Failure to Mentalize Self and Masochistic Functioning

Mentalization includes the ability to apprehend and reflect upon one's subjective state, as well as an appreciation of one's agency (Fonagy & Target, 2006 Fonagy, P. and Target, M. 2006. The mentalization-focused approach to self pathology. Journal of Personality Disorders, 20(6): 544–576. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Masochism is a character pattern that is traditionally defined as pleasure in pain or suffering (Million, 1996 Million, T. M. 1996. Disorders of personality: DSM-IV and beyond , 2nd, New York: John Wiley and Sons.  [Google Scholar]). In some cases the etiology of this character pattern may mirror failures on the part of the caregiving surround that contribute to deficits in the ability to mentalize self (Fonagy, Gergely, & Target, 2007 Fonagy, P., Gergely, G. and Target, M. 2007. The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology and Psychiatry, 48(3/4): 288–328. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Benjamin, 1988 Benjamin, J. 1988. The bonds of love: Psychoanalysis, feminism, and the problem of domination, New York: Pantheon Books.  [Google Scholar]). When this occurs masochism may be more profitably understood as an inability to register pain, rather than pleasure in pain. A case example demonstrates that when a deficit in mentalization underlies masochistic functioning, treatment may include interventions aimed at helping the patient improve the ability to reflect upon his or her mental state, especially negative affect such as pain and anger, and connect to a sense of agency.     

Failure to Mentalize: Defect or Defense?

ABSTRACT

The author reviews current thinking on the phenomena of failure to mentalize and provides an alternative to the structural defect point of view. Also included are some clinical implications of this alternative viewpoint.     

The design of the MBT‐G adherence and quality scale

Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization‐based Group Therapy Adherence and Quality Scale (MBT‐G‐AQS), which is a 19‐item scale developed to measure adherence and quality in mentalization‐based group therapy (MBT‐G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long‐term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G‐study and D‐study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26–0.86) for adherence, and 0.62 (item range 0.26–0.83) for quality. The reliability for two raters obtained mean absolute G‐coefficients on 0.71 (item range 0.41–0.92 for the different items) for adherence and 0.76 (item range 0.42–0.91) for quality. With all five raters the mean absolute G‐coefficient for adherence was 0.86 (item range 0.63–0.97) and 0.88 for quality (item range 0.64–0.96). The study demonstrates high reliability of ratings of MBT‐G‐AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT‐G‐AQS can be used for training, supervision and psychotherapy research.     

Mentalizing Family Violence Part 2: Techniques and Interventions

This is the second of two companion papers that provide an overview of mentalization‐based concepts and techniques when working with the seeming “mindlessness” of intra‐family violence. The focus of this paper is on general mentalization‐oriented approaches and specific interventions that aim to (1) disrupt the non‐mentalizing cycles that can generate intra‐family violence and (2) encourage the emergence of patterns of family interactions that provide the foundation for non‐violent alternatives. Various playful exercises and activities are described, including the taking of “mental state snapshots” and “selfies” in sessions and staging inverted role‐plays, as well as using theatrical masks and creating body–mind maps and scans. These can make “chronic” relationship issues come alive in session and permit “here and now” experiences that generate a safe context for mentalizing to take place. At the core of the work is the continuous focus on integrating experience and reflection. Without acute awareness of the thoughts and feelings occurring in the sessions, mere reflection is not likely to enable change. By increasing mentalizing in the family system, family members’ trusting attitudes grow, both within and outside the family.     

Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm

Parental reflective functioning represents the capacity of a parent to think about their own and their child's mental states and how these mental states may influence behavior. Here we examined whether this capacity as measured by the Parental Reflective Functioning Questionnaire relates to tolerance of infant distress by asking mothers (N = 21) to soothe a life-like baby simulator (BSIM) that was inconsolable, crying for a fixed time period unless the mother chose to stop the interaction. Increasing maternal interest and curiosity in their child's mental states, a key feature of parental reflective functioning, was associated with longer persistence times with the BSIM. Importantly, on a non-parent distress tolerance task, parental reflective functioning was not related to persistence times. These findings suggest that parental reflective functioning may be related to tolerance of infant distress, but not distress tolerance more generally, and thus may reflect specificity to persistence behaviors in parenting contexts.     

Mentalizing Family Violence Part 1: Conceptual Framework

This is the first of two companion papers describing concepts and techniques of a mentalization‐based approach to understanding and managing family violence. We review evidence that attachment difficulties, sudden high levels of arousal, and poor affect control contribute to a loss of mentalizing capacity, which, in turn, undermines social learning and can favor the transgenerational transmission of violent interaction patterns. It is suggested that physically violent acts are only possible if mentalizing is temporarily inhibited or decoupled. However, being mentalized in the context of attachment relationships in the family generates epistemic trust within the family unit and reduces the likelihood of family violence. The implications of this framework for therapeutic work with families are discussed.     

Période périnatale et Rorschach : normes,indicateurs, mentalisation et perspectives théorico-cliniques

ObjectiveThe perinatal period is a maturation phase characterised by the appearance of a radical psychological and identity crisis, little studied by projective methods, in particular the Rorschach inkblot test. The objective of this article is to offer a list of Rorschach norms and indicators adapted to the perinatal population. This is to comprehend the psychological modifications occurring during pregnancy.Materials and methodThe projective Rorschach inkblot test was presented to a representative sample of 54 pregnant primiparous French women. Based on the scoring and analysis methods of the Parisian School, the quantitative norms from the analysis of the psychogram, the chosen cards, and the mentalization indicators were compared to those of the general population.ResultsWith the exception of F +% and H%, all the normative data for the perinatal population are significantly different from those related to the general population (p .005). On a qualitative level, the interpretation of the data highlights the presence of major inhibition mechanisms, associated with a preconscious functioning stasis.ConclusionThe normative data in Rorschach of the perinatal population should be specifically used for the study and psychological support devoted to this population. It also allows a better understanding of the feminine psychologic modifications during pregnancy.     

Children's and adolescents' narratives of guilt: Antecedents and mentalization

In this study, situational antecedents and mentalization of guilt were examined by asking children and adolescents for written narratives. The sample of 240 participants, aged between 9 years and 15 years 6 months, was divided into two groups of 120 children (M = 9 years and 7 months; SD = 0.4) and 120 adolescents (M = 14 years and 7 months; SD = 0.4). Participants displayed typical development, were recruited at schools in Milan city, and came from middle-class backgrounds. There was an equal number of males and females in each of the two age groups. Both content analysis for antecedents and mental states language analysis for mentalization were applied to the texts. We found that the distribution of guilt antecedents varied as a function of age, and only in the adolescent group as a function of gender. We also found that the use of mental states language varied very significantly with age, but not with gender. The results support the idea that in the transition from childhood to adolescence antecedents shift their focus from externalizing behaviours to internal thoughts and intentions; in addition, a more advanced ability to represent and reflect on the experience of feeling guilty is acquired.     

The mediation effect of mentalization in the relationship between attachment and aggression on the road

Studies regarding aggression on the road are getting more frequent, due to the close relationship of these variables with risky behaviour and crash-related events. Whereas most of research has focused on both contextual and personality (proximal) variables, the current research aimed to explore the relationship between attachment styles (distal variables) and aggressive behaviour on the road, hypothesizing the mediation effect of mentalization. Then, a sample of 469 drivers (M_age = 35.60, SD_age = 12.38; 66.1% female) taken from the general Spanish population completed a set of measures about their attachment styles (secure, anxious, avoidant, and disorganized), mentalization (alexithymia, mindful attention, empathy, and emotion recognition), and aggressive behaviour on the road (verbal, physical, vehicle-use related, displaced, and adaptive aggression). The results showed that driving aggression variables were significantly associated with self-sufficiency attachment style, as well as with empathy, alexithymia, and mindful attention. A further SEM analysis suggested that mentalization did not mediate in the relationship between self-sufficiency and driving aggression, but significant indirect effects were obtained in the case of the association between preoccupation attachment style and each one of the ways of aggression. Clinical implications of the results are discussed, in terms of the possible effectiveness of mentalization-based therapies to reduce aggression on the road, especially those which refer to alexithymia and mindful attention.     

Mentalizing in Parents after Traumatic Loss. Analysis of Couple Counseling

Abstract

The aim of the study is to explore whether bereaved parents’ capacity to mentalize is related to their progression through grieving and how it changes during couple therapy. The clients’ RF levels were assessed using the Reflective Functioning Scale and Psychotherapy Reflective Functioning Scale Manual. The content of the sessions was analyzed using Thematic Analysis. At the beginning of the therapy, concrete images of the child’s death were more frequent and the parents’ RF was lower than their general RF level. As the therapy progressed these images were gradually supplanted by more mental references to the deceased child.