Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / Episode 2,How Mentalization Grows

Transcript

Episode 2,How Mentalization Grows · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:02
  SPEAKER_00: Now yesterday I talked about what mentalization is, what it means, and today I want to move on to how is it formed?
• 0:12
  SPEAKER_00: Because many people think that learning is a cognitive function, something that occurs as a consequence of information.
• 0:25
  SPEAKER_00: But of course, we also know that learning occurs through experience.
• 0:30
  SPEAKER_00: What is learned, however, cannot be relied upon.
• 0:34
  SPEAKER_00: And I say this because sometimes as parents we are trying to teach children things, but just because we are trying, whether that's explicit or implicit, in fact the child's experience of that is subjective.
• 0:51
  SPEAKER_00: And this is important because in its own way that tells us that the child's capacity to make usable sense of what they're experiencing may or may not result in them learning and accepting what it is we're trying to teach through our actions.
• 1:14
  SPEAKER_00: So if mentalization is the ability to understand ourselves and others in terms of thoughts and feelings, wishes and intentions, then we have to understand how this ability develops, and the answer may surprise you.
• 1:29
  SPEAKER_00: They don't, as I've said, learn by being taught.
• 1:33
  SPEAKER_00: As I've said, they learn it by the way it's experienced.
• 1:38
  SPEAKER_00: Because long before children can speak, they are engaged in thousands of emotional exchanges every day.
• 1:45
  SPEAKER_00: A baby becomes frightened, a parent notices and responds.
• 1:50
  SPEAKER_00: The baby gradually settles.
• 1:51
  SPEAKER_00: Now, to most people, this looks ordinary.
• 1:54
  SPEAKER_00: In reality, something extraordinary is happening.
• 1:58
  SPEAKER_00: The child is beginning to discover that internal experiences can be both understood, shared, and tolerated.
• 2:08
  SPEAKER_00: Now, this idea sits really at the heart of the work of Peter Foneggy and Mary Target.
• 2:14
  SPEAKER_00: They propose that children develop mentalization through relationship with caregivers who are capable of reflecting upon the child's internal world.
• 2:25
  SPEAKER_00: I'm going to say that again.
• 2:27
  SPEAKER_00: Capable of reflecting upon the child's internal world.
• 2:32
  SPEAKER_00: So, in simple terms, the child develops a mind capable of understanding minds because somebody first understands theirs.
• 2:42
  SPEAKER_00: Imagine that a toddler falls over.
• 2:46
  SPEAKER_00: There are three possible responses.
• 2:51
  SPEAKER_00: The first is stop crying, you're fine.
• 2:54
  SPEAKER_00: The second is oh god, well, I'm gonna have to call an ambulance.
• 2:58
  SPEAKER_00: I know that's a bit dramatic, but I'm just to make the point.
• 3:01
  SPEAKER_00: Or, oh, that hurt.
• 3:03
  SPEAKER_00: That gave you a fright, didn't it?
• 3:04
  SPEAKER_00: Now the difference is profound because in the first response, the emotional experience is dismissed.
• 3:13
  SPEAKER_00: In the second, the emotional experience is amplified and one in which the child then becomes alarmed not just by their own experience of falling over, but the experience of the caregiver who is clearly panicked by or overreacts to what is fundamentally an incident which is best managed in the third, because what what what is what is happening is all that is that the emotional experience is recognized, it's named, it's understood, and then children are okay.
• 3:53
  SPEAKER_00: Now, this process is often called reflective functioning.
• 3:58
  SPEAKER_00: It's the parent's capacity to think about the child's behavior in terms of underlying emotional states.
• 4:05
  SPEAKER_00: A reflective parent looks beyond behavior.
• 4:08
  SPEAKER_00: They ask, what might my child be feeling?
• 4:11
  SPEAKER_00: What might they be thinking?
• 4:13
  SPEAKER_00: What need are they trying to communicate?
• 4:17
  SPEAKER_00: Importantly, reflective parents aren't mind readers.
• 4:21
  SPEAKER_00: They don't always get it right.
• 4:23
  SPEAKER_00: And as a therapist, I encounter this because I'm trying to look beneath what I'm hearing, what I'm seeing, and I'm trying to speculate internally what might the patient be experiencing.
• 4:38
  SPEAKER_00: This is particularly relevant when I might see a patient who arrives and says, I'm fine, everything's okay.
• 4:48
  SPEAKER_00: And absolutely nothing about their physical behavior confirms that.
• 4:54
  SPEAKER_00: So the question is not, are they really fine or not?
• 4:59
  SPEAKER_00: The question in my mind is what's happening.
• 5:03
  SPEAKER_00: And I might not ask.
• 5:07
  SPEAKER_00: You don't seem I hear I can hear what you're telling me, but to me it looks like there's something else as well.
• 5:15
  SPEAKER_00: I just I I wonder.
• 5:17
  SPEAKER_00: Now that's important because what I'm what I'm really trying to make contact with is that which is not being expressed through words.
• 5:29
  SPEAKER_00: And sometimes I get it wrong.
• 5:31
  SPEAKER_00: And in fact, getting it wrong is often part of the process.
• 5:35
  SPEAKER_00: But what matters is remaining curious because if you like, curiosity is the engine of mentalization.
• 5:44
  SPEAKER_00: Winnicott once wrote there is no such thing as a baby, and what he meant was that babies cannot be understood in isolation.
• 5:52
  SPEAKER_00: The same is true for the work of Lavinia Gourmet, who wrote a remarkable book about object relations theory, in which, similar to Winnicott, she was talking about the nature of how we understand that the infant exists not in isolation, but in relationship with what is generally described as the object.
• 6:20
  SPEAKER_00: Now that's a not a not a very friendly term to use, but what it refers to is the fact that for the for the baby there is not a there is not a uh an independent separate caregiver.
• 6:36
  SPEAKER_00: Babies will see the caregiver as an extension of themselves in a very primitive kind of way, and that's entirely understandable.
• 6:47
  SPEAKER_00: The recognition that the caregiver is a separate other comes over time.
• 6:55
  SPEAKER_00: Now, this is part of another developing or developmental task, which is the realization of separateness and the capacity to exist.
• 7:06
  SPEAKER_00: I feel like I'm slipping into deeper psychoanalytic territory, but essentially the parent doesn't become an attachment figure in a recognizable sense very quickly, although there's some fascinating research in neuroscience about responses that can be observed between the baby and the caregiver and how they may have different responses to different caregivers.
• 7:39
  SPEAKER_00: And we're talking about very early on.
• 7:43
  SPEAKER_00: However, to return to the subject, it is important here to understand that the infant exists within a relationship or relationships.
• 7:56
  SPEAKER_00: Development occurs between people, and mentalization is no exception.
• 8:02
  SPEAKER_00: The infant first learns about themselves through the responses of those who care for them.
• 8:09
  SPEAKER_00: So when a caregiver consistently notices, reflects, and responds to emotional experiences, the child begins to develop an internal model of how minds work.
• 8:22
  SPEAKER_00: They start to understand I have feelings, other people have feelings.
• 8:28
  SPEAKER_00: People's behavior is connected to what is happening inside them.
• 8:33
  SPEAKER_00: Now, this understanding is crude at first, of course, but it becomes increasingly more sophisticated throughout childhood.
• 8:42
  SPEAKER_00: The young child learns to recognize emotions, but the older child begins to understand perspectives.
• 8:50
  SPEAKER_00: The adolescent starts to appreciate complexity and contradiction.
• 8:55
  SPEAKER_00: And eventually they discover one of the most important truths of all, and that is that two people can experience the same events very differently.
• 9:06
  SPEAKER_00: Mentalization allows us to hold multiple perspectives simultaneously, and this is incredibly important because when people talk about open-mindedness, I think, although the inference might be that this can be used as a judgment, I am open-minded, others aren't, a good example of open-mindedness.
• 9:29
  SPEAKER_00: But I think the point here is that think of a lens through which we see others and through through which we see ourselves, through which we see the intentions of others, and through which we understand and experience nuance.
• 9:53
  SPEAKER_00: We can see what is in many ways not visible.
• 9:57
  SPEAKER_00: Now, how wide is the lens?
• 10:00
  SPEAKER_00: Some people will have a very narrow lens for all kinds of reasons, developmentally that may be the case.
• 10:06
  SPEAKER_00: They've learned perhaps to have a narrow lens that has been conditioned by judgment and uncertainty and all manner of other factors that put them into a state where they develop a kind of survival lens.
• 10:23
  SPEAKER_00: Some people have much wider lenses because they ask questions.
• 10:28
  SPEAKER_00: But the questions they ask are actually questions about themselves.
• 10:33
  SPEAKER_00: What sense do I make of this?
• 10:35
  SPEAKER_00: What don't I know?
• 10:36
  SPEAKER_00: What can't I see?
• 10:37
  SPEAKER_00: What else could explain this?
• 10:39
  SPEAKER_00: This is active mentalization.
• 10:41
  SPEAKER_00: And I think it's the fact that we can understand our experiences demonstrates that we are open to the idea that there are different kinds of realities, different kinds of perspectives.
• 10:59
  SPEAKER_00: And this is one of the reasons mentalization is so important in families.
• 11:05
  SPEAKER_00: Because conflict often emerges when people stop wondering and start assuming, when certainty replaces curiosity, when behavior becomes all that we see.
• 11:18
  SPEAKER_00: Mentalization reintroduces the missing the missing questions.
• 11:22
  SPEAKER_00: What might be happening inside the parents behind other family members?
• 11:28
  SPEAKER_00: And this these implications are powerful because you don't need to have a perfect response and you don't need to understand every feeling, and you can't prevent every upset.
• 11:39
  SPEAKER_00: But what matters is that your child experiences somebody who's trying to understand, somebody wondering, somebody staying emotionally present.
• 11:49
  SPEAKER_00: Because over time, those repeated experiences become internalized and take a composite, take a composite quality.
• 12:00
  SPEAKER_00: Because the child eventually learns to do for themselves what the parents did for them.
• 12:05
  SPEAKER_00: They become capable of recognizing their own feelings, thinking about their own thoughts and reflecting on their own behavior.
• 12:14
  SPEAKER_00: In short, they develop the ability to mentalize, and it all begins with somebody taking an interest in their mind.
• 12:23
  SPEAKER_00: What is fascinating is very often I will receive parents for first consultation and they will describe behaviors which include he just doesn't think, she just she just does something, and then when you ask her why, she says she doesn't know.
• 13:00
  SPEAKER_00: When I meet those children and see them for assessment, quite often I will ask questions like when you're struggling and being angry, for example, do you know what happens inside you?
• 13:21
  SPEAKER_00: Do you know what it feels like?
• 13:24
  SPEAKER_00: Sometimes I'll talk to children about, in fact, I spoke to one recently and I was asking about how he experienced his his anger, and I likened it to the way an aircraft might take off.
• 13:40
  SPEAKER_00: And I said, Are you somebody who travels down the runway and slowly begins to lift their nose and then take off?
• 13:50
  SPEAKER_00: And before I could finish, he said, No, I'm like a rocket, and I thought, well, there you go, that tells me all I need to know.
• 13:57
  SPEAKER_00: But it was perfect because, in a sense, we weren't questioning the authenticity or the correctness of the anger.
• 14:04
  SPEAKER_00: What we were doing was that we were identifying the process and how he had no how he he had no control of it in the moment.
• 14:15
  SPEAKER_00: But by being curious about it and trying to understand it, and me accepting that's that's what this child experiences is another example of mentalization.
• 14:26
  SPEAKER_00: This is so vital.
• 14:27
  SPEAKER_00: And many children will, once they're approached in that way, with curiosity and without without judgment or without assumption, begin to tell you things that are really quite quite powerful and amazingly informing.
• 14:49
  SPEAKER_00: So, in conclusion, the process of mentalization begins very early on.
• 14:56
  SPEAKER_00: It doesn't begin with direct teaching, it begins with action.
• 15:01
  SPEAKER_00: It begins with the child experiencing the caregiver as somebody who is preoccupied with them in a healthy in a healthy way.
• 15:12
  SPEAKER_00: This is also how attachment is formed, the type of attachment style that develops as a consequence.
• 15:20
  SPEAKER_00: There are times when parents, for their own reasons, are struggling to exercise that kind of preoccupation.
• 15:30
  SPEAKER_00: And there are very good reasons why that may be the case.
• 15:35
  SPEAKER_00: So the unspoken part of this that I now want to voice is even if you are a parent who has not been able, for whatever reasons, and there are so many circumstances that influence this, if you've not been able to act in this way or in a consistent way, please do understand it's not too late.
• 16:02
  SPEAKER_00: That's really very important.
• 16:04
  SPEAKER_00: And the reason I say that is because, as I said in the first podcast, mentalization is something that continues to evolve throughout life.
• 16:15
  SPEAKER_00: So in the next episode, we're going to look at the brain that mentalizes.
• 16:22
  SPEAKER_00: And what we're going to do is to talk about some of the technical stuff which has to do with the fascinating relationship between different parts of the brain and how these develop and the psychoneurological mechanisms that are involved.
• 16:40
  SPEAKER_00: Thank you for listening.