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  1. #1
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    The Role Of Mentalization In The Development Of Borderline Personality Disorder

    The Role Of Mentalization In The Development Of Borderline Personality Disorder
    by Simone Hoermann, Ph.D.
    Jul 30th 2010

    Continuing on the topic of attachment and Personality Disorders, a paper by Fonagy and Bateman published in the Journal of Personality Disorders in 2008 recently caught my eye. As mentioned previously, to date, we still don?t quite know what causes Personality Disorders. On several occasions, I have mentioned the fact that a large number of people with Borderline Personality Disorder (BPD) have experienced childhood abuse or trauma, but that not everyone who had these adverse experiences necessarily develops BPD. In an attempt to formulate a model of how Borderline Personality Disorder develops, Fonagy and Bateman use attachment theory and the concept of mentalization in order to bring together insights from biological as well as psychological research on the topic.

    The main idea posited by Fonagy and Bateman is that people with BPD have weaknesses in their ability to mentalize, that is, to understand their own and others? internal states and motivation. This capacity to mentalize, according to the authors, develops within the context of early attachment relationships. Fonagy and Bateman emphasize that any successful treatment of BPD has to stimulate the capacity to mentalize in one form or another.

    The disruption of the development of mentalizing capacity is viewed by Fonagy and Bateman as a key factor in the development of BPD. The main reasons for this kind of disruption are typically trauma, abuse, or neglect. We know that a large number of people with BPD have experienced abuse or neglect in childhood. However, not everyone who had these experiences necessarily develops BPD. Therefore, a history of trauma, abuse, or neglect is not viewed as sufficient for the development of BPD. It is generally assumed that certain genetic and temperamental predispositions can mediate the development of BPD.

    What is emphasized by Fonagy and Bateman, though, is that there is research evidence that the parent?s response to trauma and abuse likely play a more important role than the abuse itself. In other words, if parents respond in a way that is invalidating and non-supportive, the effect of trauma will likely be potentiated. Thus, a nurturing family environment that encourages processing and discussion of mental states is crucial to the development of healthy personalities. If early caregivers are consistently invalidating of the infant, if they undermine the child?s self-perception and self-reflection, the child will have a harder time recognizing and identifying their own internal (emotional) states. This inability to identify one?s feelings and motivations obviously impacts the ability to regulate one?s emotions ? a key difficulty for people with BPD. In turn, parental under-involvement is also viewed as a key factor that inhibits the development of the ability to understand other people?s internal states ? in other words, the development of social cognition.

    Fonagy and Bateman assume that there are inborn dispositions that make individuals vulnerable to developing BPD. If these vulnerabilities meet inadequate parental behavior and disorganized attachment and trauma, this will undermine the ability to mentalize and thus cause Borderline Personality Disorder.

    Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder

    The cognitive point of view in psychodynamic psychotherapy: mentalization-based treatment

    Mentalization, the capacity to understand the mental state of oneself and others which underlies overt behaviour, is a developmental achievement through the context of attachment relationship during infancy and childhood. Mentalization based treatment (MBT) is a psychotherapy that promote the further development of mentalizing. MBT for borderline personality disorder (BPD), developed and manualised by Peter Fonagy and Anthony Bateman, is well-known. According to them, vulnerability to a loss in mentalizing particularly in interpersonal or stressful circumstances is a core feature of BPD.

    For these patients, traditional psychotherapy would produce iatrogenic harms rather than some improvements. To avoid those iatrogenic effects, MBT therapist takes the stance of "not-knowing". Therapist stimulates the patient's mentalizing, and makes the patient have some inquisitiveness about the mental states of oneself and others. For this purpose, the triad of "event-belief-affect" is explored. At first, the problematic act of the patient is detected. Secondly, rewinding to the time when that problematic act has arisen, the therapist collaborate with the patient to identify the event that provokes the failure of mentalization, and to clarify the affect of patient at the moment. Thirdly, to gain alternative perspectives, that situation is explored through the emotional context. Finally, the specific maladaptive belief which causes a disruption of mentalizing is identified. When the same pattern of mentalizing failure is occurred in the process of the therapy, it was brought up in the "here and now" relationship between the patient and therapist.

    As seen above, MBT, which explores the relationship between affect and belief, has some technical features similar to cognitive behaviour therapy, which explores the relationship between maladaptive schema and dysfunctional cognition or problematic feeling.However, to the extent of focusing on the "here and now" relationship between patient and therapist, and of placing an emphasis on the context of transference, MBT is still psychodynamic psychotherapy.

    Related video:

    http://forum.psychlinks.ca/borderlin...t-and-dbt.html

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder

    Mentalization and Understanding the Minds of Others
    AnythingToStopThePain.com
    January 26th, 2012

    I spoken about mentalization on this site before. Since I’ve lately been on a TED talk kick, mainly watching TED talks about neuroscience, I wanted to post this one from Rebecca Saxe which is called “How we read each other’s minds”. It is basically describing the process of mentalizing and how a certain part of the brain, the Right Temporo-Parietal Junction, is highly specialized for seeking to understand the motivations of others, the essence of mentalization. What is fascinating about this talk is her use of the pirate/cheese sandwich story with children of various ages. She demonstrates how the process of mentalization develops over time. I talked about anothermentalization test (which is based on the same principles) in this post. I’d encourage all of my readers to watch this video. Although she doesn’t use the words mentalizing or mentalization, that is what she is describing. Additionally, I suppose that when someone with BPD experiences a “failure to mentalize”, that part of the brain is most likely dimmed.



    Related posts:
    1. Mentalization Based Therapy Shows Promise with BPD
    2. Mentalization and BPD
    3. How mentalization and attachment might explain “high-functioning” BPD
    4. Mentalization-Based Treatment Versus Structured Clinical Management for BPD
    5. Mentalization Information Part 1
    6. A failure to mentalize – Mentalization Information Part 2

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder

    Quote Originally Posted by Daniel View Post
    For these patients, traditional psychotherapy would produce iatrogenic harms rather than some improvements.
    What does this mean exactly?

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder

    It just means harms induced or caused by the therapy, rather than the therapy improving the condition.

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder

    I understood what it means, I guess my question should have been why would this happen.

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder

    Ohhhh. Sorry! Don't know the answer to the why, though.

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    Re: The Role Of Mentalization In The Development Of Borderline Personality Disorder



    By developing your ability to "get" where you or other people are coming from (also called mentalizing), you are taking an important step toward developing compassionate self-awareness. This skill can help you to overcome your sensitivity to rejection. Learn more by reading Bouncing Back from Rejection: Build the Resilience You Need to Get Back Up When Life Knocks You Down.

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