Preparing Children for Healthy Relationships Through Mentalization

Interpersonal relationships are among the most difficult areas of children’s and adults’ lives. In order to build healthy relationships, one needs to be empathic, caring, thoughtful, and most importantly, have good mentalization skills. So what is mentalization? At its most distilled, mentalizing can be understood as the process of attending to states of mind in oneself and others, or more simply, “holding mind in mind.” Mentalizing is something that we do or fail to do on a daily basis when interacting with others. For example, suppose I’m having a bad day and somebody bumps into me while I wait in line at Starbucks for a cup of coffee. In that case, I may fail to mentalize and believe that the individual who bumped into me did it maliciously. If I am mentalizing well, I may think that the coffee shop is busy, and the individual who bumped into me did so accidentally without malice. This may seem obvious, but how about when someone cuts us off in traffic? Do we know the perpetrator did it purposely? Do we automatically make assumptions and go into a road-rage mode? Maybe we were just in their blind spot! Thus, the process of mentalizing involves the process of imaginatively perceiving and interpreting behavior as conjoined with intentional mental states.

As you can imagine, mentalizing pertains to a vast array of mental states: desires, needs, feelings, thoughts, beliefs, reasons, hallucinations, and dreams, to name just a few. As a mental activity, mentalizing includes a wide range of cognitive operations pertaining to the above-mentioned mental states, including attending, perceiving, recognizing, describing, interpreting, inferring, imagining, simulating, remembering, reflecting, and anticipating. Within a therapeutic setting, mentalizing is used frequently when thinking about feelings in oneself and others; mentalizing is crucial for psychological healing. The idea of mentalization has become so important that its own therapy has been created. Mentalization-based treatment is an evidence-based treatment for patients with borderline personality disorder, post-traumatic stress disorder, obsessive-compulsive disorder, complex trauma, self-harm in adolescents, attachment disorders, and certain forms of psychosis, to name a few. The process of mentalizing is context dependent, meaning that it goes off-line much more quickly and is much harder to get back on-line. For example, when in a heated argument with a significant other, mentalizing, reducing impulsivity, and thinking about the other’s perspective becomes obstructed, inhibiting the ability to create lasting interpersonal relationships. Remember the road rage incident? We immediately assumed the other driver purposely cut us off because he was in a rush or driving recklessly. So what causes poor mentalization? Experts in the field look to the developmental model, a way of understanding the psyche through the lens of attachment theory.

According to attachment theory, the development of the Self occurs when we are infants. That’s a big deal! We develop a sense of who we are as individuals when we are infants! For example, with good parenting, when we begin to cry, our caregiver (usually a parent) will run and “rescue” us, hold us, soothe us, and make us feel safe. One of the earliest forms of mentalizing is known as social referencing, the developmental process in which infants check their caregiver’s (attachment figures) emotional take on multiple situations to see how they should respond. In other words, the infant requires his emotional signals to be accurately mirrored by an attachment figure. This pre-linguistic emotional commentary received by the infant about the surrounding world is the building block for mentalizing and creates a secure attachment. If you ever sit in a park and watch a caregiver take care of their child, you will likely see what happens when a child falls. The caregiver stands up and says something like, “you’re okay,” with a smile on their face while maintaining eye contact with their child. The child looks at their caregiver, internalizes the caregiver’s outward response, and responds accordingly. You can imagine what happens to a child who falls and is scolded by their parent. The absence or failure of the attachment figure’s mirroring is associated with the later development of disorganized attachment.

When a child fails to develop a representation of his own experience due to the caregiver’s inability to properly mirror experience (the Self), he is left with the alien Self, which is the internalization of the caregiver as part of his self-representation. These individuals have a tendency to blame others, rarely take responsibility for their mistakes, and come off as hot-headed, overly sensitive, and defensive. Their capacity to mentalize is reduced, leading to the reduced capacity to represent interpersonal experience and self-experience. Understanding the behavior of others in terms of their likely thoughts, feelings, wishes, and desires is a critical developmental achievement that originates within the attachment relationship. In sum, one’s understanding of others critically depends on one’s own mental state being adequately understood by caring, non-threatening caregivers.

As parents, we need to remember that our responses to life situations are internalized by our children. A good exercise for building mentalization is offering a situation and helping our child come up with multiple different answers to that same situation. For example, suppose our child comes home and says their new friend “hates” them. In that case, we can inquire about why they feel that way and assist our child in coming up with additional possibilities for their friend’s behavior. Perhaps the friend was not feeling well or squinting his eyes due to the reflection from the sun rather than giving a dirty look.