“Mentalization is about understanding the relationship between our behaviors in reference to mental states,” said Dr. Lois Choi-Kain, a psychiatrist affiliated with Harvard Medical School. “It refers to our understanding of how things look on the outside in terms of actions and how they may be experienced on the inside.”
In other words, mentalization is about seeing ourselves from the outside and others from the inside. Applying the techniques of mentalization within a family can serve to improve relationships between a person with Borderline Personality Disorder (BPD) and other family members, fostering trust and more secure attachments.
In this article, we will examine how family communication that does not include mentalization can lead to a cycle of misunderstandings and dysfunction, and increase distress and vulnerability.
‘A Problem of Instability in Mentalizing’
Borderline Personality Disorder is defined by Choi-Kain as “a problem of instability in mentalizing.” People with BPD are often quite sensitive to the feelings of others. However, stressful interactions can lead to the loss of their ability to mentalize and cause them to revert back to destructive ways of thinking, such as “I am always the victim.”
This kind of thinking leaves few options because when everything is seen through this lens, it can lead to both the person with BPD and family members becoming more controlling, hostile, helpless, or passive.
Need for Secure Attachments
Secure attachments are crucial for people with Borderline Personality Disorder, but cannot be fostered when a cycle of conflict and vulnerability continues without improvement, according to Choi-Kain. People with BPD have often suffered from a lack of secure attachments in childhood that can inhibit their ability to develop a coherent sense of self.
When secure attachments and trust between family members are achieved, they can actually stimulate mentalization and instill healthier communication habits within familial relationships.
The Risk of Mirroring
Caregivers and family members may inadvertently mirror the responses of the dysregulated person with Borderline Personality Disorder, causing further distress and loss of trust. When family members begin to mirror the controlling or helpless behaviors (both somewhat typical BPD responses to distress), it perpetuates misunderstandings and contributes to escalation of heightened emotionality.
Caregivers who mirror the BPD person’s belief that they are useless or destructive can cause a return to pre-mentalizing frames of thinking.
It is easy to see how poor mirroring and lack of secure attachments can cause a snowball effect and lead to a never-ending cycle of misunderstandings and distress within the family. In a follow-up article on mentalization, we will look at the practical application of mentalization techniques and break down the steps needed for putting mentalization to use in family relationships.
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