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Ep. 3-The Brain Behind Mentalization · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:01
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:04
  SPEAKER_00: This is episode three in the series concerning mentalization.
• 0:10
  SPEAKER_00: Now, in the previous episodes, we explored what mentalization is and how it develops through childhood.
• 0:17
  SPEAKER_00: But this raises another question.
• 0:21
  SPEAKER_00: And it's this what is actually happening inside the brain when we mentalize?
• 0:26
  SPEAKER_00: Now it's important to understand that the brain develops in neutral, meaning that it's beginning to actually develop, or parts of the brain are beginning to develop before the infant is even born.
• 0:41
  SPEAKER_00: Now this process goes through a series of stages postnatally and beyond and into early adult life.
• 0:53
  SPEAKER_00: So something that is happening is not a fixed state, it's an active evolving state.
• 1:00
  SPEAKER_00: And the brain is subject to changes through adolescence where we begin to see parts of the brain that are no longer required, or parts not so much of the brain, but of the neural pathways that are no longer required.
• 1:14
  SPEAKER_00: And this is called shedding.
• 1:16
  SPEAKER_00: And new pathways form.
• 1:20
  SPEAKER_00: So what I'm want to do is to try and portray that this is something which is not a singular event, it's an evolving event.
• 1:32
  SPEAKER_00: This is important because it helps us to understand how it is that the brain becomes able to make sense of the world around it, so to speak.
• 1:45
  SPEAKER_00: So how do we move from simply experiencing emotions?
• 1:50
  SPEAKER_00: And you'll remember that I referred to the fact that infants exist in an exclusively emotional state of some kind.
• 2:01
  SPEAKER_00: They don't think.
• 2:03
  SPEAKER_00: But the answer really lies in, I think, one of the most remarkable achievements of human development, and that is the integration of feeling and thinking.
• 2:15
  SPEAKER_00: Mentalization isn't just a psychological process, it's also a neurological one.
• 2:24
  SPEAKER_00: And when we mentalize, multiple areas of the brain begin to work together so as to help us to understand ourselves and other people, but ultimately ourselves in relation to other people.
• 2:38
  SPEAKER_00: Now, one of the most important parts in this process is something called the prefrontal cortex.
• 2:45
  SPEAKER_00: And this is located behind the forehead.
• 2:48
  SPEAKER_00: And this area of the brain is heavily involved in reflection, planning, emotional regulation, not exclusively, impulse control and perspective taking.
• 3:00
  SPEAKER_00: And in many ways, this is why it's called the brain's chief executive.
• 3:05
  SPEAKER_00: And when it's functioning well, it allows us to pause before reacting, to think before acting, and to consider that somebody else's behavior may have a meaning that we don't yet understand.
• 3:19
  SPEAKER_00: So this is very much about the bit of the brain that makes sense of what's going on.
• 3:26
  SPEAKER_00: This is quite important because very often when I work with patients who have significant impulse difficulties, they become emotionally dysregulated and express that through their behaviors, that part of the brain, that executive thinking part, is overwhelmed.
• 3:49
  SPEAKER_00: And in the moment it's not available.
• 3:52
  SPEAKER_00: The person is operating from another part of the brain.
• 3:55
  SPEAKER_00: And in children, this of course is very common because the prefrontal prefrontal prefrontal cortex doesn't have the capacity because it it simply hasn't developed enough yet.
• 4:11
  SPEAKER_00: Now, when working, it operates in a kind of constant conversation with deeper emotional structures, particularly from what's called the amygdala.
• 4:22
  SPEAKER_00: And the amygdala is the part of the brain that that is essentially responsible for threat detection.
• 4:31
  SPEAKER_00: And its job is survival.
• 4:34
  SPEAKER_00: It's the primitive brain and it scans constantly for danger and responds sort of rapidly when it perceives a threat.
• 4:42
  SPEAKER_00: But this is actually useful when genuine danger exists, but it becomes less helpful when emotional situations are interpreted and experienced as threats.
• 4:54
  SPEAKER_00: I mean, think about an argument with a partner, a disagreement with a teenager or a child.
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  SPEAKER_00: If the amygdala becomes highly activated, our ability to reflect can diminish rapidly.
• 5:06
  SPEAKER_00: So we stop asking what is happening, we stop asking and thinking.
• 5:11
  SPEAKER_00: Instead, we may begin reacting automatically.
• 5:13
  SPEAKER_00: We become defensive, critical, angry, fearful.
• 5:17
  SPEAKER_00: And in those moments, mentalization often collapses.
• 5:22
  SPEAKER_00: Sometimes I give people the example when I talk about this particular part of the brain and its survival mechanisms, its survival purpose.
• 5:33
  SPEAKER_00: I say, imagine if I say to you, I want you to hold your breath for five minutes.
• 5:39
  SPEAKER_00: Well, anybody who thinks they can do that might try it.
• 5:43
  SPEAKER_00: But what will happen is that there is a point at which the internal chemistry and uh systems inside the individual will start to become activated and distressed, and the amygdala will kick in and it will make you breathe.
• 6:03
  SPEAKER_00: You won't be able to control it because its job is about survival.
• 6:06
  SPEAKER_00: So, in a sense, if we if we think of that and think about if children have been in experiences where there has been perceived threat, there has been perceived experience of isolation or anything which threatens the psychological survival or integrity of their system, as far as they experience that, then what we have is a kind of alarm bell which gets triggered very quickly.
• 6:41
  SPEAKER_00: So people who are very reactive, people who sometimes you know we call it having a short fuse, sometimes we just, you know, it's emotional dysregulation.
• 6:52
  SPEAKER_00: Those people have a highly active amygdala.
• 6:56
  SPEAKER_00: The alarm system is activated quickly.
• 6:59
  SPEAKER_00: But the problem is the alarm system isn't necessary or it's it it's it's responding to a threat that you know just isn't there.
• 7:09
  SPEAKER_00: Now, Foneggy, who I've spoken about before, Peter Foneggy's frequently described mentalization as being highly vulnerable to emotional arousal.
• 7:20
  SPEAKER_00: Uh and that that means that the capacity to use the executive brain becomes compromised because when emotions become overwhelming, reflective thinking can just disappear.
• 7:33
  SPEAKER_00: And many parents will recognize this immediately.
• 7:37
  SPEAKER_00: You know, you are calm one moment, your child screams, swears, refuses, or latches out, and within seconds you find yourself reacting in ways that do not necessarily reflect your best self.
• 7:52
  SPEAKER_00: Now, this isn't moral failure, it's neuroscience.
• 7:55
  SPEAKER_00: The thinking brain has temporarily been overwhelmed by a survival brain.
• 8:00
  SPEAKER_00: And one of the most important developmental achievements in childhood is therefore that the gradual integration of these systems.
• 8:10
  SPEAKER_00: Daniel Siegel refers to this also as integration, the sort of linking together of the different parts of the brain into a coordinated whole.
• 8:21
  SPEAKER_00: Now, children aren't born with this capacity.
• 8:24
  SPEAKER_00: In fact, large parts of the executive brain continue developing well into early adulthood.
• 8:32
  SPEAKER_00: And this means that children often experience emotions that are far bigger than their ability to understand or regulate them.
• 8:40
  SPEAKER_00: And if you think as an adult, there are times in our lives when we experience that as well.
• 8:45
  SPEAKER_00: There are times when we experience things which are emotionally overwhelming.
• 8:50
  SPEAKER_00: It could be cumulative stress, it could be life being horrible in one form or another.
• 8:57
  SPEAKER_00: And our capacity to think our way through that is often compromised and delayed because we're just trying to survive.
• 9:08
  SPEAKER_00: And again, we come back to this notion of survival.
• 9:11
  SPEAKER_00: The amygdala is activated and constantly scanning.
• 9:16
  SPEAKER_00: Therefore, the the the the speed with which that can translate into dysregulation is very, very, very quick.
• 9:28
  SPEAKER_00: So infants and small children feel before they can think.
• 9:33
  SPEAKER_00: They react before they can reflect.
• 9:37
  SPEAKER_00: They become overwhelmed before they can make sense of what's happening.
• 9:41
  SPEAKER_00: This is normal.
• 9:42
  SPEAKER_00: And the task of development is not to eliminate emotion, it is to build stronger connections between emotion and reflection to help the child from I feel something to I understand what I'm feeling.
• 9:59
  SPEAKER_00: And eventually I understand why I'm feeling it.
• 10:03
  SPEAKER_00: Now, this process depends heavily upon relationships because the developing brain isn't built in isolation, it's built in interaction.
• 10:13
  SPEAKER_00: So every time a parent helps a child name a feeling, regulate distress, or make sense of an experience, neural pathways are being both formed and strengthened.
• 10:26
  SPEAKER_00: If you think about a rope, you think about how strong a rope is, if you look at a rope carefully, you'll see it's made up of individual strands.
• 10:36
  SPEAKER_00: The individual strands aren't necessarily that strong, but when you've got hundreds or thousands of them, the strength and the security becomes really apparent.
• 10:49
  SPEAKER_00: Well the mind is similar in that it is, but the the the strands are interactions.
• 10:55
  SPEAKER_00: Now, if the interactions are healthy, building, repairing, that rope gets stronger and stronger, which means that we see children and young people who become more robust, and is true with with adults.
• 11:13
  SPEAKER_00: And so if you think if as an adult you are somebody who experiences dysregulation, overwhelm, then the question you might ask is how strong are the strands in certain situations that I have formed?
• 11:31
  SPEAKER_00: How strong is the rope?
• 11:33
  SPEAKER_00: And sometimes, and I'm not going to cover this now, but sometimes this process of mentalization is compromised.
• 11:40
  SPEAKER_00: So that means that in a sense, maybe some people have a thinner rope than others.
• 11:46
  SPEAKER_00: Some people are less robust.
• 11:47
  SPEAKER_00: Some people may overcompensate as a consequence and portray themselves as robust and have developed significant ways of managing this internal fragility.
• 12:02
  SPEAKER_00: But the truth is it's there.
• 12:04
  SPEAKER_00: But once again, I come back to the fact that just because that's the case, it's not the end of the story.
• 12:10
  SPEAKER_00: So this is why emotional development isn't separate from brain development.
• 12:17
  SPEAKER_00: They're the same processes, but they're just from different angles.
• 12:21
  SPEAKER_00: So mentalization isn't simply something we do, it's something our brains gradually become capable of, but through experience.
• 12:31
  SPEAKER_00: And it's shaped, strengthened, and refined through these thousands of everyday reactions and interactions with the people who care for us.
• 12:42
  SPEAKER_00: The next question then is this if children borrow emotional regulation from adults before they develop their own, what exactly is the parent's role in the process?
• 12:58
  SPEAKER_00: And this is where we turn next.
• 13:01
  SPEAKER_00: We're going to look at the parent as the child's external brain.
• 13:07
  SPEAKER_00: Before I finish, I'm very often struck by how people communicate how they make sense of what they're experiencing.
• 13:20
  SPEAKER_00: And sometimes people will say, I think.
• 13:26
  SPEAKER_00: You know, this and this happened, so I think.
• 14:08
  SPEAKER_00: Now objectively, that makes no sense because what was being said was in no way comparable with what was being felt and translated into the the description that was given.
• 14:31
  SPEAKER_00: So what was said was repeated calmly and very specifically as a corrective intervention.
• 14:40
  SPEAKER_00: When I say corrective, that sounds a bit strong, that's not quite the the way I would necessarily frame it.
• 14:47
  SPEAKER_00: But no, it was more a kind of no, no, what were the words that you heard?
• 14:53
  SPEAKER_00: And we had to do this two or three times before the person could see that what and how they were hearing what was said did not match its true meaning.
• 15:09
  SPEAKER_00: It was something inside them was aroused, which had nothing to do with what was that the discussion was about, but nonetheless it came to the surface.
• 15:21
  SPEAKER_00: So if we look at that psychoneurologically, it suggests here was a person who very probably was constantly primed for criticism, and the capacity to actually stop and think what was said was unavailable.
• 15:40
  SPEAKER_00: Sometimes people will say, I feel, and what then happens is that can become used as a statement of truth.
• 15:50
  SPEAKER_00: Well, for that person, it is a truth, but that is theirs.
• 15:56
  SPEAKER_00: So often I'll remind people that alongside feeling we have to think.
• 16:02
  SPEAKER_00: Those two things can coexist, it's not an either or, and sometimes we can't in the moment do the thinking.
• 16:11
  SPEAKER_00: We have to return to it and we have to reflect and we have to ask ourselves what it was that happened inside of us, and then we can revisit having thought about it to do whatever is required.
• 16:26
  SPEAKER_00: Now think about how valuable that is with children.
• 16:29
  SPEAKER_00: In the moment, they're not able to think.
• 16:31
  SPEAKER_00: Maybe in the moment you're not able to think because you're overwhelmed with what you're feeling, and that's entirely understandable.
• 16:38
  SPEAKER_00: But the mentalizing comes as a consequence of revisiting it and saying, what happened there?
• 16:45
  SPEAKER_00: What was the thing that what do you think I meant?
• 16:49
  SPEAKER_00: What do you think I was trying trying to say?
• 16:53
  SPEAKER_00: Now this this is you know back to rupture and repair, but it's also going back to the notion of strands of a rope, it's repairing one.
• 17:03
  SPEAKER_00: Okay.
• 17:04
  SPEAKER_00: So in episode four, we will look at the parent as the child's external brain.
• 17:11
  SPEAKER_00: Thank you for listening.