Written by Cathi Spooner, LCSW, RPT-S

Image by 460273 from Pixabay 

 

What is mentalization? What is its relationship with co-regulation between caregivers and their children? This blog article focuses on understanding the connection between the concept of mentalization and its connection to attachment and co-regulation for children, youth, and families. As mental health professionals working with children, youth, and families, we have an opportunity to give our young clients and their families a gift that “gives” through the generations by helping them to identify the stories activating shame and emotion dysregulation. So, here we go – what is mentalization and why is it so important to understand when we’re discussing co-regulation?

As mental health professionals working with children, youth, and families, we have an opportunity to give our young clients and their families a gift that “gives” through the generations by helping them to identify the stories activating shame and emotion dysregulation.

First, I’m going to “nerd out” a little about one of my favorite authors researching authenticity and shame resiliency – Dr. Brene Brown. She is the author of several best-selling books including Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead (Brown, 2012). As a modern-day guru for understanding shame and developing shame resiliency, she often refers to the “stories” we tell ourselves about self, others, and relationships. It’s my belief that these stories have their roots in the mentalization process, which influences our ability to effectively regulate our emotions. Think about it – if the stories in my head are predominately shame-based, then my ability to tolerate my emotional distress will be hampered because my “alarm systems” will be activated as if to say “bad things are going to happen to you because you’re ‘bad’.” Check out her TedTalk here: Listening to Shame. You will be so glad that you watched it. Then come right back and read the rest of this article or watch is right after reading this article!

 

What is mentalization?

Mentalization (also referred to as reflective functioning) is a concept developed by Fonagy and his colleagues (Fonagy, Steele, Steele, Moran, and Higgitt, 1991) to understand the way in which humans make sense of themselves, others, and relationships. It’s heavily influenced by our attachment relationships. I view the concept of mentalization as similar to Bowlby’s internal working models (Marrone, 2014) in that our primary attachment relationships lay the foundation for the understanding of ourselves, others, and relationships and how to navigate a complex social world. (See my previous blog posts for more information about the role of mentalization in our conceptualization of self, others, and relationships and more information about emotion regulation and co-regulation.) According to Falkenstrom, Solbakken, Moller, Lech, Sandell, and Holmqvist (2014), “the concept of mentalization is defined as the capacity to understand human behavior in terms of underlying mental states; that is, thoughts, feelings, wishes, needs, and so forth” (p. 27).

 

How is mentalization connected to attachment?

Mentalization develops and changes over time beginning with our earliest caregiver-infant experiences. Children develop an understanding of themselves through their perceptions and how they make sense of the actions of their caregivers toward them, which contributes to their conceptualization of their own actions that are motivated by their mental states, i.e. emotions, thoughts, desires, and wishes. For example, if I’m a small child and I perceive my mother’s behaviors toward me as indicating that I am “bad,” then it will influence how I perceive myself as “bad,” which will, in turn, impact my emotional state.

 

The quality of the attachment relationship influences the quality of the mentalization process and development. A caregiver’s ability to access and use a well-developed and defined reflective self facilitates a secure attachment relationship. These caregivers have a high mentalization capacity, which means they are self-aware, able to self-reflect and recognize they are separate and distinct from their child, and able to be attuned to their child and their child’s needs. This requires caregivers to have a strong reflective capacity to be aware of their own internal mental states. Essentially this attunement helps caregivers to accurately assess and understand the cues of their child and meet the needs of their child. This interaction requires the child to remain connected to his caregiver through his ability to recognize the mental state of his caregiver for providing safety and lovingly attend to his needs. This is a process that develops over time and through many, many attachment experiences.

Initially, caregiver-infant interactions lay the foundation for physiological experiences accessed through their senses – feeling warmth, hearing a soft and gentle voice, seeing smiles from the caregiver.

 

How is mentalization connected to co-regulation and why does it matter for co-regulation?

Initially, caregiver-infant interactions lay the foundation for physiological experiences accessed through their senses – feeling warmth, hearing a soft and gentle voice, seeing smiles from the caregiver. “The development of the capacity for mental representations of the psychological functioning of self and other is closely related to affect and its regulation” (Fonagy, Steele, Steele, Moran, and Higgitt, 1991, p. 206). Mentalizing focuses both on self and others, cognition and affect, and the underlying psychological and neurobiological processes involved with interpreting one’s own mind and the mind of others based on external factors, such as facial expressions, body language, and voice prosody. Infants learn to pay attention to these external factors in their early caregiver experiences. These processes play a crucial role in the neural connections “wired in” with attachment relationships that we are not consciously aware of and influence our arousal states.

 

Luyten and Fonagy (2015) report the research from cognitive and affective science supports their belief that one’s mentalizing capacity is greatly impacted by two interacting factors: stress or arousal and one’s attachment history. Co-regulation experiences of secure attachment enable children to develop the ability to view themselves as capable, loveable, and acceptable which helps to mitigate the experiences of stressors and arousal states. Inconsistent and inadequate co-regulation experiences as seen in insecure attachment relationships interfere with a child’s ability to “lay down” strong emotion regulation neural pathways necessary for tolerating their emotional distress within a wide window of tolerance. This leaves them vulnerable to developing shame messages that will ultimately leave them at the mercy of their strong emotions and dysregulation.

 

How can mental health professionals help our young clients using play therapy and expressive arts?

Mental health professionals can help identify the stories our clients and their parents are telling themselves and then help them re-write these scripts. Human beings heal within the context of safe, caring relationships. Mental health professionals can provide a safe, therapeutic space for healing using the therapeutic powers of play to help children engage in the change process. Using play therapy and expressive arts interventions can help our young clients to access and explore underlying issues impacting their mental health and facilitate change. We can help parents engage in the treatment process to improve the attachment relationship and teach parents how to be the therapeutic agents of change for their child.

 

 

Recap:

  • The concept of mentalization refers to the ways in which we make sense of ourselves, others, and relationships.

 

  • Mentalization develops within the context of attachment relationships and is impacted by the quality of the attachment relationship

 

  • Emotion regulation and co-regulation are impacted by the quality of the attachment relationship, so it’s important to help our young clients and their caregivers identify and change unhealthy understandings of themselves, others, and relationships using the therapeutic powers of play.

 

 

Are you a mental health professional working with children, youth, and families using play therapy and expressive arts? Download this free pdf for the Be 5 Framework for providing an integrated approach to play therapy and expressive arts with children, youth, and families using intention to create a safe therapeutic space and clinical decision-making.

 

 

References

Brown, B. (2012). Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. New York, NY: Avery.

Falkenstrom, F., Solbakken, O. A., Moller, C., Lech, B., Sandell, R., and Holmqvist, R. (2014). Reflective functioning, affect consciousness, and mindfulness: Are these different functions? Psychoanalytic Psychotherapy, 31(1), 26-40. doi.10.1037/a0034049

Fonagy, P., Steele, M., Steele, H., Moran, G. S., and Higgitt, A. C. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12(3), 201-218.

Luyten, P., and Fonagy, P. (2015). The neurobiology of mentalizing. Personality Disorders: Theory, Research, and Treatment, 6(4), 366-379. doi.10.1037/per0000117

Marrone, M. (2014). Attachment and interaction: From Bowlby to current clinical theory and practice (2nd  ed.). London, UK: Jessica Kingsley.