Week 4 - Clinical Practice Flashcards
psychic equivalence mode
internal reality = external reality
- viewing feelings as absolute truth
- rigid, black-and-white thinking with unshakable beliefs
- lacking openness to alternatives
teleological mode
- Intentions are only acknowledged when someone takes visible action
- states of mind are recognized and trusted if their effects are physically observable
- if there is no visible proof, nothing is reassuring you
pretend mode
internal world is disconnected from the external world
- associated with feelings of emptiness, meaninglessness, and dissociation
- engaging in risky behavior as an attempt to feel something
- inner mental world is disconnected from physical existence
- therapy sessions may involve endless, inconsistent, and seemingly meaningless discussions of thoughts and feelings
mentalizing
ability to understand and interpret one’s own and others actions in terms of intentional mental states, such as feelings, thoughts, intentions, wishes, and desires
characteristics of mentalizing
- mental states are internal and not easily visible
- we infer or assume these states in others; such assumptions are prone to error
- the key is to approach with a ‘not-knowing’ mindset, remaining open and willing to learn
- attributing meaning and intent to human behavior by comprehending emotions, thoughts, intentions, and desires
- mentalizing shapes a meaningful sense of self and facilitates understanding of ourselves and others
- helps identify and resolve misunderstandings and is essential for effective interaction and relationships
dimensions of mentalizing
multidimensional ability; its effectiveness depends on the context in which it is applied
automatic vs controlled
automatic: quickly recognizing that someone’s smile indicates happiness
controlled: reflecting on why someone might feel sad in a specific situation
internal vs external
internal: understanding one’s own or another person’s internal mental states
external: understanding observable external behaviors
self vs others
self: mentalizing about your own thoughts and emotions
other: mentalizing about others thoughts and emotions
cognitive vs affective
cognitive: understanding mental states through logic
affective: empathizing with emotional states
teleological mode (around 1.5 years)
objects are seen as non-existent if out of sight
psychic equivalence mode (around 2 years)
internal reality is equated with external reality
play pretend mode (around 3-4 years)
distinction is made between internal and external reality
attachment
crucial for mentalizing. children develop the ability to mentalize in relation to their attachment figure
secure attachment (in children)
anxiety and sadness during separation, but quickly recovers and resumes playing/exploring once reunited. supports mentalizing
avoidant attachment (in children)
shows little fear during separation and avoids the parent when reunited. relied on pretend mode
ambivalent attachment (in children)
anxious during separation, clingy, and exhibits anger or tension upon reunion. relied on equivalent mode
disorganized attachment (in children)
no clear or consistent strategy for dealing with separation or reunion. shifting between pretend mode and equivalent mode
autonomous attachment (in adults)
provides clear, coherent, and nuanced explanations
reserved attachment (in adults)
idealized partners without support, sees them as unimportant, and lacks concrete memories
preoccupied attachment (in adults)
confused, non-objective, passive, or displays anger and conflict
unprocessed/disorganized attachment (in adults)
pain from loss or memories of abuse resurface without resolution
lower ability to mentalize
linked to insecure attachment styles. disorganized attachment tends to lead to psychopathology
congruent mirroring
response directly matches the expression of the other person
marked mirroring
response directly reflects the expression of the other person, but is dramatized to make the emotion noticeable and easier to interpret
contingent mirroring
response is directly and appropriately tied to another’s action or emotional state
escalation
when the parent accurately resonates with the child’s feelings but without marked expression. this is due to unmarked mirroring—linked to psychic mode
sense of emptiness
when the parent does not resonate appropriately, this leads to the child’s inner experience being disconnected from reality. this is due to incongruent mirroring—linked to pretend mode
‘opening up’ the learning environment
create a space where the patient feels at ease and ready to explore and share their thoughts and emotions. personalize the interaction by using their name and maintaining eye contact. focus on how the client thinks about the situaiton and not on what they think
spectrum on the intervention (most to least complex)
- support and empathy
- clarify, elaborate, and challenge
- affect focus
- mentalizing in/of the relationship
support and empathy
support the patient’s mentalizing by recognizing movements of accurate reflection on their own or others mental states. highlight the emotional relief and clarity that comes from effective mentalizing, reinforcing their growth and understanding
clarify, elaborate, and challenge
to help the patient make sense of behavior stemming from a failure to mentalize, its important to place their action in the proper context rather than viewing it as meaningless. using the technique, stop and take a step back; the therapist intervenes when a transition to non-mentalizing occurs
affect focus
2 important techniques to be considered
- stop, listen, and watch: applied when the patient’s ability to mentalize diminishes
- stop, go back, and explore: used when there is a risk that the patient’s may escalate or get out of control
mentalizing in/of the relationship
involves validating the patient’s feelings, exploring their current experience, and examining how the therapist’s actions may influence the interaction
stop and take a step back
helps patients identify and reflect on the moment they shifted to non-mentalizing, staying focused on the trigger without distractions
stop, listen, and watch
pauses the session to explore emotions in real-time, encouraging reflection from multiple perspectives
stop, go back, and explore
revisits a recent escalation to analyze triggers and gain insight into emotional reactions
