Psychologist's Advice - The Importance of Mentalization

Mentalization – is the normal ability to attribute intentions and meaning to human behavior, to understand the "unwritten rules". It encompasses both a self-reflective and an interpersonal component, offering a person a well-developed ability to differentiate between inner reality and outer, physical experience and the mind, and internal mental and emotional processes from interpersonal communication. Mentalization can be described as the ability to see oneself from the outside and others from the inside. It is a fundamental social competence essential for human interaction and relationships. Its significant clinical importance lies in the fact that mentalization promotes affect regulation. Mentalization skills are important for identity, self-awareness, and a sense of autonomy, true intersubjectivity, healthy relationships with others, and feeling understood. Impaired mentalization often leads to loneliness. Good mentalization reflects flexibility of mind and relationships, as well as mental and relational strengths such as curiosity, perspective-taking, forgiveness, reflective thinking, a trust-filled perspective, humility, playfulness, a willingness to take responsibility, and awareness of one's impact on others. In summary, mentalization is the ability to perceive what is happening in one's feelings and thoughts and to infer what is happening in another person's mind and feelings, in the relationship between oneself and another.

To mentalize means to understand one's misunderstandings. Impaired mentalization can cause confusion and misunderstandings, leading to actions based on false assumptions. Being misunderstood is very frightening. It can trigger intense emotions that may result in violence, withdrawal, hostility, overprotection, rejection, and symptom escalation. A person with impaired mentalization, for example, someone with an eating disorder, often experiences a vicious cycle: impaired mentalization leads to relational misunderstandings and breakdowns, and an unsafe world becomes even more insecure. Such stress, fear, and emotional arousal further deteriorate mentalization ability. Thus, anorectic withdrawal and behavioral expressions can be expressions of control and predictability.

Everyone seeks social learning to navigate their life world. When a person feels insecure in their beliefs and intuition, they seek reassurance from others. However, while the learning need of an insecure person can be intense and sought with anxiety, the content of reassurance may be misinterpreted as having hostile intent, meaning confused and rejected. As a result, the distrustful person is in a state of chronic uncertainty. So, how do you reach those who are hard to reach? Individuals today live in a culture of rapid change, both internally and externally, requiring each to connect with others to cope with this world.

NON-MENTALIZING STATES

In interacting with others and with ourselves, subjectively intense emotion can "throw" us out of the here and now and "catapult" us into non-mentalizing states. This can happen when experiencing stress or interacting with very close people, activating an insecure attachment style.

In a non-mentalizing state, a person's understanding of themselves, their behavior, another person, or mutual relationships becomes weakened. We may feel confused, suspicious, frightened, and rush to "fix" our feelings with various destructive activities, such as alcohol, not eating/vomiting, self-harm, etc. We may leave others feeling confused and unsettled, withdraw, or even feel paranoid about others. Our communication with others would become extremely difficult without the ability to mentalize.

I will further outline and describe three non-mentalizing states, how to recognize, name them, and how to return oneself to mentalization. The following non-mentalizing states are distinguished: psychic equivalency, pretend mode, and teleological.

Psychic Equivalency Non-Mentalizing State (Psychic Equivalency). This non-mentalizing state occurs when our inner psychic reality seems to us as real as the external reality (inside=outside). The state can be called the "Godzilla" state, where an imagined "monster" becomes real, scary, and intimidating. When "I think (feel) THIS, therefore I am THIS." For example, a person with anorexia may feel fat and start to think they are fat because they feel that way. Negative thoughts and feelings about oneself can become overly real (e.g., the feeling of evil can be unbearably intense). This non-mentalizing state can be recognized if: there is "all or nothing" thinking; black-and-white thinking; emotions overwhelm; it seems like "my feeling is 100% true"; "if it seems like someone is angry with me, then it is so"; "if I feel ugly, then I am"; alternatives, different perspectives are not tolerated, there is no doubt, only categorical thinking.

Teleological, Bodily Non-Mentalizing State (Teleological Mode). This is a state of wanting to quickly fix, solve things, where the environment, emotional and external world is understood only within the framework of tangible (bodily or action) reality. Psychic states are acted out through self-harm or violence, destructive behavior. It may seem like we control the psyche by "employing" our body. For example, "I won't believe it until I see it." The teleological non-mentalizing state can be recognized if there is harmful behavior: overeating; alcohol, drug use; not eating, fasting, or increased desire to lose weight; unsafe casual sex; overly intense exercising; suicidal or self-harming behavior; deliberately induced vomiting; migraines; increased dissatisfaction with the body; panic attacks; stomach pains; excessive shopping; impulsive quitting of jobs; abrupt relationship endings, etc.

Pretend Non-Mentalizing State (Pretend Mode). Unlike in the psychic equivalency state, in the pretend state, inner reality is separated from external reality (Inside/Outside). The mental world is separated from external reality. This non-mentalizing state can be called the "elephant in the room" state, where, for example, after a loss, family members do not talk about it, living and behaving as if the loss did not happen, not talking about feelings of sadness or mourning. This state can also be called the "Batman" state, as it is a state where we "fly away" into our thoughts, another reality, but separate ourselves from the here and now difficulties, heavy feelings (such as grief, envy, loneliness, love, etc.). In this state, fantasy and reality exist completely separately, thoughts and feelings can become monotonous, dull, constantly repeated, and spun in the head, escaping into fantasy, considerations (dissociation) distract us from the existing reality. Characteristics of the pretend non-mentalizing state include: intellectual talking without feelings; "elephant in the room" thinking (ignoring what is important here and now); fantasy world; closing in on oneself; withdrawal from friends, activities, the external world; immersion only in activity, communication; avoiding delving into feelings; pseudomentalization.

In Mentalization-Based Therapy (Mentalization-Based Therapy [MBT]) it is important to learn to recognize these states. Recognizing being in a non-mentalizing state indicates that one is beginning to mentalize what is happening with themselves and reflecting that they are in a state likely affected by a difficult feeling or thought. Each non-mentalizing state may require a different strategy. In the psychic equivalency state, soothing or allowing/inviting others to help calm oneself is important, while in other states, stopping the behavior/state is crucial. In the pretend (Batman) state, it is important to stop the ruminations and redirect elsewhere (to less destructive thoughts). Think about "here and now". In the teleological non-mentalizing state, it is important upon recognizing, catching the desire to act destructively - to stop destructive behavior, try to recognize the difficult emotion or thought that triggered it, and stay with it or redirect elsewhere. Phrases like "don't rush to act" or "morning is wiser than evening" are suitable here, aiming to stay with more difficult emotions and thoughts, not rushing to transfer them into actions, which are often harmful or destructive.

Questions to Ask Yourself:

• Try to delve into these three non-mentalizing states and notice which states you fall into daily. You can think of or write down an example for each state.
• Notice what "triggers" or stimuli are characteristic for you that throw you into non-mentalizing states?
• Are you able to exit these states? If so, how do you manage to do that?
• Write down 10 stress coping strategies that help you calm down and redirect during stress.

The effectiveness of mentalization-based therapy is scientifically proven. I conducted it at the Vilnius City Mental Health Center, treating individuals with eating disorders, personality disorders, mood disorders, post-traumatic stress disorders, and addictions. Currently, I apply mentalization-based therapy methods in individual, couples, family, and group consultations. Therefore, I invite you to contact me - psychologist Nikol if you are experiencing difficulties in mentalizing and want to work on it together. I believe that it can be difficult to catch one's non-mentalizing states and return oneself to mentalization alone. Thus, I would be delighted to help you do so and recover from the experienced symptoms or disorders.

- Medical Psychologist Nikol Stičinskaitė