Using Mentalizing in practice – The Mentalization Guidebook, by Janne Oestergaard Hagelquist

Why Mentalization is a gift for anyone working with Trauma and Neglect

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The interest in mentalization as a concept has been steadily on the rise over the last decades. Mentalization and mentalization-based theory aimed at collecting different schools of thought and years of research, and by doing that has succeeded in describing complex phenomena in relation to interaction between people – both when it is successful and when high emotional arousal prevents the ability to mentalize.

Mentalization-based theory provides a collective theory about child-development in relation to their primary caregiver. Furthermore, it adds understanding to the effect of trauma – among other things on trauma’s effect on the ability to mentalize, as well as providing tools for treatment and concepts for understanding the non-specific factors in treatment.

empathy-5-2-14-1-1Mentalization theory provides a usable common language for what teachers and caregivers are already doing to support human development. In addition, the theory gives valuable hope for the successful treatment of people suffering from trauma and neglect, as the ability to mentalize can be developed and improved over the span of a single lifetime.

Most of all, I think that mentalization is a gift for everyone working with trauma and neglect. I have in recent years been doing mentalization-based supervision and education in mentalization in relation to a number of professionals; foster parents, teachers, counsellors, psychologists and parents in general. I have experienced how easy and then again useful, the concepts and tools of mentalization-based treatment are, in bringing meaning to complex psychological phenomena and bringing life and meaning to the theory in practice.

Through the years, I have written a number of books and articles about mentalization. This new book, The Mentalization Guidebook, is fundamentally practical and is meant as a tool for professionals working with traumatized and neglected people who want to use mentalization in their work. The intention of the book is to show the concepts, psycho-education methods, and tools of mentalization and trauma psychology. The purpose is to share those models and tools, along with the best tips and tricks that can be used in the daily practice working with mentalization.

hesselberth_empathy_nytimesBelow, I will take a case-driven approach to illustrate how professionals in supervision and in general practice can use the Mentalization Guidebook. Recently, I was supervising on a case in relation to a father who had fled to Europe from a Middle Eastern country. The father had lived in Denmark for the past 20 years and was married at an early age to a woman of the same religious and cultural background. He was brought to the attention of the authorities, as concerns appeared about him being violent to his 9 year old daughter. A family treatment programme was initiated, and as the professional administrating this programme, I was supervising. The family counsellor in charge told the story about the father:

In recent years, the father had been working very hard to provide for his family. He had started a small business – a news-stand, and he recently added a small restaurant to his business. The father was working day and night and spending most of the waking hours away from his home and family. This, and the fact that he himself had clear expectations about the role of his wife as a stay-at-home wife, led to conflicts between them.

The wife was raised in Denmark and even though they both came from the same cultural background, the wife had clear expectations of a more western, liberal kind of marriage. The conflict led to violent abuse and in the end, the wife left the him and their two children, a boy and a girl, in his care. The father told the family counsellor that he was frustrated, that his daughter didn’t do her domestic chores and like her mother disrespected him in his role as sole provider for the family. It was self-evident to him, that he had to punish his daughter into doing the tasks expected of her. The father explained that his only motivation now was to earn more money and eventually get a new wife – expectantly from his home country.

In supervising, I used the Mentalization Guidebook to analyse and remedy the case in the eyes of the family counsellor. The book is divided into four sections: theory and analyses, psycho-education, tools for the professional, and exercises. Please find a navigational chart below:

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Part one of the book concerns itself with mentalization theory and analysis. In this particular case, the supervision was centred around the father’s inability to mentalize and the fact that he suffered from mentalization failures primarily in the Teleological mode – a mode where only physical representation of facts count.

fig2-jpegUnder supervision, the family counsellor used the mentalization model of ‘self and other’ to engage the father in talking about the importance of being curious about the mental states behind his wife’s and daughter’s behaviour.  She was able to talk to the father about the importance of mentalizing in child caring and in good relationships, and she was curious about why the father thought that the only way to be happy and take care of his family was to provide money and to use punishment when people were not behaving the way he wanted them to. The family counsellor elaborated further on the case below:

Through the conversation with the father, it emerged that he fled with his family to Europe when he was 11 years old. Before the escape, his own father had disappeared in police custody and that had led him, his mother, and his little sister to flee. The father had, despite his young age, taken on the role as primary provider, responsible for bringing his family safely to Europe. At a border-crossing checkpoint, the father was offered the possibility that the family could be smuggled over the border for a certain sum of money. In that process he lost contact with both his mother and little sister; he hadn’t been in contact with them since. After this episode he fought his way alone through Europe as an unguarded refugee child. Since being resident in Denmark, his only aim had been to earn enough money and never again to be put in a situation where he couldn’t provide for his family.

fig3-jpegDuring the supervising session, the second part of The Mentalization Guidebook – about psycho-education – came into use in relation to talking with the father about his traumatic past. The family counsellor used the concept of the ‘triune brain’ to explain how he, when he was under a lot of pressure, would naturally fall back to using the reptilian part of the brain, and how these strategies – which were once evolutionarily useful –  are sometimes used in situations where they are no longer helpful. In relations to the loss of his family and his journey through Europe, the father had the choice of either fighting, fleeing, or giving up, and the conservation was centred around the fact that these strategies were still very much in use in his relationships and actions today.

p-142-1During the supervising session, the family counsellor told me about her own history of family violence and how it had impacted her ability to stay open and maintain a mentalizing stance. On a personal note, the case with the father had made her experience herself as angry and frustrated. And even though the proper authorities were involved and the violence had ended, the family counsellor saw the need to focus on regulating her own feelings and emotions in that regard. In part 3 of The Mentalization Guidebook, I talked the family counsellor through a number of models in relation to working with her own ability to mentalize, as a professional. She found the OPEN Thermometer and the related App particularly useful in testing her ability to have an OPEN mind before entering a meeting with this particular father.

During supervision, the family counsellor requested specific exercises to bring into her talks with the father and his two children. Peter Fonagy and his colleagues find that feelings are the royal road to mentalization. In the little family, the need to develop more mentalizing skills and develop a specific language in relation to talking about and regulating their own feelings, was obvious.

fig4-jpegIn part four of the Guidebook, the ‘Compass of emotions’ model became the gateway to providing a language about feelings, and for the father to be able to talk about his grief over losing his family as a young child. Furthermore, it made it possible for him to put into words his anger and grief concerning the fact that his wife had left him. Finally, the compass opened up the possibility of talking about the children’s parallel feeling of grief over losing their mother, whom they had lost contact with.

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Janne Østergaard Hagelquist

Using this case in supervision as an example shows how models and concepts help professionals to mentalize neglected and traumatized people and at the same time support their own ability to mentalize. This case is just one of many where The Mentalization Guidebook could be helpful in supporting the development of children, adolescents and adults.

Janne Østergaard Hagelquist is a psychologist and accredited specialist in child psychology and supervision, and founder of the Danish Center for Mentalization. Most of her work has dealt with the treatment, supervision and education in relation to neglected and traumatized children, adolescents and adults. She works to disseminate psychological knowledge in a way that is easily understandable and useful.

    Her book, The Mentalization Guidebook, has just been published by Karnac.

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