Mentalization, insightfulness, and therapeutic action The importance of mental organization

Continuing debates over the relative importance of the role of interpretation leading to insight versus the relationship with the analyst as contributing to structural change are based on traditional defi nitions of insight as gaining knowledge of unconscious content. This defi nition inevitably privileges verbal interpretation as self‐knowledge becomes equated with understanding the contents of the mind. It is suggested that a way out of this debate is to redefi ne insight as a process, one that is called insightfulness. This term builds on concepts such as mentalization, or theory of mind, and suggests that patients present with diffi culties being able to fully mentalize. Awareness of repudiated content will usually accompany the attainment of insightfulness. But the point of insightfulness is to regain access to inhibited or repudiated mentalization, not to specifi c content, per se. Emphasizing the process of insightfulness integrates the importance of the relationship with the analyst with the facilitation of insightfulness. A variety of interventions help patients gain the capacity to refl ect upon and become aware of the intricate workings of their minds, of which verbal interpretation is only one. For example, often it seems less important to focus on a particular confl ict than to show interest in our patients’ minds. Furthermore, analysands develop insightfulness by becoming interested in and observing our minds in action. Because the mind originates in bodily experience, mental functioning will always fl uctuate between action modes of experiencing and expressing and verbal, symbolic modes. The analyst's role becomes making the patient aware of regressions to action modes, understanding the reasons for doing so, and subordinating this tendency to the verbal, symbolic mode. All mental functions work better and facilitate greater self‐regulation when they work in abstract, symbolic ways. Psychopathology can be understood as failing to develop or losing the symbolic level of organization, either in circumscribed areas or more ubiquitously. And mutative action occurs through helping our patients attain or regain the symbolic level in regard to all mental functions. Such work is best accomplished in the transference. The concept of transference of defense is expanded to all mental structure, so that transference is seen as the interpersonalization of mental structure. That is, patients transfer their mental structure, including their various levels of mentalizing, into the analytic interaction. The analyst observes all levels of the patient's mental functioning and intervenes to raise them to a symbolic one. At times, this will require action interpretations, allowing oneself to be pulled into an enactment with the patient that is then reprocessed at a verbal, symbolic level. Such actions are not corrective emotional experiences but are interpretations and confrontations of the patient's transferred mental organization at a level affectively and cognitively consistent with the level of communication. Nonetheless, the goal becomes raising the communication to a symbolic level as being able to refl ect symbolically on all aspects of one's mind with a minimum of restriction is the greatest guarantee of mental health.     

BUILDING CHARACTER THROUGH SPORTS: MYTH OR POSSIBILITY?

In this article the authors ask whether striving to win in sports is compatible with the belief that participation in sports builds character. In identifying two viewpoints on winning in sports—winning as consequence and winning as experience—the authors suggest ways in which counselors might encourage athletes, coaches, and parents to perceive winning as experience so that participation in sports can foster “character” and build feelings of self-worth.     

A School-Based Multilevel Preventive Intervention: Issues in Program Development and Evaluation

This article describes conceptual, methodological, and practical issues of prevention research generally and specifically relevant to a school-based primary and secondary prevention effort to reduce the prevalence of learning and emotional disorders in primary grade children.     

Career Transitions for Dancers: A Counselor's Perspective

The author describes a counseling program designed to assist professional dancers in making the transition to a postperformance career.     

Licensure in the helping professions: anatomy of an issue

The licensing of psychologists is not generally a concern of counselors, counselor educators, or supervisors. However, with the enactment of new licensing laws such as the one described here, an issue is emerging that members of the counseling professions should not leave unattended. Through ignorance or complacency, we may contribute to the demise of the counseling professions as self-regulating groups. The authors examine this matter here and offer some recommendations for action.