Dr. Owen Muir is one of a handful of official MBT supervisors in North America in mentalization.
He's also the co-editor of Adolescent Suicide and Self Injury: a Mentalization-Based Treatment Approach. This article is a lesson, more or less.
I am a medical doctor, and I went to med school to learn how to use medicines because I thought, wow, this is going to be great. I'm going to fix all my patients’ problems. And it turned out… not to be the case.
When mentalization-based treatment came into my life, I realized I had this whole other realm of tools in really specific psychotherapies that weren't being broadly utilized in the U. S. I thought, “I guess I'm going to have to get good at this because no one else seems to be doing it.”
My favorite teacher in medical school, Jeffrey Lyness, taught us, when you lecture:
“tell them what you're going to tell them,
Tell them,
and then tell them what you told them.”
The first thing we will do is define a very wonky word: mentalization.
We have to define it in a couple of different ways. The nice thing about it is no one has any idea what you're talking about when you use the word.
This is freeing! We're going to learn a bit about the basis of attachment. This theoretical construct allows the process of considering minds a.k.a. mentalizing to take place.
Mentalizing is fundamental to being human: We are trying to work out what's going on in the minds of ourselves, and others. That's the beginning of the process of mentalizing. It begins at an early age, before we have any language.
Mentalizing is about alternative perspectives. Thus, I can skate—on being so anti-concise— giving you “multiple definitions” because the process is the message.
One definition is
“seeing yourself from the outside, as others might see you, and seeing someone else from the inside, as they see themselves.”
Another might be:
“Understanding a misunderstanding.”
Humans are, at our best, working out how we could have gotten that wrong. Imagine calling your date after you feel you were stood up!
“Oh, you were at the other Starbucks on 3rd Avenue!”
“Neither of us stood each other up, and we were both very upset that we got stood up. Because there are two Starbucks on this block, not the “only one” we had assumed!”
The ability to hold the mind in mind and recognize what's going on inside it?
This is mentalizing.
This ability—to consider minds—comes from attachment1. I have twin children, Trent and Quinn. They learned much about minds from interacting with each other—before they could even talk. Let’s dive down the developmental psychology rabbit hole.
Attachment Theory is based on John Bowlby's work from the 1960s—its scientific exploration was enabled by the invention of the video camera. Video cameras allowed science to be performed on recordings of human interaction—they could be measured, not just recalled and described.
This is what a baby does when a mother doesn’t respond with their face (spoiler—the baby freaks):
Mary Ainsworth did studies using the strange situation paradigm:
When we're talking about attachment, we're talking about something that we can see as early as one-years-old— before children represent their experience with language.
How kids are observed to relate to their caregivers at a young age has predictive power for how they will react later in life, even into their 30s.
Attachment style predicts responses when close relationships are hurt, separated, or perceive a threat.
People can freak out when they think something's going wrong with a close relationship. Even the idea that they might be abandoned can be devastating for some.
To have a secure attachment develop in your child, you only have to get it sorta right. You have to understand their emotional state about 30% of the time. That's good enough. Perfect understanding of your child's state? That would be bad— there'd be no misunderstandings to work out!
Secure Attachment
Imagine you're looking at it at your young kid, and your kid is crying, and say, “Oh, what's wrong?” And you do it with a sad face and tone.
This is mirroring. It’s the same emotional state reflected back to the child. That's called contingent mirroring. Suppose you use a sad voice and make a sad face—how sad should it be? A parent often uses exaggerated words and putting them with an exaggerated facial expression that mirrors the child. This is metabolism of feelings, and re-presenting them. We call this slight exaggeration “marking.”
If the feelings are “not metabolized well,” this can look like a frantic patent, crying and screaming: “Why are you crying? What is wrong?” That's also contingent. You're both sad, kid and parent.
However, in the above moment, no emphasis lets the child know there's a different mind interpreting their mind. This “emotional metabolism”—Marked and Contingent Mirroring— acts for learning how to feel like spacing and punctuation do for deriving meaning from letters. It takes what would be a mess and gives it structure and organization.
This structure makes it useful for communication— mentalizing develops that is able to help humans manage feelings. Absent Marking of a child's experience—taught by example using contingent mirroring which has to be (just enough) imperfectly marked and imperfectly contingent— problems can arise. Through a little bit of error, but not too much, we learn to punctuate our own emotions. I’ll prove it to you by just taking the paragraph you just read, and eliminating all the formatting:
Butthere snoemphasisth a tletsthec hildkno. wtheresadifferentmi. ndinterpreting. the. irmindThis emo. tionalm. etabolis. mactsaspu. nctuati ondoes. forla nguage. It takes. whatwouldbeamess andgivesittheki. ndofs. tructureandorga. nizatio. nthatmak. es
…you get the point.
What Does Anxious Attachment Look Like?
In the strange situation, Mary Ainsworth had the mother leave the room while she kept a stranger there.
Next, Mom comes back.
What do we see—on video—among kids with insecure attachments? Different behavior is there, but they share the same underlying physiology. All the kids—one-year-olds in the experiment on videos—have their heart rates going through the roof.
How they acted is very different — you might not even be able to tell they're in distress, visually. In anxious attachment, the child goes back to the caregiver and hugs and just never lets go. These kids can't be consoled enough.
Avoidant Attachment
In avoidant attachment, the caregiver comes back in the room— the child seems to be uninterested in the mom's return — but the child’s heart rate is through the roof if we measure it.
Separation and reunion have the same underlying physiology. The attachment style predicted behavior that is quite different.
At some point, in avoidant kids, the child learned— ”I'm getting nothing from this caregiver either way! Why bother going for them to get support?”
Disorganized Attachment
Disorganized attachment, which I clumsily try to illustrate with weird typos about spacing above, develops when children have no predictability in what kind of response they will get from their caregiver.
It’s like removing the punctuation and spacing! This is a reason why depressed mothers have worse outcomes when raising children.
The attachment style developed early does persist over time. This is more than “a problem”—it’s an adaptation. What kind of social information was it adaptive to learn for a person to learn early in life? The attachment system is the emotional editor that teaches us how to punctuate our experience appropriately.
The Role of Mistrust in Mentalizing: A Contrast.
How long does it take to learn math?
That's right, all the years.
And how long does it take to learn to trust Mom when she says: “don't go with the bad man in the free candy van?”
Generally, instantaneous!
Is free candy something that would be normative in the context in which it was offered? If yes, well, I’ll have a Twizzler, thank you! Individually wrapped? You shouldn’t have!
If No?
Stay away from those vans.
The system by which humans learn an unbelievably complex trust discrimination task? It has to work! Mistrust keeps is from dying on the single mistake on the 7000th “emotional captcha” of our lives?—imagine the task was to select the “crosswalk”— but it was all traffic lights! And if you get it wrong? Instant death.
These are the stakes the Attachment system lets us navigate, and it uses early experience to calibrate its response to your likely environment.
We do that by having a system that lets us understand certain information as immediately relevant to the self. This system—which we call “trust” on a casual basis— can be used against us too.
In situations of chronic mistrust —like Orwell's 1984— the government intentionally created an environment where people couldn't trust the information they were getting. Thank god —this has never happened in our modern world. It is just a story. By the way, I have a quick math question for you, dear readers. What is two plus two…?
what's the answer?
Wrong!
What's the answer?
Four?
Wrong!
What's the answer?
Five.
Wrong.
What's the answer?
…Four?
It's four! Of course, it’s four. Everything is going to be fine. Did the bad question-asking newsletter writer man scare you? What's wrong?
That inability to predict, in the same way as the above text did, as you just experienced, what's going be the answer— when we really all know what it is—can generate tremendous mistrust. Learning to mistrust our very experiences—it’s adaptive in some contexts, and horrid in others.
That's the message a lot of kids are getting early in life from disorganized attachment relationships that lack the “marked contingent mirroring” they need. The message they get this crook in my house someone I should be trusting? My mom sure seems to be close with them.
That creates confusion about what to trust or who to trust. Awareness of trust is is why I write this newsletter the way I do. It is why I use humor. It’s why I am silly sometimes. It is why I write daily. When bringing in new information like this article right now to you… I want to be a trusted source if possible. I think about your minds, as readers, a lot. Every day. I write all the time…and when I do, I’m imagining minds.
I hope I'm a trusted source today. I seem to be passionate about this and all that. It makes it easier for people to believe me. I want to create change in your life! And thusly, use it in a way that's useful to you.
The only goal of mentalization-based treatment? We take these ideas about attachment—it is learned by relentlessly correcting little misunderstandings.
We turn those “understanding misunderstandings” into treatment.
Luckily, it's simple, and this is why I loved learning MBT. If someone's not mentalizing? Get them mentalizing . Understanding the misunderstandings— and working out what's in someone's mind? Sounds pretty good!
And if they are mentalizing, you keep them mentalizing. That's it! There are no insights. There are no skills (other than being curious).
Stay tuned for part II!
The word “attachment” has been misunderstood.
Attachment parenting is very much not what attachment theory is about.
Thanks for the very informative and fun article! I don't know much about mentalization or the attachment theory, so far I only listened to some interviews and lectures by Peter Fonagy and Anthony Bateman, and what I heard got me really interested in those. I can't wait to learn more!