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Clinical Meeting: The mentalizing stance

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Image by Jane Landers

We were pleased to be joined this month by Ellen Wade, a psychodyanamic psychotherapist and bodywork therapist, who came to talk to us about mentalization. Ellen works for the Haringey personality disorders service, which uses mentalization as part of its group treatment programme.

For the art-making part of the session, Ellen asked us to think about the word “curiosity”. Several images featured cats, one of which has been killed by curiosity, and all explored the notion of open-eyed, child like wonderment. The image featured here shows small hands opening a cupboard door and finding the surprises which are hidden inside. Ellen explained that her reason for choosing this theme was that the ability to be curious about one’s own internal and external worlds is the bedrock of the “mentalizing stance”.

This “stance” aims to teach clients to “see themselves from the outside and others from the inside”: to have a good sense of their own emotional state, the way their behaviour might be perceived by others, and to mentalize about the emotion states of others and ways in which it motivates their behaviour.

Mentalization Based Therapy, also known as MBT, was developed by Peter Fonagy and Anthony Bateman as a way of treating borderline personality disorder. In the forward of the Handbook of Mentalization-Based Treatment, it is referred to as the “conceptual revolution” as well as the “least novel therapeutic approach imaginable.” Perhaps it is simply a different way of putting together, and re-framing, ideas which have been present in therapy for many years. MBT’s greatest distinction from the more psychodynamic approaches appears to be the combination of the notion of “theory of mind” as a neurological deficit found in both autism and psychopathology and the idea that empathy can be, to some extent, taught and learned. This lends the approach a psycho-educational quality, while also being informed by both attachment-based theory and psychoanalytic understanding.

In group discussion we explored art therapy’s position in relation to mentalisation. It seems that the use of artwork in the sessions (in addition to the transference between therapist and client) allows for the client’s internal world to be externalised through the image. The ability to relate to the image as well as the therapist, and in group work to see and be seen through the images produced by the various group members, seems to place art therapy as a therapeutic model which naturally encourages mentalisation skills.

Finally, following the “curiosity killed the cat” notion, a group member shared this paragraph from a poem by Alastair Reid:

“…And what cats have to tell
on each return from hell
is this: that dying is what the living do,
that dying is what the loving do,
and that dead dogs are those who do not know
that dying is what, to live, each has to do.”

For more information on art therapy and mentalization:
International Journal of Art Therapy: Formerly Inscape, Volume 12, Issue 1, 2007
Handbook of Mentalization-Based Treatment by Fonagy and Allen.  

Posted by Nili Sigal, art therapist &
clinical meetings coordinator

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