Mentalization promotion and affect mobilization in clinical work

Abstract

The author presents a model of clinical intervention based on patients’ mentalization, or mind reading, that is, the function of the mind to understand the mind. The action of mind reading means a type of thought, mostly not conscious, implicit, often not even encoded in words, that expresses the meaning “I think that you think that I think.” Thoughts about the analyst’s states of mind crowd the minds of patients, taking shape in these questions: “What do you think I have in mind?” and so “How do you plan to act towards me?” If the analyst does not capture and does not disambiguate the doubts, the patient’s perplexity and insecurity can intensify and produce emotions of anxiety, fear, fright, but also anger towards a silent interlocutor. Conversely, the analyst who mentalizes the state of mind of the patient and verbalizes it heteroregulates the patient’s fears and anxiety level. Mentalization and affect regulation are also related to the analyst’s recognition of the patient’s metacognition process. At the conclusion of the theoretical section, a clinical sketch shows examples, and highlights in therapeutic work the abovementioned theoretical issues.

Key words:

• mentalization
• metacognitive competence
• social referencing
• mind reading
• states of mind
• affects

Notes

1 In the broad panorama of studies on the theory of mind (ToM), even if mentalization implies metacognitive skills, metacognition and mentalization are not synonymous and, although they are partly similar, they show different nuances (Allen, Fonagy, & Bateman, 2008). Besides that, mentalization is not a univocal concept and, except for the common reference to social referencing, distinct meanings rise up in the literature (Jurist, Slade, & Bergner, 2008), as, for example, is detectable between Fonagy (Allen et al., 2008; Fonagy, Gergely, Jurist, & Target, 2002) and Baron-Cohen (2000; Baron-Cohen, Tager-Fluxberg, & Cohen, 2007; Golan, Baron-Cohen, Hill, & Rutherford, 2007), two emerging names about the research on ToM and its mechanisms (the theory of mind mechanism, ToMM, according to Baron-Cohen’s acronym).

2 Here, starting from a clinical observatory related to the mentalization that the patient directs towards the therapist, the central point of the present speech will necessarily be focused on the attention to the patient’s mental states towards the analyst, even if this function also affects the analyst. In fact the mentalization of both one’s own status and that of others, that is, both subjectively and interpersonally oriented, is always necessarily intersubjective.

3 Patterns of affect self-regulation and co-regulation are related to the main issue of affect regulation. Such a preeminent topic characterizes emotion-focused therapy (Greenberg & Safran, 1989), an orientation whose emotion-centered approach, in my view, falls, however, more into a training technique or therapeutic intervention based on “standard” procedures than into a therapeutic approach.

4 Therefore, knowing, recognizing, and focusing on the emotional context in the here-and-now of the session (Hill, 2015; Wilkinson, 2010) allows the psychoanalyst to include among the objectives of clinical action the devices useful to achieve a higher emotional competence of the patient and to extend their range of resilience (Tronick, 2006).

5 The experiment, conducted on a sample of one-year-old children, consists in making the child walk or crawl across a floor that along the way presents a visual discontinuity, that is, a “false cliff.” On the other side of the “cliff” there is the mother; the child looks at the mother, “using” the expression on the mother’s face to disambiguate the situation in order to regulate their own behavior. Depending on whether the mother’s face expresses joy, encouragement, fear, or anger, the child crosses the cliff or stops. The results show that children make greater use of facial expressions in contexts of uncertainty. Operationally, the sequence can be summarized as follows: the child communicates a state of mind using bodily signals (a range of emotions and experiences that can range from perplexity to indecision, fear, etc.); the mother captures the child’s state of mind and communicates, with the same code, her own state of mind of trust and security; and the child “understands” the mother’s state of mind and includes it in their own state of mind, with the effect of expanding their own state, thus achieving a capacity for self-regulation that is new and superior to the previous state (see also Sander, 2002).

6 In this perspective, it could be useful to revisit the concept of the therapeutic alliance: a definition of classical psychoanalysis that is influenced by a rational matrix. Starting from a more actualized reading, we could translate in more interactive and emotional terms what the concept of “secure attachment” proposes.

7 Let us suggest that, in clinical work, “secure attachment” or “epistemic trust,” or security, or recognition, etc., are different ways to conceptualize with “vocabulary” that is more relational, emotional, and affective, the Freudian and traditional concept of “therapeutic alliance” or “working alliance” (Breuer & Freud, 1895; Freud, 1912 ; Greenson, 1965; Sterba, 1934; Zetzel, 1956, 1958).

Additional information

Notes on contributors

Daniela de Robertis

Daniela De Robertis is philosopher and psychotherapist. She is a training and supervising analyst at the Società Italiana di Psicoanalisi della Relazione (SIPRe). She is a professor of Freudian theory and epistemology at the institutes of Rome, Milan, and Parma; a member of the International Federation of Psychoanalytic Societies (IFPS); a member of the Referee’s Committee of the journal Psicoterapia e Scienze Umane; and the author of numerous articles on psychoanalytic epistemology, psychoanalytic theory, and practical psychoanalysis.