Forging a link between arts therapies and mentalization-based treatment
When clients work with nonverbal means such as art, movement or music in a way that focuses specifically on affect regulation and mentalization, it gives them an opportunity to grow mentally.
Mentalizing in Arts Therapy describes the use of therapeutic art, music, and dance interventions against a background of mentalization, thus forging a link between arts therapies and mentalization-based treatment. This book has its roots in the theory of Mentalization-based Treatment by Antony Bateman and Peter Fonagy, and combines the broad experience of many art therapists with art, music and dance/movement therapy in psychiatric settings in the treatment of adults with personality disorders both individually and in groups, as well as adolescents and children with disorganised attachment and developmental disorders.
As a treatment concept, mentalization is quite straightforward because mentalizing is a typically human ability. As Bateman and Fonagy (2012) say: “Without mentalizing there can be no robust sense of self, no constructive social interaction, no mutuality in relationships, and no sense of personal security”.
On the other hand, it is not so simple to fully grasp the significance of mentalization. Mentalization-based therapy is a specific type of psychotherapy designed to help people reflect on their own thoughts and feelings and differentiate them from the perspectives of others.
Everyone has their own representation of the word ‘chair’
This explicit verbal form of mentalization is preceded by an earlier, more fragile stage of implicit interactive affect regulation as the mind opens up to mentalization. Physically dealing with art mediums, movements, or musical sounds is one way of representing this implicit self-regulation. It is an immediate way in which to evaluate thoughts and feelings on nonverbal sensorimotor, perceptual and symbolic levels.
When clients work with nonverbal means such as art, movement or music in a way that focuses specifically on affect regulation and mentalization, it gives them an opportunity to grow mentally, even if they have a mild intellectual disability.
The house where Ellen wants to live later.
In this book, I have attempted to tailor the description of mentalization to the work of arts therapists, and to make it more readily recognisable by liberal use of image material. The book includes case histories portraying the use of mentalization in psychomotor therapy, dance and movement therapy, music therapy and art therapy. Wijntje van der Ende compiled an integrated development table showing the various developmental stages of the self and the corresponding levels of mentalizing with their names as used in the various therapeutic approaches. Several forms of group work that promote mentalizing are described.
Ingrid has portrayed herself with her teddy bear. Another group member says that it looks like the teddy bear is about to fall. Ingrid is upset, and says in a high-pitched, agitated voice, “Teddy bears never leave you.” Ingrid seems to be insecurely attached.
The book can be used as a guideline for mentalizing in arts therapies. The plain language, the logical composition and distribution makes it an accessible study book. I proudly quote Peter Fonagy: ‘This book is the first comprehensive introduction to this area and deserves to become a classic.’
Arts therapists often have a difficult time combining mentalization with their medium, and may even feel they have been forced into a verbal straitjacket. As often happens when changes are introduced, the old debate is revived: how much talking should there be in a nonverbal therapy?
I am lucky enough to work in a free, stimulating environment—a transitional space, as Winnicott would put it. I am curious about how nonverbal arts therapies relate to the ability to mentalize, an ability that also comes to development in the pre-verbal period of a person’s life. And how these nonverbal therapies can foster and encourage the ability to mentalize. It is such a natural and compassionate therapeutic stance with such a firm grounding in theory. As I explored the use of mentalization in arts therapies, I was once again struck by the work of Daniel Stern. He builds a bridge between the verbal and nonverbal psychotherapies by focusing attention on the pre-verbal period of life.
“Some things reach me just fine, and go back to others just fine, but other info is stained, tainted by the black at the bottom of my heart.”
In the past ten years the concept of mentalization has been embraced around the world. A wide range of disciplines have described its use in their specific field. I take great pleasure in being able to contribute to the further propagation of mentalizing in arts therapies. I hope that this book will help arts therapists to better bring to the fore the mentalizing capacity of their clients so that the gap between verbal and nonverbal psychotherapies can be bridged more easily.
“I don’t understand how she can love me and not think that I’m a monster,” Ted says after drawing this picture, also the book’s cover
In arts therapy, the way clients handle the medium forms a reflection of their problems. Many clients have a negative selfimage. They simply cannot imagine that anyone else likes them or even loves them, because they see themselves as a “monster”. Their ability to mentalize may be underdeveloped, or it may regularly leave them in the lurch because their emotions can quickly become overwhelming.
Two works by Angelique, who is allowed to see very little of her children because of her irresponsible behaviour. First she has represented herself as a mother bear, with her children happy and smiling in her pouch; she has them close to her heart.
In the second work her unhappy children are out of her reach, held captive by the care facility snake. The snake speaks with a forked tongue, is untrustworthy and dangerous.
Angelique has managed to represent her deepest wish and her hate. It is now easy for the other group members to feel how very awful she thinks this is. Angelique seems to be one hundred percent certain of how this must feel for her children; she is in the equivalent mode. Naturally, it is extremely hard for a mother not to be allowed to take care of her children. The first thing she needs in therapy is support. In the therapy group, we try to keep Angelique’s mind in mind, and at the same time we help her to keep her own children’s minds in mind. Can she imagine that the children might experience this differently? How do they feel in their new situation?
He has formed an attachment, and we can all see it.
Marianne Verfaille started her career working with children with attachment problems. For the past twenty years she has been senior art therapist at De Wende, a psychotherapeutic day treatment centre for people with personality disorders in Eindhoven, in the southern Netherlands. She has been a driving force behind the movement to integrate mentalizing into arts therapies since 2004. Marianne developed the professional course on mentalizing in arts therapies which ultimately led to her book, Mentalizing in Arts Therapies, recently published by Karnac Books. She also has her own practice, “Marianne Verf”, offering further training and refresher courses for arts therapists. She lectures at RINO, the Regional Institute for Further Training in Amsterdam and is a registered supervisor and registered MBT-specialised therapist. Marianne has a number of publications to her name.
Reviews and Endorsements
‘Art therapy is arguably the most fertile area of application for mentalization based techniques. This book is the first comprehensive introduction to this area and deserves to become a classic.’
– Peter Fonagy, Freud Memorial Professor of Psychoanalysis and Head of the Research Department of Clinical, Educational and Health Psychology, UCL; Chief Executive, Anna Freud Centre, London
‘With a delightfully light touch, Marianne Verfaille deftly circumscribes the mentalization informed approach to arts therapy praxis she has developed with her colleagues. She vibrantly illustrates the art of mentalizing while bringing professional clarity and vigour to the arts therapies. The result is a joyful and compassionate testimony to the significance and efficacy of the arts therapies with contemporary clinical populations.’
– Ruth E. Jones, psychotherapist, author of Foreshoring the Unconscious: Living Psychoanalytic Practice and co-editor of Psychodynamic Art Therapy Practice with People on the Autistic Spectrum
‘Marianne Verfaille and colleagues have written a book that will appeal to all expressive therapists. Every major theoretical point comes alive through detailed clinical examples illustrated by rich images, all of which will help expressive arts therapists fully integrate the process of mentalization.’
– Lisa D. Hinz, PhD, ATR clinical psychologist and art therapist, author of Drawing from Within: Using Art to Treat Eating Disorders, and Expressive Therapies Continuum: A Framework for Using Art in Therapy