Mentalization, Intersubjectivity, Attachment: Concepts and Clinical Implications

INTRODUCTION:

The concepts of mentalization, intersubjectivity and attachment can be very helpful in psychotherapy practice. Yet there is much uncertainty and even confusion about them. This course aims to bring greater clarity and depth to each and draws out their clinical applications.

The course begins with an “executive summary” of the history and current status of attachment theory, including the categories of organized and disorganized attachment and the Adult Attachment Interview, including new developmental findings.

The concept of mentalization will be elaborated. Many colleagues think this means something like “having ideas.” But there is more to it. Mentalization refers to a crucial capacity and developmental achievement—becoming aware that other people have minds of their own. This means that there can be different views of the same thing, the same situation, and even the same person; that how you see the world depends on your perspective, rather than that your view is the only one. This is having a “theory of mind”–both one’s own and those of others. One clinical implication here is that interpretations will often backfire with patients who have not achieved this capacity,

This brings us to intersubjectivity. Recognizing that one’s mind is one among many means that there is a difference between one’s own subjectivity what common sense calls “objective reality,” and also a difference from the subjectivity of other people’s minds. So, this is a basic change in how it feels to be someone: The “mentalizing” child—or patient—is now living in a world in which making contact with others means finding a way to bridge these differences—navigating the space between subjects–inter-subjectivity. This approach is different from some that emphasize intersubjectivity as a kind of harmonious communication. Intersubjectivity can also be full of mismatches and multiple ways of organizing this space between subjectivities. We will apply this to how to help patients who struggle in this area.

We will also discuss how trauma interferes with these developments, affecting this perspective-taking and importantly, regulating strong emotions. Some of the most effective interventions in different psychotherapeutic approaches–psychodynamic, DBT, CBT—converge in helping with these problems.