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424 Pages·2008·3.066 MB·English
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Mentalizing in Clinical Practice This page intentionally left blank Mentalizing in Clinical Practice Jon G. Allen, Ph.D. Helen Malsin Palley Chair in Mental Health Research and Professor of Psychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas Peter Fonagy, Ph.D., FBA Freud Memorial Professor of Psychoanalysis and Director of the Sub-Department of Clinical Health Psychology, University College London; Chief Executive of the Anna Freud Centre, London, England Anthony W. Bateman, M.A., FRCPsych Consultant Psychiatrist in Psychotherapy, Halliwick Unit, St. Ann’s Hospital, Barnet, Enfield, England, and Haringey Mental Health Trust Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards. As medical research and practice continue to ad- vance, however, therapeutic standards may change. Moreover, specific sit- uations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors some- times occur, we recommend that readers follow the advice of physicians di- rectly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. If you would like to buy between 25 and 99 copies of this or any other APPI title, you are eligible for a 20% discount; please contact APPI Customer Ser- vice at [email protected] or 800–368–5777. For 100 or more copies of the same title, please e-mail us at [email protected] for a price quote. Copyright © 2008 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 12 11 10 09 08 5 4 3 2 1 First Edition Typeset in Adobe’s Palatino and Kabel American Psychiatric Publishing, Inc. 1000 Wilson Boulevard Arlington, VA 22209–3901 www.appi.org Library of Congress Cataloging-in-Publication Data Allen, Jon G. Mentalizing in clinical practice / Jon G. Allen, Peter Fonagy, Anthony W. Bateman. — 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58562-306-8 (alk. paper) 1. Psychotherapy. 2. Mental healing. 3. Self-perception. I. Fonagy, Peter, 1952- II. Bateman, Anthony. III. Title. [DNLM: 1. Awareness. 2. Psychotherapy—methods. 3. Psychoanalytic Theory. 4. Social Behavior. 5. Social Perception. WM 420 A427m 2008] RC480.5.A454 2008 ′ 616.8914—dc22 2007044458 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents About the Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Stuart C. Yudofsky, M.D. Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 PART I Understanding Mentalizing 2 Mentalizing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 3 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 4 Neurobiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113 PART II Practicing Mentalizing 5 The Art of Mentalizing . . . . . . . . . . . . . . . . . . . . . . 149 6 Mentalizing Interventions . . . . . . . . . . . . . . . . . . . . . 163 7 Treating Attachment Trauma . . . . . . . . . . . . . . . . . . . 211 8 Parenting and Family Therapy . . . . . . . . . . . . . . . . . . 239 9 Borderline Personality Disorder . . . . . . . . . . . . . . . . . 259 10 Psychoeducation . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 Appendix: What Is Mentalizing and Why Do It? . . . . 311 11 Social Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 John M. Oldham, M.D., M.S. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 Recommended Reading . . . . . . . . . . . . . . . . . . . . . . 389 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391 About the Authors Jon G. Allen, Ph.D., holds the positions of Helen Malsin Palley Chair in Mental Health Research and Professor of Psychiatry in the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine, and Senior Staff Psychologist in The Menninger Clinic, Houston, Texas. He conducts psychotherapy, diagnostic consultations, psychoeducational programs, and research, specializing in trauma- related disorders and depression. He is past editor of the Bulletin of the Menninger Clinic, associate editor of the Journal of Trauma and Dissocia- tion, and a member of the editorial board of Psychiatry; he also serves as a reviewer for several professional journals and book publishers. He has authored and co-authored numerous professional articles and book chapters on trauma-related problems, depression, psychotherapy, hos- pital treatment, the therapeutic alliance, psychological testing, neuro- psychology, and emotion. Previous books he has authored, co-authored, or co-edited include Traumatic Relationships and Serious Mental Disorders; Coping With Trauma: Hope Through Understanding; Coping With Depres- sion: From Catch-22 to Hope;Diagnosis and Treatment of Dissociative Disor- ders (with William Smith); Borderline Personality Disorder: Tailoring the Treatment to the Patient (with Leonard Horwitz, Glen Gabbard, and col- leagues); Restoring Hope and Trust: An Illustrated Guide to Trauma (with Lisa Lewis and Kay Kelly); and the Handbook of Mentalization-Based Treatment (with Peter Fonagy). Peter Fonagy, Ph.D., FBA, is Freud Memorial Professor of Psychoanalysis and Director of the Sub-Department of Clinical Health Psychology at University College London; Chief Executive of the Anna Freud Centre, vii viii Mentalizing in Clinical Practice London; and Consultant to the Child and Family Program at the Men- ninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine. He is Chair of the Postgraduate Education Com- mittee of the International Psychoanalytic Association and a Fellow of the British Academy. He is a clinical psychologist and a training and su- pervising analyst in the British Psycho-Analytical Society in child and adult analysis. His work integrates empirical research with psychoana- lytic theory, and his clinical interests center around borderline psychopa- thology, violence, and early attachment relationships. He has published over 300 chapters and articles and has authored or edited several books. His most recent books include Psychoanalytic Theories: Perspectives From Developmental Psychopathology (with Mary Target); What Works for Whom? A Critical Review of Psychotherapy Research (with Anthony Roth); Psycho- therapy for Borderline Personality Disorder: Mentalization-Based Treatment (with Anthony Bateman); Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide (also with Anthony Bateman); Reaching the Hard to Reach: Evidence-Based Funding Priorities for Interven- tion and Research (with Geoffrey Baruch and David Robins); and Hand- book of Mentalization-Based Treatment (with Jon Allen). Anthony W. Bateman, M.A., FRCPsych,is Consultant Psychiatrist in Psy- chotherapy, Halliwick Unit, St. Ann’s Hospital, Barnet, Enfield, and Haringey Mental Health Trust; Visiting Professor, University College London; and Visiting Consultant, The Menninger Clinic and the Men- ninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine. In collaboration with Peter Fonagy, he has devel- oped mentalization-based treatment for personality disorder and is conducting clinical research trials on its effectiveness. He is an expert member of the National Institute for Clinical Excellence (NICE) devel- opment group for treatment guidelines for borderline personality dis- order in the United Kingdom. He has authored numerous research articles and book chapters on personality disorder and the use of psy- chotherapy in psychiatric practice. His several books include Psycho- therapy for Borderline Personality Disorder: Mentalization-Based Treatment and Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide, both co-authored with Peter Fonagy. Disclosure of Interests: The authors of this volume have no competing interests to declare. Foreword The Ox Cart An ancient philosophical riddle asks the following question: “What is the most important part of an ox cart?” Most people answer, “The wheel.” “The ox.” “The cart.” “The driver.” “The axles.” “The apparati connect- ing the ox to the cart,” etc. One seasoned psychoanalyst even quipped, partially in jest, “The whip.” The answer to this riddle that I prefer is, “The concept of an ox cart.” I believe that this is, by far, the best answer to the riddle, because the answer demonstrates how important and how powerful concepts can be—even if concepts are unable to be seen, pal- pated, or imaged with MRI. A related question is, “What, among the vast universe of concepts, makes a particular concept potent or valuable?” I propose that there are four elements that measure the merit of a concept: 1) the clarity of its def- inition; 2) its utility; 3) its longevity; and 4) its elaboration into future concepts. Applying these four elements to the ox cart: the concept of joining a pair of wheels to a pair of axles, fastening these to a wooden box, and then attaching the wheeled box to an ox is clearly defined (ele- ment #1); of obvious use for transportation of people and goods (element #2); and after 3,000 years since its initial conceptualization, remains in use to this very day in many parts of the world (element #3). Further, the ox cart has evolved into more potent concepts (element #4)—such as the automobile and truck, which, like the ox cart, are four-wheeled vehicles for transportation of humans and material goods, with the power source in the front and a seated human responsible for the guidance. Note that I do not propose that “originality” and “novelty” are requisite measures ix

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