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Mentalization Impairments

What is mentalizing?

Good mentalizing is inquiring deeply into understanding the mental experiences of self or other.

  • It is trying to figure out all the nuances of what made a person do or say something.

  • It might be actively wondering how a person interpreted or related to the words or actions of another to generate the worry, anxiety, and agitation that we see and hear from them.

  • It could be contemplating with curiosity what is driving one's own anxiety or tiredness or any other state that one experiences.

Mentalizing is like trying to get inside another person's mind and seeing the world from behind their eyes, between their ears, and inside their skin.

We have to be able to mentalize ourselves as well. That includes being aware of what one's self is thinking, feeling, and wanting. It is being very clear on what is motivating one's own behavior.

Mentalizing often requires slowing down or even pausing, with the goal of increasing our mental clarity or seeing the nuances in the bigger picture.

Mentalizing goes wrong regularly. We often try to take a shortcut in our communication, ignore all the details, or overlook the importance of feelings, for example. This is normal.

Good mentalizing: "Hi sweetie, I see you are watching TV, I have something to ask, can I pause this for one minute?...Thanks. I don't know if your forgot, but I had asked you to take the chicken out of the freezer this morning and you said okay. But, it is still in there. Did you forget? I know you seemed a little distracted this morning. Did something happen?"

No mentalizing: "The chicken is still frozen! What's wrong with you? You never pay attention to anything!"

Some people rarely engage in intentional, conscious mentalizing. Many people do try to mentalize, but it is quite impaired or distorted in very specific ways.

Attached is a summary of impairments in mentalization. There are three modes of thinking that a considered to be NO Mentalization:

Concrete thinking

Magical thinking

Pretend Mode

Then there are various forms of IMPAIRED Mentalization:

Hypermentalization (excessive mentalizing)

Hypomentalization (insufficient mentalizing)

Unbalanced mentalization (thinking in extreme mental polarities only in self or other, cognitive or emotional, automatic or controlled, and/or interior or external)

Also, of great interest is the issue of trust. Epistemic trust, or trust of knowledge and information is necessary to mentalize. In other words, one must be willing to consider that incoming information from others is accurate, trustworthy, generalizable, and personally relevant. This kind of trust is necessary to learn self-relevant information about the world. In BPD, epistemic trust "freezes" according to researchers!

The challenge for family members is to MELT that frozen trust with VALIDATION. Then to foster learning through MENTALIZING, including the ability to develop and sustain a healthy mentalization stance through attitudes of inquiry that include presence, tentativeness, humility, playfulness, flexibility, taking turns, and accountability.

Want to learn more? Click below to download a pdf on these issues!

the dance of mentalization
Download PDF • 3.73MB

If you want to learn even more, you will find 3 more articles on mentalization exclusively on the Wiser Minds blog!

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