Mentalizing as Common Ground
for Psychotherapy:
Educating Patients and Clinicians
Jon G. Allen, Ph.D.
The Menninger Clinic
Baylor College of Medicine
jallen@menninger.edu
Collaboration
Colleagues
 Peter Fonagy, Mary Target & Anthony Bateman;
Efrain Bleiberg, Pasco Fearon, Toby HaslamHopwood, Elliot Jurist, George Gergely, Jeremy
Holmes, Linda Mayes, Richard Munich, Lois Sadler,
John Sargent, Carla Sharp, Arietta Slade, Helen
Stein, Stuart Twemlow, Laurel Williams
Consortium
 University College London, Anna Freud Centre,
Yale Child Study Center, The Menninger Clinic,
Human Neuroimaging Laboratory at Baylor College
of Medicine
Books
Fonagy, Gergely, Jurist & Target (2002). Affect regulation, mentalizing,
and the development of the self. New York: Other Press.
Bateman & Fonagy (2004). Psychotherapy for borderline personality
disorder: Mentalization-Based Treatment. New York: Oxford
University Press.
Bateman & Fonagy (2006). Mentalization-Based Treatment for
borderline personality disorder: A practical guide. New York: Oxford
University Press.
Allen & Fonagy, Eds. (2006). Handbook of Mentalization-Based
Treatment. Chichester, UK: John Wiley & Sons.
Allen, Fonagy, & Bateman (2008). Mentalizing in clinical practice.
Washington, DC: American Psychiatric Publishing.
Definitions of “mentalizing”
mentalizing is a form of imaginative mental activity, namely,
perceiving and interpreting human behavior as conjoined with
intentional mental states (e.g., needs, desires, feelings,
beliefs, goals, purposes, and reasons)
Shorthand
• attending to mental states in self and others
• holding mind in mind
•
•
•
holding heart and mind in heart and mind
mindfulness of mind
understanding misunderstandings
Part I
Mentalizing as a common factor
in psychotherapeutic treatment
A capsule history of “mentalizing”
First recorded use of the word, 1807
First appeared in Oxford English Dictionary, 1906
give a mental quality to; picture in the mind;
cultivate mentally
Used in French psychoanalytic literature in late 1960s
Employed in understanding autism in 1989 (Morton)
Employed in understanding developmental
psychopathology in 1989 (Fonagy) and extended
to treatment of BPD (Bateman & Fonagy)
Advocated as a common factor in psychotherapeutic
treatment (Allen, Fonagy & Bateman)
Much, if not all, of the effectiveness of different forms of
psychotherapy may be due to those features that all have in
common rather than those that distinguish them from each other.
—Jerome Frank (1961): Persuasion and healing
What is the therapeutic alliance if not an attachment bond?
—Jeremy Holmes (2001): The search for the secure base
Mentalizing is the most fundamental common factor among
psychotherapeutic treatments…perforce, clinicians mentalize in
conducting psychotherapies and also engage their patients in doing
so.
—Allen, Fonagy, & Bateman, Mentalizing in Clinical Practice
In advocating mentalization-based treatment we claim no innovation.
On the contrary, mentalization-based treatment is the least novel
therapeutic approach imaginable.
—Allen & Fonagy, Handbook of Mentalization-Based Treatment
mentalizing, even if not always explicit in our language, is implicit in
many forms of psychotherapy…Allen and colleagues, of course, have
already said this, when they suggest: “You’re already doing it.” And
indeed we are, if we’re doing our job.
—Oldham (2008), Epilogue to Mentalizing in Clinical Practice
Two broad questions
What is distinctive about mentalizing?
as a treatment approach?
as a concept?
What’s all the fuss about?
Plakun’s Y model: Generic and specific facets
cognitive-behavioral
psychodynamic
formulation
boundaries
alliance
empathic listening
common factors
Plakun’s Y model: Generic and specific facets
cognitive-behavioral
psychodynamic
mentalizing
Treatments for BPD
Dialectical Behavior Therapy
Transference-Focused Psychotherapy
Mentalization-Based Therapy
relatively single-minded focus on
mentalizing process: consistency; a
style of psychotherapy
Implication: extensive
overlap between MBT
and other treatment
approaches to BPD
mentalizing
Mentalizing: Generic and specific facets
Third-Generation CognitiveBehavioral Therapies
Mentalizing Focus in
Psychotherapy
metacognitive approaches
Acceptance and Commitment Therapy (ACT)
mindfulness practice
mentalizing
The Menninger Clinic: Historical Context
Long-term psychoanalytically oriented hospital treatment
throughout most of its history in Topeka, Kansas
Gradual reductions in hospital stays coupled with
increasing array of partial-hospital and outpatient
services
Increasing theoretical eclecticism (e.g., CBT, DBT,
psychoeducational approaches)
Downsizing to specialty inpatient treatment programs with
4-8 week lengths of stay
Relocation to Houston, Texas to partner with Baylor
College of Medicine
Jump-starting treatment for treatment-resistant patients
Developing the “common factor” approach to
mentalizing at The Menninger Clinic
Wide range of disorders beyond BPD: depression, anxiety,
trauma, substance abuse, other PDs
Professionals in Crisis program emphasizes mentalizing; initiated
psychoeducational intervention
Clinicians’ resistance to “mentalizing”
sounds foreign
already know it all
Increasing desire for conceptual coherence in a
psychotherapeutic culture (integrative function)
Belatedly educating clinicians after educating patients
Mentalization-Based Adolescent Treatment Program developed in
consultation with Peter Fonagy, Mary Target, & Anthony
Bateman
Complaints
“Mentalization” has an intellectualizing and potentially
dehumanizing ring to it and must be humanized:
 We must keep in mind that the mental states
perceived and the process of perception are
suffused with emotion; mentalizing is a form of
emotional knowing
A grammatical preference for the verb (or gerund)
 emphasizes agency, activity, and process;
 mentalizing is mental action; something we do
 Aspiring to render “mentalizing” an everyday
word rather than a technical concept
New words
The word in language is half someone else’s. It becomes
‘one’s own’ only when the speaker populates it with his own
intention….many words stubbornly resist, others remain
alien, sound foreign in the mouth of the one who
appropriated them and who now speaks them…Language is
populated—overpopulated—with the intentions of others.
Expropriating it, forcing it to submit to one’s own intentions
and accents, is a difficult and complicated process.
—Wertsch: Mind as action
Mentalizing emotion (“mentalized affectivity”)
Mentalizing
• transforming non-mental into mental
• mentally elaborating primitively mental experience
Emotion includes much that is potentially non-mentalized
•
•
•
•
non-conscious cognitive appraisals
physiological arousal
action tendencies and motoric activation
expressive motor behavior
Emotion (affect) is mentalized when felt
Mental elaboration includes understanding and attributing meaning to
feelings, which includes continuous conscious cognitive appraisals
and reappraisals
Mentalizing in the midst of emotion
Mentalizing while remaining in the emotional state
1. identifying feelings
•
•
labeling basic emotions
awareness of conflicting emotions
•
attributing meaning to emotions (narrative)
2. modulating emotion
•
downward and upward
3. expressing emotion
•
outwardly and inwardly
Two impairments of mentalizing (besides misuse):
too little or too much imaginativeness
nonmentalizing
mentalizing
distorted
mentalizing
concreteness,
indifference,
aversion
grounded
imagination
imagination gone
wild (paranoia)
mindblindness
excrementalizing
Overlapping concepts (hairsplitting)
mindblindness: antithesis of mentalizing; employed originally to
characterize autism
mindreading: applies to others and focuses on cognition
theory of mind: conceptual framework for mentalizing, focuses on
cognitive development
metacognition: focuses primarily on cognition in the self
decentering: observe one’s thoughts/feelings as events in mind
reflective functioning: measurement of mentalizing in attachment context
mindfulness: focuses on present and not limited to mental states
empathy: focuses on others and emphasizes emotional states
emotional intelligence: pertains to mentalizing emotion in self and others
psychological mindedness: broadly defined, the disposition to mentalize
insight: mental content that is the product of the mentalizing process
Mentalizing as an umbrella term
Full range of mental states
Self and others
Implicit (intuitive) and explicit (deliberate) processes
Varying time frame
present
past
future
Varying scope
narrow (e.g., feeling at the moment)
broad (e.g., autobiographical narrative)
Criticisms of “mentalizing”
Choi-Kain & Gunderson (Am J Psychiatry, in press)
•
•
•
The concept is broad and multidimensional
The core measure, the Reflective Functioning Scale, yields only a single
score, is time-consuming and costly, and has limited research
Research should focus on more limited-domain concepts for which (primarily
self-report) measures have been developed (e.g., theory of mind,
mindfulness, psychological mindedness, empathy, affect consciousness)
Semerari, Dimaggio et al., Metacognitive Assessment Scale
•
•
Separates self and others
Differentiates four facets




Identifying mental states
Differentiating subjective from objective (mental states as representational)
Relating mental states to each other and behavior
Integrating metacognitive knowledge into abstract narratives
Limitations of emphasizing process over content
Mentalizing: links to other domains of knowledge
THEORY OF MIND
EVOLUTIONARY
BIOLOGY
NEUROBIOLOGY
MENTALIZING
PSYCHOANALYSIS
ATTACHMENT
ethics
PHILOSOPHY
philosophy of mind
Mentalizing: links to other domains of knowledge
THEORY OF MIND
EVOLUTIONARY
BIOLOGY
NEUROBIOLOGY
MENTALIZING
PSYCHOANALYSIS
ATTACHMENT
ethics
PHILOSOPHY
philosophy of mind
Part II
Attachment trauma and impaired mentalizing:
A focus for psychotherapy
Trauma spectrum
impersonal
trauma
interpersonal
trauma
attachment
trauma
nonhuman
agent
human agent
attachment
figure
Attachment trauma: Two senses
 Trauma that occurs in an attachment
relationship, in childhood or adulthood
 Trauma that adversely affects the capacity
for secure attachment—the bane of the
therapeutic relationship
Dual liability associated with attachment
trauma in childhood (Fonagy & Target)
 provokes extreme, repeated stress
 undermines the development of the capacity to
regulate distress
§ insecure (disorganized) attachment
§ impaired mentalizing capacity
§ impaired self-regulation
Intergenerational transmission of mentalizing
A mother’s capacity to hold in her own mind a representation of
her child as having feelings, desires, and intentions allows the
child to discover his own internal experience via his mother’s
representation of it; this representation takes place in different
ways at different stages of the child’s development and of the
mother-child interaction. It is the mother’s observations of the
moment to moment changes in the child’s mental state, and her
representation of these first in gesture and action, and later in
words and play, that is at the heart of sensitive caregiving, and is
crucial to the child’s ultimately developing mentalizing capacities
of his own [Slade, 2005]
Intergenerational transmission of mentalizing
mentalizing [is] the mechanism by which (1) the mother-child
relationship exerts its influence on the attachment security of the
child and (2) the mother-child relationship influences the child’s
socio-cognitive development…secure attachment is fostered through
accurate and appropriate parental mentalizing of the child, which in
turn positively stimulates the development of the mentalizing
capacity of the child. As a result, the mentalizing child is able to form
a secure attachment to the parent…The parent’s capacity to engage
in accurate and appropriate mentalizing may be disrupted by a
variety of child characteristics, most notably temperament. The
process by which secure attachment is fostered via accurate and
appropriate parental mentalizing is therefore likely to be
bidirectional. (Sharp & Fonagy, 2008, Social Development)
High parental reflective functioning (mentalizing)
Sometimes she gets frustrated and angry (child mental state) in
ways I’m not sure I understand (opacity of child’s mental state). She
points to one thing and I hand it to her but it turns out that's not
really what she wanted (opacity). It feels very confusing to me
(mother's mental state) when I’m not sure how she’s feeing (opacity
of child's mental state) especially when she’s upset. Sometimes she’ll
want to do something and I won’t let her because it’s dangerous and
so she'll get angry (mother recognizes diversity of mother and child
mental states). (Slade, 2005)
Model of intergenerational transmission and developmental psychopathology
child
attachment
security
parental attachment
security
child
mentalizing
parental mentalizing
in relation to
childhood attachment
parental
mentalizing of
child
emotion
regulation
psychosocial
functioning
adapted from Sharp & Fonagy
(2008) Social Development
Intergenerational transmission of trauma
Disturbed and abusive parents obliterate their
children’s experience with their own rage, hatred,
fear, and malevolence. The child (and his mental
states) is not seen for who he is, but in light of the
parents’ projections and distortions. The infant
then takes on the parent’s hatred and aggression,
a primitive form of identification with the aggressor
[Slade 2005]
“Trauma” broadly construed
ALONE
AFRAID
unbearable
emotional
states
DBT:
affective dysregulation
+
absence of
experience of
being mentalized
feeling abandoned
neglected, unloved,
invisible
invalidating environment
IMPAIRED
MENTALIZING
CAPACITY
BPD
Mentalizing failure in traumatizing behavior
traumatizer
terrorizing
mindblind
ALONE
AFRAID
unbearable
emotional
states
+
absence of
experience of
being mentalized
feeling abandoned
neglected, unloved,
invisible
IMPAIRED
MENTALIZING
CAPACITY
Non-mentalizing modes of experience
psychic equivalence: world=mind; mental representations are not
distinguished from the external reality that they represent, such that
mental states are experienced as real, as in dreams, flashbacks, and
paranoid delusions. [clinical example: “dead”]
pretend: mental states are separated from reality but maintain a sense
of unreality inasmuch as they are not linked to or anchored in reality
teleological: an action-oriented mode in which mental states such as
needs and emotions are expressed in action; only actions and their
tangible effects—not words—count.
mentalized: actions are understood in conjunction with mental states
(as contrasted to the teleological mode), and mental states have
neither an exaggerated sense of reality nor unreality but rather are
appreciated as representing multiple perspectives on reality (as
contrasted with the psychic equivalence and pretend modes).
PTSD and psychic equivalence
psychic
equivalence
mentalizing
mind=world
mind
represents
world
REEXPERIENCING
flashbacks &
nightmares
REMEMBERING
as painful
experience
The pretend mode: bullshitting
This is the crux of the distinction between [the bullshitter] and the liar.
Both he and the liar represent themselves falsely as endeavouring to
communicate the truth. The success of each depends upon deceiving us
about that. But the fact about himself that the liar hides is that he is
attempting to lead us away from a correct apprehension of reality; we
are not to know that he wants us to believe something he supposes to
be false. The fact about himself that the bullshitter hides, on the other
hand, is that the truth-values of his statements are of no central
interest to him; what we are not to understand is that his intention is
neither to report the truth nor to conceal it. This does not mean that
his speech is anarchically impulsive, but that the motive guiding and
controlling it is unconcerned with how the things about which he speaks
truly are.
Frankfurt: On Bullshit
An ironic mentalizing perspective on self-knowledge
There is nothing in theory, and certainly nothing in experience, to
support the extraordinary judgment that it is the truth about himself
that is easiest for a person to know. Facts about ourselves are not
peculiarly solid and resistant to skeptical dissolution. Our natures are,
indeed, elusively insubstantial--notoriously less stable and less inherent
than the natures of other things. And insofar as this is the case,
sincerity itself is bullshit.
Frankfurt: On Bullshit
Applications to BPD
Persons with BPD often mentalize adequately but are highly
vulnerable to losing mentalizing, especially when attachment
needs are activated in the context of insecure attachments (e.g.,
distrust; threat of loss or betrayal)
frantic responses to perceived abandonment can be construed as
posttraumatic reexperiencing of painful emotional states in the
context of non-mentalizing attachment relationships
the core “trauma” in BPD might be the failure to develop robust
mentalizing capacities stemming from relative deficiency of
mentalizing in early attachment relationships (with or without
abuse)
this trauma is associated with impaired affect regulation and impaired
social cognition, especially in attachment contexts (i.e., when
attachment needs are evoked), including in psychotherapy
relationships, which have the potential to undermine mentalizing if
too stimulating
Mentalization-Based Therapy for BPD
Bateman & Fonagy, American Journal of Psychiatry, 2008
Effectiveness of MBT Day Hospital vs. Treatment as Usual
•
•
•
•
•
•
8-year follow-up (5 years post-termination of MBT)
23% versus 74% of patients made suicide attempts
fewer ER visits and hospital days; less medication use
13% versus 87% met criteria for BPD at end of follow-up
Significant differences in impulsivity and interpersonal functioning
(including marked improvement in intense-unstable relationships and
frantic efforts to avoid abandonment)
three times longer periods of good vocational functioning
Minding the Baby: Sadler, Slade, & Mayes
High-risk, first-time inner city parents and infants
Extends from pregnancy to child’s second birthday
Nurse home visitation
Infant-parent psychotherapy
promote mother’s mentalizing re: the self (e.g., verbalizing
feelings about pregnancy)
promote mother’s mentalizing re: the infant (e.g., speaking
for the infant)
Mentalization-Based Adolescent Treatment Program:
Efrain Bleiberg, Laurel Williams, Carla Sharp
Develop assessment and treatment for emerging
personality disorder
Assessment
•
•
•
•
•
•
Diagnoses
Mentalizing capacity
Executive and cognitive functioning
Trauma history
Emotion regulation and risky behaviors
Family functioning (parenting style, attachment, mentalizing)
Part III
Promoting an alliance through psychoeducation
Psychoeducational Approach
Purposes
•
•
promote a therapeutic alliance
draw patients’ attention to a natural process
Curriculum
•
•
•
•
understanding mentalizing and its development
psychiatric disorders and mentalizing impairments
how treatment modalities promote mentalizing
mentalizing exercises (projective, metaphors, role-playing, etc.)
Incorporating “mentalizing” into other psychoeducational groups
•
•
Coping with trauma
Coping with depression
Articles for patients and family members
Allen, Bleiberg, & Haslam-Hopwood (2003). Mentalizing as a compass for treatment.
Allen, Fonagy, Bateman (2008). What is mentalizing and why do it? (Appendix in Mentalizing
in clinical practice)
Broad scope of mentalizing
thoughts
feelings
self
others
empathy
Holding mind in mind
Holding mind in mind in emotional states
Part IV
Cultivating mentalizing in psychotherapy:
Mentalizing begets mentalizing
what good therapists do with their patients is analogous
to what successful parents do with their children
—Jeremy Holmes (2001): The search for the secure base
Mentalizing as the engine of attachment: Therapist’s
contribution (in caregiving role)
 Fostering an attachment relationship; emotional proximity
 Attentiveness to distress (empathy, attunement, responsiveness)
 “Marked” emotional responsiveness: representing the patient’s emotion to
the patient rather than becoming fully immersed in it
 Emotional self-awareness and self-regulation
 Providing support, encouragement and help while appraising and
respecting the patient’s competence and autonomy
 Questioning and challenging the patient’s perspective while providing
alternative perspectives
 Understanding how attachment patterns are reenacted from childhood to
adulthood and in the transference with the caveat that process
(mentalizing capacity) is emphasized over content (specific insights)
 Note parallels to a secure base in supervision
Core mentalizing competencies for therapists (and patients)
 Affective competence (Diana Fosha)






How affect is handled relationally
The capacity to feel and deal while relating
Neither overwhelmed nor hostile to emotion in patient or self
Requires affect tolerance and affect regulation
Allows therapist to provide an affect-facilitating environment
Note: entails “mentalized affectivity” or mentalizing emotion
 Narrative competence (Jeremy Holmes)




Psychological equivalent of immunological competence
Collaborative and coherent discourse (e.g., as in secure/autonomous AAI
narratives)
Balancing prose and poetry, stories and images
Evident in story telling, story listening, story-understanding; story making and
story breaking
Narrative competence
Secure attachment is marked by coherent stories that convince and
hang together, where detail and overall plot are congruent, and
where the teller is not so detached that affect is absent, is not
dissociated from the content of her story, nor is so overwhelmed
that her feelings flow formlessly into every crevice of the dialogue.
Insecure attachment, by contrast, is characterized either by stories
that are over-elaborated and enmeshed, or by dismissive, poorly
fleshed-out accounts…[there are] three prototypical pathologies of
narrative capacity: clinging to rigid stories, being overwhelmed by
unstoried experience, or being unable to find a narrative strong
enough to contain traumatic pain.
—Jeremy Holmes (2001): The search for the secure base
Our Humanity: The art of mentalizing
Appeal to special abilities of analysts must not violate the
following principle: It must be possible to show that the
claimed capacities are refinements of ordinary human
capacities, and it must be made plausible why under specified
circumstances such refinement can actually occur. This can
be called the continuum principle, because it postulates that
the abilities claimed for analysts must be on a continuum
with ordinary human abilities.
—Carlo Strenger Between hermeneutics and science: An essay on the
epistemology of psychoanalysis
Mentalizing as the engine of attachment: patient
contribution to attachment relationships
 Selection of attachment figures and appraisal of trustworthiness
 Self-awareness regarding needs and feelings
 Expression of emotional distress (affective competence) and context
(narrative competence); associated emotion-regulation skills
 Appraisal of the attachment figure’s receptiveness, attunement,
responsiveness (i.e., the caregiver’s mentalizing)
 Appraisal of the effectiveness of strategies to influence the caregiver’s
responsiveness
 Ability to manage conflicts, understand misunderstandings, and repair
ruptures
 Correcting and updating mental representations of self and others (internal
working models)
 Reciprocating caregiving
Mentalizing in maintaining an internalized secure base
 Jeremy Holmes: “the secure base can be seen not just as an eternal figure,
but also as a representation of security within the individual psyche”
 Activating mental representations and memories of secure attachment
experiences
 Relating to oneself in an empathic manner, for example, protective,
encouraging, reassuring, accepting, compassionate, approving (mentalizing
stance)
 Engaging in comforting and self-soothing activities
Parallel contributions to mentalizing: Meeting of minds in therapy
attachment & arousal
mentalizing
Patient
attachment & arousal
mentalizing
current
functioning
attachment & arousal
current
functioning
mentalizing
attachment & arousal
developmental
history
mentalizing
Therapist
developmental
history
A patient’s perspective on Bowlby
John Bowlby: the role of the psychotherapist is “to
provide the patient with a secure base from which
he can explore the various unhappy and painful
aspects of his life, past and present, many of which
he finds it difficult or perhaps impossible to think
about and reconsider without a trusted companion
to provide support, encouragement, sympathy,
and, on occasion, guidance.” [A Secure Base]
Jon Allen: “The mind can be a scary place.”
Patient: “Yes, and you wouldn’t want to go in there
alone!”
The ability to think and talk about past pain is a protective factor
leading to secure attachment, no matter how traumatic a
childhood may have been. This inspiring finding is in itself an
endorsement of psychotherapy, on of whose main functions, it can
be argued, is to enhance reflective function [mentalizing].
—Jeremy Holmes (2001): The search for the secure base
Challenges: Simone Weil
At the bottom of the heart of every human being, from earliest infancy
until the tomb, there is something that goes on indomitably expecting,
in the teeth of all experience of crimes committed, suffered, and
witnessed, that good and not evil will be done to him. It is this above all
that is sacred in every human being.
Affliction is by nature inarticulate. The afflicted silently beseech to be
given the words to express themselves. There are times when they are
given none; but there are also times when they are given words, but illchosen ones, because those who choose them know nothing of the
affliction they would interpret.
Thought revolts from contemplating affliction, to the same degree that
living flesh recoils from death. A stag advancing voluntarily step by step
to offer itself to the teeth of a pack of hounds is about as probable as an
act of attention directed towards a real affliction, which is close at hand,
on the part of a mind which is free to avoid it.
The Mentalizing Stance (mentalizing mindfully)
Psychological aspects
 inquisitive, curious, playful, open-minded
 “not knowing” (cleverness as cardinal sin)
 not creating the capacity but rather promoting attentiveness to
the activity of mentalizing
Ethical aspects (as in parenting, for example)
 good will and compassion
 acceptance and forgiveness


respect for autonomy
love
Therapeutic paradox




activating attachment needs undermines
mentalizing for patients with insecure
attachment
psychotherapy activates attachment needs
patient must learn to mentalize in the context
of intense emotional states in attachment
relationships
note contrast with mindfulness practice
General tips on mentalizing in psychotherapy
You are doing it already
Cultivate alternative perspectives
Balance focus on self and others
Maintain an optimal level of emotional arousal
Challenge patient’s assumptions about your mental states
Focus on mental states in the here-and-now, in current
relationships and in the transference
Avoid attributing mental states to patients of which they are
unaware; liable to be taken in as alien or rejected outright
[extremely common in our setting with “anger”]
Use “I” statements
Example of “I” Statements (Bateman & Fonagy)
“You are angry with me”
versus
“The way you are frowning makes me think that you
may be feeling angry about something and I am
wondering what that may be about”
Mentalizing the transference
validating the patient’s experience of the patienttherapist interaction
exploring the current patient-therapist relationship
accepting and exploring enactments, including the
therapist’s own contribution and the therapist’s
distortions
collaborating in arriving at an understanding
presenting an alternative perspective
monitoring and exploring the patient’s reaction
Transference work: transparency
The patient has to find himself in the mind of the therapist and, equally, the therapist has to
understand himself in the mind of the patient if the two together are to develop a mentalizing
process. Both have to experience a mind being changed by a mind (Bateman & Fonagy)