Chapter

Therapist stance

Anthony W. Bateman and Peter Fonagy

in Mentalization-based Treatment for Borderline Personality Disorder

Published on behalf of Oxford University Press

Published in print September 2006 | ISBN: 9780198570905
Published online February 2013 | e-ISBN: 9780191754456 | DOI: http://dx.doi.org/10.1093/med/9780198570905.003.007

Series: International Perspectives in Philosophy & Psychiatry

Therapist stance

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Mentalizing in psychotherapy is a process of joint attention in which the patient’s mental states are the object of scrutiny. The mentalizing therapist continually constructs and reconstructs an image of the patient in his mind to help the patient to apprehend what he feels and why he experiences what he does. 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.

Whilst this process sounds rarefied, in practice it is not. You, the therapist, must ensure that your primary concern is the patient’s state of mind and not his behaviour. Your principal interest is in what is happening in his mind now, not what was happening then, and your curiosity is about what you or your patient has or might have had in mind which has created the current situation, recognizing that neither you nor your patient experiences an interaction other than impressionistically. This requires you to monitor your own mind as much as that of the patient’s and to keep an eye on your occasional enactments, however small. Despite our contention that borderline patients have a reduced capacity to monitor the minds of others accurately, they can be very sensitive to some underlying motives of others and may pick up, with remarkable and sometimes uncomfortable accuracy, your mistakes and weaknesses. So, as we will see, appropriate humility and capacity to learn on the therapist’s part is an important part of treatment.

In an attempt to capture the therapist stance which gives the best chance of achieving mentalizing goals, we have defined a mentalizing, inquisitive or not-knowing stance.

Chapter.  3361 words. 

Subjects: Psychiatry

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