Transcription
Hi, I'm Janice Polac, director of clinical social work at the Menninger Clinic. I'm here today with Dr. John Allen to talk about mentalizing. Dr. Allen is a senior psychologist at the Menninger Clinic and professor of Psychiatry at the Baylor College of Medicine. Dr. Allen has lectured and written extensively on the subject of mentalizing. Thank you so much for being here.
Happy to be here. Appreciate it. And I have a lot of questions about mentalizing.
Okay. Mentalizing actually seems like a new word. What, what does it mean?
Well, it's interestingly actually, it's two centuries old, the word, but it's a rare word, so lots of people haven't heard of it. No wonder you're asking about it. Basically, mentalizing refers to being aware of what's going on inside yourself and other people. Being aware of your thoughts and feelings and the thoughts and feelings, uh, that other people have. And it's a little confusing because it sounds like a technical, esoteric thing, mentalizing. But basically, it's something that we all do naturally, except, uh, we don't all always do it so well. And of course, with psychiatric disorders, uh, they really get in the way of mentalizing. That's why we pay so much attention to it.
Well, it sounds like it might be quite a bit like mindfulness.
Well, it is a lot like mindfulness. The way I think of it is that, uh, really, you have to start with mindfulness if you're going to mentalize. And mindfulness means you're being attentive to something. So you could be attentive to paying attention to a flower or paying attention to your breath. But when you think of mindfulness being mindfulness of what's going on in your mind or someone else's mind, then you're in the territory of mentalizing.
But it's more than just paying attention to what's yourself or inside someone else. So, for example, if suddenly we're sitting here filming and I bolt out of this chair and run out of the room, what would you, what would go on in your mind?
Well, I think first I'd be concerned about what's going on with you. And then I would probably try to figure out what it is, um, something that's happened, right? So that gets to the mentalizing piece. First, you're aware of what's going on, and then you're trying to understand it, come up with some kind of explanation or some story about it.
So, what, what do you think the story? What would you create? What would be the story?
Maybe you had gotten ill suddenly or something like that.
Yeah, or panicky or something like that. So that's the mentalizing piece. Let me give you another example. So what if you're sitting there interviewing me, your heart starts racing?
What would go on in your mind?
Well, I would wonder why. Why all of a sudden am I nervous? Might be these cameras here.
Yeah. Okay. So you'd be mindful in the sense of paying attention to your heart, maybe starting to think, what, what are you feeling? And then what the reasons for your feeling. So that puts mindfulness and mentalizing together.
Well, how is that different than empathy?
Well, again, it's quite similar. If you think about empathy refers to being aware of, uh, what somebody's feeling and concerned about it, compassionate about it, or even more broadly, empathy means you kind of put yourself in their shoes. So you have a sense of what's going on in their mind. So what I like to say if patients are confused about what mentalizing means, I think think about empathy, but also include empathy for yourself. And why I like the idea of mindfulness is that it implies that while you're trying to pay attention, be aware, and understand, you have this kind of non-judgmental attitude, curious about what's going on inside yourself and others.
But why would this be important?
Well, a couple of reasons. First, mainly in order to have relationships go well, we need to mentalize. We need to have some sense of what's going on in the other person and ourselves. And we're really interested in relationships that can provide a sense of security and comfort in the face of distress. Since we're working with people who are in major distress, so we think about secure attachment relationships where you're really connected to the other person because in order to have that feeling of connection and security, really, you have to have a sense that this other person is attentive to you and has some understanding of, uh, you know, what you're distressed about. The other thing about mentalizing is it does include this empathy for yourself, self-awareness. So in order to be aware, self-aware, we need to mentalize. And if we come back to relationships, you need to be self-aware and be able to mentalize in order to communicate with the other person what is going on with you, what you need, what you know, what you're troubled about, so that they can mentalize and understand.
So what gets in the way of mentalizing?
Well, most obviously strong feelings. So, for example, if you're afraid, you're not going to be so curious and interested about what's going on in the other person. You're going to really think about protecting yourself. So you kind of get, get concerned with your own welfare and, and shut down mentalizing. Or anger would be another thing. When you're angry, you tend to blame somebody for something rather than trying to understand it. Or shame is another big one. It's very hard to mentalize when you're feeling ashamed. You want to hide and hide from yourself. Interestingly, romantic infatuation is another thing that gets in the way of mentalizing. You may miss red flags, you know, not pay attention to things, uh, because you're so infatuated. So the first answer is strong feelings. But the other thing is defensiveness. See, we encourage people to mentalize, but there's a lot often that we don't want to know. We may not want to think about what's going on with us or be aware of some of the needs or feelings or fantasies that we have. And we may not want to know what's going on in the other person's mind if we're, you know, fearful that they're not so keen on us. You know, we'd rather not know. Uh, it's a rather scary idea to imagine that we could be aware of what everybody thinks about everything. There's plenty that we don't want to know.
That would be true.
Well, how can families use mentalizing to support other family members who may be struggling with psychiatric disorders?
Well, if we start with the idea of understanding that to understand another person requires with what we call mentalizing. And actually understanding a family member with a psychiatric disorder is no small task. These can be very confusing. I mean, if you think about like self-destructive behavior, think about, well, why would somebody keep doing something that is so obviously self-damaging? It just doesn't make sense on the face of it. So I mean, this is why we need the professional understanding of these problems, really, to help us mentalize. So education actually is extremely important in, uh, helping us to mentalize about these problems. And ditto for the patient. I mean, he or she really has to be able to understand himself or herself, uh, you know, what these struggles are about. Patients are often extremely confused about why they feel the way they do, why they're so depressed, why they're so fearful. So that requires mentalizing. But this is a two-way street because, you know, we emphasize that family members need to mentalize, understand the patient. The patient also really needs to understand the impact of their behavior and problems on their family members so that they can relate to each other. It's, it's a mutual process, mentalizing.
Well, one more question, and that would be, what do you think is the most important thing to keep in mind or to know about mentalizing?
A couple of thoughts about it. One is, uh, we're often asked by patients, okay, they're at Menninger, and we're interested in mentalizing, and we have groups where we talk about mentalizing. So they say, okay, well, now I'm trying to mentalize, you got me doing it. How do I get my spouse to do it? Very important question. Well, our answer is, mentalize. Now, let me tell you what that's about. We know that the way to encourage somebody else to mentalize is to be mentalizing yourself. We know it from developmental research. Children learn to mentalize by being mentalized. So when someone takes an interest, empathic, mindful, curious interest in what's going on with you, that helps you mentalize. So if you're in the middle of an argument, very difficult to mentalize in that state. But if somebody can get into what we call the mentalizing stance, "Hey, what's going on with us? How did we wind up here?" or, "You know, when I said this, what, what were you thinking?" It kind of shifts the conversation into a more reflective conversation where it's possible to sort out what's, uh, happening. So you're promoting mentalizing. So I would say the most important thing is this idea of a mentalizing stance, where you're in a relationship, you're curious, open-minded, non-judgmental, just interested in what's going on inside you and the other person. If we could all do that more consistently, this would be an easier world to live in. But again, the reason we're so occupied with this is that psychiatric disorders, depression, anxiety, substance abuse, get in the way of it. And then we need to really pay more attention to it and even have a word for it.
Well, thank you so much. This has been a wonderful discussion, and we appreciate it very much.
Dr. Allen.
Yeah, my pleasure. Thank you.