The Mentalization-Focused Approach to Self Pathology

Abstract

Our approach to understanding self pathology in personality disorder assumes that the capacity to mentalize, that is, the capacity to conceive of mental states as explanations of behavior in oneself and in others, is a key determinant of self-organization. Along with contributory capacities of affect regulation and attention control mechanisms, the capacity for mentalization is acquired in the context of early attachment relationships. Disturbances of attachment relationships will therefore disrupt the normal emergence of these key social-cognitive capacities and create profound vulnerabilities in the context of social relationships. Ours is fundamentally a psychoanalytic approach but we have elaborated our model of social development on the basis of empirical observations as well as clinical work. We define mentalization as a form of mostly preconscious imaginative mental activity, namely, perceiving and interpreting human behavior in terms of intentional mental states (e.g., needs, desires, feelings, beliefs, goals, purposes, and reasons). Mentalizing is imaginative because we have to imagine what other people might be thinking or feeling; an important indicator of high quality of mentalization is the awareness that we cannot know absolutely what is in someone else’s mind. We suggest that a similar kind of imaginative leap is required to understand one’s own mental experience, particularly in relation to emotionally charged issues. In order to conceive of others as having a mind, the individual needs a symbolic representational system for mental states and also must be able to selectively activate states of mind in line with particular intentions, which requires attentional control.