Psychology to mentalizing 

book abstracts

The Psychology of Mentalizing, authored by Dr. Pia Tohme Khalaf and Dr. Rudy Abi-Habib, delves into the concept of mentalizing—the capacity to understand one’s own and others’ mental states—and its significance in emotional development and interpersonal relationships. 

The book traces the evolution of mentalizing from early psychoanalytic theories to contemporary neuropsychoanalytic perspectives. It emphasizes the role of secure parent-child attachments in fostering mentalizing abilities and explores the concept of epistemic trust within various relational contexts, including parent-child, teacher-student, and supervisory relationships. 

Additionally, the authors examine mentalizing across different cultures, with a particular focus on the Arab world, and discuss its potential in addressing the intergenerational transmission of trauma. Contributions from experts in the field provide both clinical applications and research insights, making this work a comprehensive resource on mentalizing.

Chapter 1

Mentalizing, meaning the ability to think about and infer mental states related to the self and others, is an imaginative human capacity. This construct was influenced by several developmental and psychoanalytic theories. While the cognitive component of mentalizing emerged from theory of mind, as well as attachment theory, the affective component is inspired by psychoanalytic theories. It is thus conceived as a multidimensional construct with neurobiological underpinnings. This capacity develops early on in childhood, essentially within the context of a secure attachment relationship with the primary caregiver. While genuine mentalizing has been shown to be associated with healthy development from childhood, through adolescence and later childhood, mentalizing failures can, in turn, be associated with a wide array of psychological/clinical symptoms and disorders. In this chapter, we discuss the development of the construct of mentalizing, starting with its theoretical conceptualization, to discussing how this capacity develops through the caregiver-child relationship, before finally tackling its practical day-to-day impact on one’s mental health and psychological functioning.  

Keywords: Mentalizing, attachment, caregiver-child relationship, psychoanalysis, reflective functioning, multidimensionality

Chapter 2

According to neuropsychoanalysis and the theory of mentalizing, empathy is a developmental achievement that occurs when PLAY mechanisms are engaged. Children must consider the feelings of their playmates to maintain the reciprocity of play interactions. Therefore, it is only when children acknowledge the mind of the other, i.e., mentalize, that they can enjoy the rewards of play. Mentalizing is the combination of capacities needed to make sense of one’s own internal world and behavior and distinguish it from those of others. The current chapter explores the interconnection between mentalizing capacity and the PLAY drive, as described by affective neuroscience and neuropsychoanalysis. Play can be conceptualized as an emotional experience that allows the realistic satisfaction of people’s emotional needs. Oftentimes, play requires outside narration (by a parent, teacher, or therapist) to support the child’s ability to recognize, discriminate, and make sense of bodily sensations and perceptual input while interacting or playing. The authors are interested in how the intertwined development of both mentalizing and play could contribute to healthy mental functioning.

Keywords: Play, neuropsychoanalysis, development, mentalizing, drive, childhood

Chapter 3

Mentalizing has been conceptualized as the ability to understand oneself or others, and thus as a form of imagery capable of grasping the causal factors underlying overt behaviors and covert reasoning alike. Higher mentalizing skills have been shown to protect the individual against mental distress, through the promotion of effective coping skills and emotional competency. This finding has instigated several empirical studies on the topic, with the quest of characterizing the interplay between early life experiences and later distress. But apart from childhood and adolescence, adults may also reshape their mentalizing abilities, particularly while in education or training. The fundamental role exerted by parental figures during development is mirrored in education or training by different role-models (e.g., teachers, mentors, tutors), fostering the (re)definition of personal and occupational identities. Specific professions are more interested in this phenomenon, which is nonetheless general and transversal to each occupation. For instance, the role of the mentor in medical training has been observed as crucial to promote a later positive sense of accomplishment during work or training, harboring resilience against emotional exhaustion in face of moral injuries to one’s own practice (e.g., the death of a patient, policy, and economic limitations).  By contrast, mistreatment, objectification, or frank exploitation suppress the positive reinforcement of identity development, increasing the risk for later burnout. The current chapter reviews the existing evidence on the topic of mentor-mentee relationships, as nurturing mentalizing skills during adult life and exerting a pivotal influence on resilience and burnout. A novel perspective on mentalizing in relation to transformative experiences is proposed. An overarching role for mentors in promoting epistemic trust and self-worth is discussed. Finally, the implications of these findings for specific professions are considered, extending Corson’s model of vocational education (1985).

Keywords: Mentalizing, epistemic trust, mentoring, occupation, identity

Chapter 4

Mentalizing has gained recognition as an effective transdiagnostic approach for treating various psychological disorders. Nowadays, the concept of mentalizing is extending beyond clinical settings and finding its way into non-clinical environments, including schools. The classroom serves as a significant arena for establishing relationships, not only with pupils but also with parents, colleagues, and school administrators. Within this complex web of relationships, teachers are tasked with not only imparting academic knowledge but also teaching cooperation, conflict resolution, and empathy among pupils. Teachers constantly engage in learning, discussions, consultations, and setting boundaries, all within the context of relationships. As a result, being a teacher can be a challenging role, as relationships don’t always run as smoothly as desired. Nurturing connections with pupils, parents, and colleagues may pose occasional difficulties, involving misunderstandings, frustration, friction, and challenging behaviors within and around the classroom. Therefore, to effectively manage a classroom, teachers must possess a certain level of expertise in building and maintaining relationships. Mentalizing, which involves attentiveness to our own feelings, thoughts, desires, intentions, as well as those of others, is considered a crucial element in fostering positive and secure relationships. In this chapter, the authors delve into the dynamics between teachers and pupils, offering insights on how mentalizing can make a significant difference, not only in clinical treatment settings, but also in the classroom.

Keywords: School, education, classroom, mentalizing, wellbeing, intervention

Chapter 5

Mentalization-Based Treatment (MBT) was originally developed as an intensive treatment program for adult patients with borderline personality disorder (BPD). The MBT framework offers a theoretically firmly anchored model of the mind and an understanding of psychopathology. Over time, MBT has evolved into a transdiagnostic treatment model, providing an overarching framework for addressing deficits in the fundamental capacities of mentalizing and epistemic trust with matched interventions across various clinical stages of evolving psychopathology and diverse phenotypical expressions throughout the lifespan. This chapter provides an overview of the clinical MBT framework for personality pathology, with the aim of aiding clinicians in their understanding of personality pathology and guiding clinical intervention. Although – inherent to MBT principles – all distinct MBT interventions are tailored to each specific target population needs, they share common principles and characteristics. General presumed working mechanisms are outlined, detailing how a focus on improving mentalizing and epistemic trust may facilitate improvement in the self and in relational functioning. The structure of MBT interventions is delineated including the phases of treatment, treatment components and respective foci. The interventional framework is introduced in terms of the generic principles of mentalizing interventions along with a description of the domains of interventions. Lastly, the chapter provides an update of MBT applications for BPD and the adaptations for other personality pathology including avoidant, antisocial, and narcissistic personality disorder.  

Keywords: Mentalizing, treatment, personality disorder, self-other, relational functioning

Chapter 6

Attachment and mentalizing have been consistently found to crucially influence psychosocial adjustment across the lifespan. However, evidence for this influence has mainly been garnered in Western industrialized countries, and only a few studies have examined these constructs cross-culturally in the Arab world. This chapter will present a detailed examination of the literature from the Middle East and assess the generalizability of empirical findings to collectivistic, patriarchal societies where multiple caregivers play similar roles. The main themes explored include (1) a cultural approach to mentalizing and findings from the region, (2) the conceptualization of attachment security from a cultural perspective, specifically in the Middle East where alloparenting practices are more prevalent, and (3) a critical review of attachment studies conducted in the Middle East, including factors determining attachment security. The implications of these findings will be discussed in light of the impact of globalization on gender roles, the potential effects of socio-economic and political instability on attachment and mentalizing, and the roles of patriarchal ideology, religion, and the political circumstances that characterize Middle Eastern countries.

Keywords: Attachment, mentalizing; Middle East, cross-cultural research, parenting  

Chapter 7

According to official sources, the Civil War in Lebanon (1975-1990) caused more than 150,000 deaths and 350,000 injuries, i.e. 8.35% and 12.5% of the Lebanese population estimated at 2.8 million inhabitants in 1994. At the end of this war, we also count 17,000 disappeared and hundreds of thousands exiled or displaced. The figures and percentages relating to war casualties tend to be easy to account for because statistics count the physical losses and injuries. But what about the psychological wounds that have since marked the history of most Lebanese and that of their children? What about the abuse, maltreatment, family dysfunction, decompensation, and suicide that took place during and after the war and which were due to chronic exposure to fear and atrocity, to losses, and the non-symbolizable senseless? This chapter will touch upon the traces the war left on the individual and the collective unconscious, especially considering that memory has only been timidly worked through and the mourning process seems frozen. It will further discuss the repercussions of the war on intra-familial relationships, as well as on the transgenerational level; in other words, who do we become when we are invaded by unprocessed trauma from the past that is being passed on to our children.  

Keywords: War, trauma, intergenerational transmission, mentalizing, relationships