent of the affect has formed, a representation. The affect is therefore not immediately experienced passively with the typical physical phenomena that typically accompany the fundamental emotions; the affect receives a correspondence in the psyche. For this reason, one speaks of secondary representation . The affect or the emotion can now become the object of reflection, which allows the older child or adult to reflect on this emotion, its origin and meaning, and to regulate it. “Emotional self-control only becomes possible when secondary regulatory or control structures have developed through representations”. This resulting representation allows a first conscious perception of one's own condition. It therefore belongs to the rudimentary contents of the understanding of one's own person, which is called the self in psychology . In the further course of development it is possible that the psyche or the spirit itself become the object of reflection. In cognitive psychology, this is known as metacognitions . Fonagy and Target speak of meta-representations. They assume that representations already exist before a verbal ascription is learned, i.e. before language has been learned (name joy as joy ). In addition, it is now possible for infants and toddlers to perceive the affects of others and to simulate them.

Related psychoanalytic models

The theory that the (emotionally healthy) mother stores the negative emotions that the child projects onto her and returns them "detoxified" was already described by Wilfred Bion in the 1960s. Bion speaks of the fact that the mother develops a container function for negative affects towards the child . This process described by Bion also has the effect that affects can be symbolized in the child's psyche. It is very similar to the affect mirroring described above.

Intentionality

Fonagy and Target see it as an important intermediate step in the development of the ability to mentalize that children, at nine to fifteen months old at the earliest , can recognize an intention , i.e. an intention , in the actions of others . This is initially limited to very rudimentary things such as attention or emotions. From this point on you understand that people have an intention with an action. For example, they understand that pointing to an object should draw attention to it. This ability develops over time into very complex ideas about others, such as that a person may have a wrong idea about something.

The “playing with reality” theory

Fonagy and Target complement the affect mirroring theory with the "playing-with-reality" theory . This takes place in a later development phase, from about eighteen months to four years. According to the authors, it has the same status as affect reflection. You investigate the question of what psychic reality is like before it is perceived as psychic, i.e. before the child has an idea of ​​the spiritual-mental.

The researchers assume two different modalities in which feelings and thoughts are experienced and which coexist:

  • the as-if mode (pretend mode) and
  • the mode of psychic equivalence (psychic equivalence mode) .

The as-if mode is understood to mean a state in which reality is suspended, as it were canceled. In this mode, the child can play without fear of the game becoming real (e.g. shooting others). In this way, the child can represent his internal states externally (in the playful as if mode ). The role of the parents during this mode is determined by their understanding of the plot of the game. Through their comments on the play, they can verbally reflect the child's internal states. So you use it to name the child's self-state (“but now you're angry”).

The mode of psychological equivalence is understood to mean a state in which the child experiences his thoughts as actual reality. The thought that a crocodile is under the bed is just as frightening to the child as if one were actually there. The child does not see his thoughts in the equivalence mode separated from reality. Here, too, the parents play a significant role in the child's perception. Here they represent both reality, but at the same time they can mentally take or not take the child's thoughts seriously.

At the end of this development there is the integration of the as-if mode and the equivalent mode . Fonagy and Target call the resulting psychic mode reflective mode . After developing in the as-if and equivalence modes , the child has mostly developed a representational theory of mind. Now he can see that his thoughts and feelings are attitudes towards reality. He realizes that reality is influenced by his thoughts, but does not correspond exactly to it, as in the equivalence mode . Now he is able to play with his thoughts about reality, as he does not have to fear that they will turn into reality. "If the mother is angry with the child now, the child can defend itself against it: My mother believes or thinks I am angry, but I believe and think something else."

Attachment Theory and Mentalization

The attachment theory establishes a connection between the attachment behavior of the child on the one hand and the behavior of his caregivers on the other. She relates this interaction to the later development of the child and also tries to explain the development of a possible psychopathology through this interaction. The observable attachment behavior only describes how the child tries to establish closeness to the caregiver and, when the need for closeness is satisfied , begins to show exploratory behavior. But already John Bowlby , the founder of the attachment theory , suggested that the early attachment could exert a formative influence on the later relationships and mental health. He explained this through inner working models, i.e. the psychological representation of the attachment experience. It turned out that the quality of attachment has an impact on later attitudes towards relationships and this can even affect the mental health of the next generation.

As described above, Fonagy and Target see the development of the ability to mentalize as being closely linked to the child's attachment to his or her caregiver. They use elements from attachment theory for their theoretical concept of the influence of the early relationship with caregivers on the development of affect regulation and the development of mentalization. But they also use research methods from attachment theory to empirically test their assumptions. For example, Fonagy has developed a method for examining the reflection function he describes by evaluating an adult attachment interview with the “Reflective Function Manual” he developed . Here, too, a connection between high reflective function and secure attachment could be established (as in the adult attachment interview). The effects of this on the child's attachment behavior are tested in the strange situation . Fonagy was thus able to demonstrate a connection between the reflective function of the caregiver and the attachment style of the children. It turns out that “the caregiver's awareness of the child's mental states is obviously a significant predictor of the likelihood of secure attachment”.

Fonagy sees a connection between the mentalization ability (reflection function) of the caregiver and the attachment style of the child. Fonagy sees an important reason for developing a secure attachment style that the mother can adopt an intentional attitude towards an as yet unintentional infant, i.e. that she assumes that the infant is acting intentionally, although this has not yet been developed. For example, it was shown that the attachment style of the child at one year could be predicted on the basis of the mentalizing statements made by the mother towards her six-month-old baby. The complex evaluation of the mother's statements included statements that alluded to the child's knowledge, wishes, thoughts, interests, but also emotional engagement and mental processes (“Are you thinking?”). Comments on whether the infants had thoughts about the mother or tried to influence her (“Are you trying to annoy me?”) Were also taken as an indicator of a mentalizing attitude. If these comments were frequent and if they also related to the assumed conditions of the infant, the children were very likely to be securely bound at one year of age. The secure attachment style is considered to be the best possible attachment setting of the child. It was also measured whether the mother's statement about the child probably correctly reflected the child's condition, which was also rated as a high mentalization ability. The mother's ability to mentalize has a great influence on the child's attachment behavior.

Fonagy and his colleagues believe that a secure bond is also to enable the child, his state of excitement ( arousal ) of the central nervous system to keep at an optimal level. Neurophysiological research shows that this is a positive side effect of secure attachment and thus also offers the framework conditions for mentalization to develop. The ability to mentalize requires the ability to leave the predominant physical reality aside and to concentrate on the less compelling reality of an inner state in which the other is. This is guaranteed by a secure binding.

Neuroscience and Mentalization

In addition to the regulation of the state of excitation of the central nervous system, other effects of attachment are also discussed in neuroscience . The right brain hemisphere is dominant in the first three years of life. The attachment relationship has a direct formative influence on this brain hemisphere, which is responsible for feelings and social cognitions. A secure bond could thus contribute to social-emotional behavior and self-regulation.

Fonagy and his colleagues show that several brain regions in adults are involved in social interaction processes, social cognition and mentalization. The responsiveness to communicative facial expressions obviously takes place in the temporal lobes. There, this complex, visual information is identified and processed in the amygdala , i.e. checked for emotional significance. The control needed in social interactions requires constant updating of the interpretation of emotional signals as well as regulation of one's own emotional states and expressions. The orbito-frontal cortex plays an important role here. Functions that are particularly important for social exchange could be located there. These brain areas could be responsible for the process of mentalization.

The function of the prefrontal cortex, in turn, is strongly influenced by the state of excitement ( arousal ). If the excitation of the prefrontal cortex and the brain systems associated with it increases too much, other brain regions are activated and the flexible and reflective reactions of the prefrontal cortex are apparently overlaid by fight-or-flight reactions. People with insecure or disorganized relationships react to social encounters with a high arousal. Even relatively uncomplicated social situations can limit the ability to react reflexively and flexibly - a possible indication that a heightened state of arousal could influence mentalization.

It was possible to locate the regions of the brain that were involved in the solution of typical experiments that are used in theory-of-mind research, as well as regions that could probably enable a representational self . Research into the influence of mirror neurons also suggests an influence on the interpretation of intentional action. However, more precise relationships have not been adequately researched.

The disruption of memory functions , such as those that occur in psychotraumas , can also have a negative effect on the ability to mentalize.

Psychopathology

The researchers assume that deviations in the development processes described can lead to sometimes considerable mental disorders .

The marked reflection of the child's expression of affect by the caregiver leads to the child being able to represent affects , i.e. consciously perceive, assign and reflect. If the caregiver is burdened by their own difficulties and conflicts, they can feel overwhelmed by negative expressions of affect from the infant. She reflects her own feelings to the child or cannot react appropriately at all. Under these circumstances, the mirroring or marking of the affect expression as a feature of mutual relatedness ( interaction ) may be absent.

The caregiver reacts in these circumstances by expressing unlabeled emotions as they would with adults. The infant cannot relate to the emotion shown. He sees his own negative affect expression reflected in the reaction of the caregiver. But the infant cannot understand that it is a reaction to its own expression. He perceives the caregiver's reaction to his own negative affects as their state, not as a reflection. The negative affect of the child is not weakened in the interaction, but even intensified. The infant's emotions can neither be regulated nor represented by him. The result is impairment of self-perception. The child cannot form secondary representations of his emotions and, as a result, cannot control his emotions independently. In this way a psychic experience would be created, which corresponds to the projective identification . The sufferer will often perceive their own emotional states as those of others. For later development, this also means that the inner world is perceived as superreal. Such an interaction behavior means that no regulating distance can be built up to one's own affects. This largely corresponds to the equivalence mode (see above).

Another pathological deviation in this developmental process would be a failure of the mirroring. If the caregiver does not reflect the affects of the child, i.e. if the response reaction does not show the infant's affect, but a completely different one, a “false” self-representation can build up. Although secondary representations are formed, these have no relation to the infant's actual self-state . The result is that the state of one's own self is perceived and represented in a distorted manner. Fonagy and Target combine this process with the concept of the false self of Donald Winnicott . Since the perceived inner self-representations do not correspond to the actual feeling of affect, these individuals often perceive their inner world in a pretend mode (see above).

Trends in the family of origin that do not allow playful development in the phase of the as-if mode and the mode of psychological equivalence can have further effects on this development . Child abuse , in particular, would hardly allow playfulness, since in such an environment every movement of adults can have serious consequences and must therefore always be taken seriously. But also more subtle forms of neglect complicate the important integration of the as-if mode and the mode of psychological equivalence to the reflective mode . The development of the ability to mentalize is hindered to different degrees.

In addition, the inability to regulate one's own affects can also be passed on over generations; there are indications of this in attachment research. The inability to represent affects in the psyche means that they cannot be controlled. The emotional states are always experienced intensely, but cannot be named. Confusion and loss of control are the consequences.

An early, secure attachment to the caregiver allows the child to focus attention on less existential issues than simply securing the attachment to the caregiver. This allows the child to focus attention away from concrete actions and towards interpersonal contact. An insecure attachment can also impair attentiveness.

An insecure bond is closely related to a low, maternal reflective function (i.e. the mother's concrete ability to mentalize). An unsafe-disorganized attachment is very often associated with behavioral problems such as self-harm, aggressive and violent behavior. The mother's poor understanding of the child's psychological situation has an impact on the behavior problems described.

Attachment trauma (sexual abuse, mistreatment, early experiences of loss) are very common in severe mental disorders such as personality disorders . Fonagy and Bateman also suspect in connection with such psychotraumas a persistence in the equivalence mode , i.e. in equating the inner, mental world and reality . In such a case, the individual's ability to understand the destructive behavior of others in their social environment would be very limited. The person affected could only poorly mentalize the destructive acts of others. He can react to this with increased brutality even in close relationships.

reception

The concept of mentalization is a systematic representation of a psychoanalytic- intersubjective theory, which makes many results from neighboring disciplines usable for the psychoanalytic consideration. Fonagy and Target also refer to the psychoanalytic object relationship theory according to Donald Winnicott and Wilfred Bion . Martin Dornes sees points of criticism that the theory applies primarily to severe personality disorders and less to neuroses . She is very cognitive and contributes little to sexual problems. They focus too much on a single mechanism (mentalization) and go too much into early childhood trauma. In doing so, they leave little room for psychological injuries in adolescence and adulthood.

The concept of mentalization led to the development of mentalization-based psychotherapy or the mentalization-based treatment concept (Mentalization Based Treatment MBT) by Peter Fonagy and Anthony W. Bateman . This treatment concept is intended to help patients suffering from severe personality disorders to develop a better understanding of themselves and other people.

Mentalization-based psychotherapy in groups (MBT-G)

Mentalization-based psychotherapy is also used in groups; The Norwegian group analyst Sigmund Karterud has created a manual with 19 interventions (Karterud, 2015a), and developed and validated scales with his research group to measure treatment adherence and competence (Karterud et al., 2013).

Efficacy research on mentalization-based group psychotherapy in German-speaking countries showed high effect sizes (Brand et al., 2016); MBT-G interventions have proven to be helpful as a supplement to psychodynamic group psychotherapy interventions, especially for patients with structural limitations, and are also used in modified form in the treatment of patients from the psychosis spectrum (Schultz-Venrath, Felsberger, 2016).

Intervention programs based on the mentalization concept for children and young people

In addition to mentalization-based psychotherapy, other intervention concepts were developed on the basis of the psychotherapy developed by Fonagy and Bateman:

  • MBFT: Mentalization-Based Family Therapy (Mentalization-Based Family Therapy by Fearon)
  • SMART: Short-term Mentalizing and Relational Therapy (the short-term mentalization and relational therapy also from Fearon)
  • MBT-A (mentalization-based psychotherapy for adolescents by De Viersprong, NL)
  • Peaceful Schools Project (a group project for schools from Twemlow)
  • Adolescent Trauma Educational Group (the concept of mentalization in group treatments for the traumatized by all)
  • Parents First Reflecting Parenting Workshop (a parenting program by Slade)
  • MTB Minding the Baby Project (a program for parents with young children by Sadler)

See also

literature

  • Peter Fonagy, György Gergely, Elliot L Jurist, Mary Target: Affect regulation, mentalization and the development of the self. Klett-Cotta, Stuttgart 2004, ISBN 3-608-94384-6 .
  • Jon G. Allen, Peter Fonagy (Ed.): Mentalization Supported Therapy. The MBT Handbook - Concepts and Practice . Klett-Cotta, Stuttgart 2009, ISBN 978-3-608-94521-8 .
  • Sharone Berger, Elliot Jurist, Arietta Slade (Eds.): Mind to Mind: Infant Research, Neuroscience, and Psychoanalysis: Mentalization, Internalization, and Representation. Other Press, 2008, ISBN 978-1-59051-251-7 . (English)
  • Ulrich Schultz-Venrath: Textbook Mentalizing: Designing Psychotherapies Effectively . Klett-Cotta, Stuttgart 2013, ISBN 978-3-608-94544-7 .

Individual evidence

  1. ^ P. Fonagy, G. Gergely, E. Jurist, M. Target: Affect regulation, mentalization and the development of the self . Klett – Cotta, Stuttgart 2002.
  2. ↑ (PDF) Mentalization in coaching. Pp. 3-4 , accessed on February 21, 2019 .
  3. ↑ Otto F. Kernberg: Love and Aggression: An inseparable relationship . Schattauer, 2018, ISBN 978-3-608-26857-7 ( google.de [accessed on February 21, 2019]).
  4. ↑ AW Bateman, P. Fonagy: Psychotherapy of the borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, p. 124.
  5. ↑ a b c Martin Dornes: The soul of the child. Origin and development. Fischer Taschenbuch Verlag, Frankfurt am Main 2006.
  6. ^ Markus R. Pawelzik: Mentalization-based psychotherapy. ( Memento from August 24, 2009 in the Internet Archive ) (Workshop series “Psychotherapy of Borderline Personality Disorders”) EOS Clinic for Psychotherapy Münster.
  7. ↑ a b c d e f g h i j k l m n A. W. Bateman, P. Fonagy: Psychotherapy of borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008.
  8. ↑ AW Bateman, P. Fonagy: Psychotherapy of the borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, p. 128.
  9. ↑ AW Bateman, P. Fonagy: Psychotherapy of the borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, p. 115.
  10. ↑ As a rule, the scientists of the disciplines involved distinguish between affects as innate and thus already available to the infant to express comfort or discomfort, from emotions , which are understood as more complex and composed of different emotional qualities, and therefore a certain maturity presuppose. See Rainer Krause : General psychodynamic treatment and disease theory. Basics and models . 2nd, completely revised and expanded edition. Kohlhammer, Stuttgart 2012, ISBN 978-3-17-019888-3 .
  11. ^ A b c Peter Fonagy, Mary Target: Reassessing the development of affect regulation against the background of Winnicott's concept of the "false self." In: Psyche-Z Psychoanal. 56, 2002, pp. 839-862.
  12. ↑ a b c d e G. Gergely, J. Watson: The social biofeedback model of parental affect-mirroring. In: International Journal of Psycho-Analysis. 77, 1996, pp. 1181-1212./ The theory of social biofeedback through maternal affect mirroring. Translated by E. Vorspohl. In: Self Psychology. 17/18, pp. 143-194.
  13. ^ G. Gergely, J. Watson: Early social-emotional development: Contingecy perception and the social biofeedback model. In: P. Rachat (Ed.): Early Social Cognition: Understanding Others in the First Months of Life. Erlbaum, Hillsdale, NJ 1999, pp. 101-137.
  14. ^ H. Papoušek, M. Papoušek: Intuitive parenting: a dialectic counterpart to the infant's integrative competence. In: JD Osofsky (Ed.): Handbook of Infant Development. 1987, pp. 189-197.
  15. ↑ M. Papoušek (ed.): Regulatory disorders in early childhood . Huber Verlag, Bern 2004.
  16. ↑ Martin Dornes: The competent infant: The preverbal development of humans . Fischer, Frankfurt am Main 1994.
  17. ↑ AW Bateman, P. Fonagy: Psychotherapy of the borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, p. 119.
  18. ↑ WR Bion: A Theory of Thought. In: EB Spillius (Ed.): Melanie Klein today. Volume 1, Verlag Intern. Psychoanal., Stuttgart 1990, 1962, pp. 225-235.
  19. ↑ P. Fonagy, M. Target, H. Steele: Reflectiv-Functioning Manual, version 5.0, for Application to Adult Attachment Interviews. University College London, London 1998.
  20. ↑ M. Ainsworth, MC Blehar, E. Waters, S. Wall: Patterns of Attachment: A Psychological Study of the Strange Situation . Erlbaum, Hillsdale (NY) 1978.
  21. ↑ AW Bateman, P. Fonagy: Psychotherapy of the borderline personality disorder. A treatment concept based on mentalization. Psychosozialverlag, Giessen 2008, p. 131.
  22. ↑ E. Mains, C. Fernyhough, E. Fradley, M. Tuckey, Rethinking maternal sensitivity: Mothers' comments on infants mental processes predict security of attachment at 12 months. In: Journal of Child Psychology and Psychiatry. 42, 2001, pp. 637-648.
  23. ↑ AN Schore: Effect of a secure attachment relationship on right brain development, affect regulation, and infant mantal health. In: Infant mental health Journal. 22, 2001, pp. 7-66.
  24. ^ JP Allen, P. Fonagy: The development of mentalizing and its role in psychopathology and psychotherapy . (Technical Report No. 02-0048). The Menninger Clinic Research Department Toepeka, KS 2002.
  25. ^ DW Winnicott: Maturation Processes and Supporting Environment. Studies on the theory of emotional development. Psychosozial-Verlag, Giessen 1974, ISBN 3-89806-091-8 . (German new edition: 2002)
  26. ↑ Martin Dornes: The emotional world of the child . Fischer, Frankfurt am Main 2000.
  27. ↑ Sigmund Karterud: mentalization-Based Group Therapy (MBT-G): A Theoretical, Clinical, and Research Manual . Oxford University Press, 2015, ISBN 978-0-19-875374-2 ( google.de [accessed February 20, 2017]).
  28. ↑ Sigmund Karterud, Geir Pedersen, Magnus Engen, Merete Selsbakk Johansen, Paul Niklas Johansson: The MBT Adherence and Competence Scale (MBT-ACS): Development, structure and reliability . In: Psychotherapy Research . tape 23 , no. 6 , November 1, 2013, ISSN  1050-3307 , p. 705-717 , doi : 10.1080 / 10503307.2012.708795 , PMID 22916991 .
  29. ↑ Tanja Brand, Dagmar Hecke, Christian Rietz, Ulrich Schultz-Venrath: Mentalization Based Group Therapy and Psychodynamic Group Psychotherapy in a Randomized Day Clinic Study: Therapy Effects . In: Group Psychotherapy and Group Dynamics . tape 52 , no. 2 , June 1, 2016, ISSN  0017-4947 , p. 156–174 , doi : 10.13109 / grup.2016.52.2.156 ( vr-elibrary.de [accessed on February 20, 2017]).
  30. ^ Ulrich Schultz-Venrath, Helga Felsberger: Mentalizing in groups: Mentalizing in clinics and practices . Klett-Cotta, Stuttgart 2016.
  31. ↑ ( Page no longer available , search in web archives: Mentalization-Based Treatment (MBT) in the cross-setting psychotherapy of BPS Thomas Bolm Clinic for Psychosomatic Medicine and Psychotherapy Specialist Clinic Christophsbad, Göppingen BPS: Child and Adolescent Psychotherapeutic Treatment Approaches ) (PDF file), accessed on August 25, 2009.@1@ 2Template: Dead Link / www.upkbs.ch
This version was added to the list of articles worth reading on February 15, 2009 .