What is the purpose of psychotherapy and psychoanalysis if not to reach an understanding of our own inner psychological workings? That goal is both the grandest and most difficult objective in clinical psychology, and not surprisingly most research has previously focused on the much safer study of habits, affects, and motivations. The ability to mentalize, however, to maintain enough self-awareness both of oneself and of others, is something of a holy grail in clinical practice, and only recently have psychologists begun to make true breakthroughs.
Mind to Mind: Infant Research, Neuroscience, and Psychoanalysis is the result of a 2005 conference on mentalization that will be of interest to clinical practitioners, informed-enough patients, cognitive scientists, and philosophers alike. It takes an interdisciplinary approach to a psychotherapeutic topic that is possibly the riskiest and most rewarding of any in the field.
One of the appeals both in the title and the book’s purported goal is the introduction of neuroscience into the psychoanalytic approach. This is obvious a hot new approach in psychoanalysis, one that revitalizes the legitimacy of a declining field. In reality, however, the neuroscience offerings are rather limited, residing mostly in one chapter that essentially provides a functional anatomy of mentalization. The other biological topics take on more of an evolutionary psychology and animal psychology-influenced approach to mentalization. While evolutionary psychological analyses are notoriously spurious, in a subject like mentalization, one which speaks to the very essence of the human mind, such an approach to psychology seems more proper than say, the evolution of canoe-building.
One of the most notable innovations of Mind to Mind is its approach to child-parent psychology. While most such studies understandably focus on the parent’s impact on the child, Mind to Mind offers two refreshing chapters on the child’s impact on parent psychology and the parent’s ability to mentalize both the parent’s own and one’s child in relation to the parent. In James E. Swain et al.’s study of infant psychology, we see that parents of newborns often have difficulty rationally mentalizing their children. Most parents see their babies as “perfect” and have irrational fears of their children being vulnerable to catastrophe. The problems extend into childhood for parents, when many parents have difficulty imagining their child’s right to a personal space and personal life in the period when the child is still dependent on the parent’s support. The problems of adoptive childhood are addressed in multiple chapters, as well as the cases of traumatic and abusive experiences with parents. In nearly every case, an abusive relationship with a parent led to an inability of an individual to properly mentalize their own psychology, let alone express healthy empathy of others.
The repercussions of an inability to effectively mentalize are on display throughout Mind to Mind. In the opening chapter by mentalization pioneers Peter Fonagy and Mary Target of the Anna Freud Center at the University College London, we see that criminals who had abusive parents are unable to coherently express self-awareness. What is normally seen as antisocial or even sociopathic behavior is, from this perspective, the result from a confused and retarded development of mentalization as a result of trauma or neglect. In one chapter by Karen Gilmore, we hear the devastating story of Mr. N, an adopted, talented man prone to failure who did not undergo any form of psychotherapy until the age of 28. Despite stories of an excessively tough adopted father, the early death of his adopted mother, and his insecurities regarding his seemingly flawless wife, Mr. N simply could not mentalize at a healthy level, and behaved irrationally and disinterestedly towards his therapist. At the same time, while the five years on therapy ended on sour and incomplete note, Mr. N still gained significant tools to address his psychological problems with introduction to mentalization training. Even a little ability to mentalize can mean significant progress.
In terms of therapeutic practice, two strands of mentalization theory seem to be dominant: Mentalization-Based Treatment (MBT), which seeks to intensively train a patient to become more self-aware of his own mind, and Transference Focused Psychotherapy (TFP), which focuses on making connections of current associations to past experiences in order to awaken a patient’s mentalization ability more subliminally. Both treatments may be crucial for people suffering from Borderline Personally Disorder, and in comparing MBT to TFP, the latter is older, more battle-tested, and more historically successful. In each case, however, the focus is on, according to Otto F. Kernberg, et al., utilizing “implicit and explicit mentalization.” Treatment of borderline personality has its dangers, and traditional practices such as free association and looser talk therapy can be especially pernicious. Yet, breakthroughs in mentalization research have opened up the floodgates to treating a disorder once thought untreatable.
The concluding chapter of the book by NYU Psychoanalyst Philip M. Bromberg takes on the movie Analyze This in a section titled, appropriately enough, “Mentalize This!” Bromberg sees the Billy Crystal and Robert DeNiro movie as an example of the potential dangers that occur in mentalization therapy: in DeNiro’s case, a mafia don doesn’t want to show any signs of vulnerability or worse, weakness over his father’s death. For Crystal’s character, the shrink runs a risk too, as Crystal’s mere association with the inner workings of a mobster’s mind can put his own life in danger.
Bromberg poignantly concludes that to obtain a true breakthrough in therapy, and in mentalization psychotherapy especially, often therapy requires both the therapist and patient to enter emotional and inner psychological territory that they both fear going. Bromberg’s conclusion speaks to the dangers of becoming aware of your motivations, as naked and often negative as they can be. To paraphrase a man who understood human psychology well before Freud, most of all, it's important to thine own mind be true.