Week 4 - Clinical Practice

Question 1

psychic equivalence mode

Answer 1

internal reality = external reality
- viewing feelings as absolute truth
- rigid, black-and-white thinking with unshakable beliefs
- lacking openness to alternatives

Question 2

teleological mode

Answer 2

• 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

Question 3

pretend mode

Answer 3

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

Question 4

mentalizing

Answer 4

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

Question 5

characteristics of mentalizing

Answer 5

• 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

Question 6

dimensions of mentalizing

Answer 6

multidimensional ability; its effectiveness depends on the context in which it is applied

Question 7

automatic vs controlled

Answer 7

automatic: quickly recognizing that someone’s smile indicates happiness
controlled: reflecting on why someone might feel sad in a specific situation

Question 8

internal vs external

Answer 8

internal: understanding one’s own or another person’s internal mental states
external: understanding observable external behaviors

Question 9

self vs others

Answer 9

self: mentalizing about your own thoughts and emotions
other: mentalizing about others thoughts and emotions

Question 10

cognitive vs affective

Answer 10

cognitive: understanding mental states through logic
affective: empathizing with emotional states

Question 11

teleological mode (around 1.5 years)

Answer 11

objects are seen as non-existent if out of sight

Question 12

psychic equivalence mode (around 2 years)

Answer 12

internal reality is equated with external reality

Question 13

play pretend mode (around 3-4 years)

Answer 13

distinction is made between internal and external reality

Question 14

attachment

Answer 14

crucial for mentalizing. children develop the ability to mentalize in relation to their attachment figure

Question 15

secure attachment (in children)

Answer 15

anxiety and sadness during separation, but quickly recovers and resumes playing/exploring once reunited. supports mentalizing

Question 16

avoidant attachment (in children)

Answer 16

shows little fear during separation and avoids the parent when reunited. relied on pretend mode

Question 17

ambivalent attachment (in children)

Answer 17

anxious during separation, clingy, and exhibits anger or tension upon reunion. relied on equivalent mode

Question 18

disorganized attachment (in children)

Answer 18

no clear or consistent strategy for dealing with separation or reunion. shifting between pretend mode and equivalent mode

Question 19

autonomous attachment (in adults)

Answer 19

provides clear, coherent, and nuanced explanations

Question 20

reserved attachment (in adults)

Answer 20

idealized partners without support, sees them as unimportant, and lacks concrete memories

Question 21

preoccupied attachment (in adults)

Answer 21

confused, non-objective, passive, or displays anger and conflict

Question 22

unprocessed/disorganized attachment (in adults)

Answer 22

pain from loss or memories of abuse resurface without resolution

Question 23

lower ability to mentalize

Answer 23

linked to insecure attachment styles. disorganized attachment tends to lead to psychopathology

Question 24

congruent mirroring

Answer 24

response directly matches the expression of the other person

Question 25

marked mirroring

Answer 25

response directly reflects the expression of the other person, but is dramatized to make the emotion noticeable and easier to interpret

Question 26

contingent mirroring

Answer 26

response is directly and appropriately tied to another’s action or emotional state

Question 27

escalation

Answer 27

when the parent accurately resonates with the child’s feelings but without marked expression. this is due to unmarked mirroring—linked to psychic mode

Question 28

sense of emptiness

Answer 28

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

Question 29

‘opening up’ the learning environment

Answer 29

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

Question 30

spectrum on the intervention (most to least complex)

Answer 30

1. support and empathy
2. clarify, elaborate, and challenge
3. affect focus
4. mentalizing in/of the relationship

Question 31

support and empathy

Answer 31

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

Question 32

clarify, elaborate, and challenge

Answer 32

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

Question 33

affect focus

Answer 33

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

Question 34

mentalizing in/of the relationship

Answer 34

involves validating the patient’s feelings, exploring their current experience, and examining how the therapist’s actions may influence the interaction

Question 35

stop and take a step back

Answer 35

helps patients identify and reflect on the moment they shifted to non-mentalizing, staying focused on the trigger without distractions

Question 36

stop, listen, and watch

Answer 36

pauses the session to explore emotions in real-time, encouraging reflection from multiple perspectives

Question 37

stop, go back, and explore

Answer 37

revisits a recent escalation to analyze triggers and gain insight into emotional reactions