San Antonio Pot 052313

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Reviving Plain Old Therapy:
Promoting Mentalizing in Relationships
Exploring Parallels in Psychotherapy and Parenting
Jon G. Allen, Ph.D.
Senior Staff Psychologist, The Menninger Clinic
Professor of Psychiatry, Baylor College of Medicine

Goals
I: Desri!e ommonalities among di""erent therapies
II: Dra# parallels !et#een therapy and parenting$
eah in"orms the other
III: %&plain ho# 'mentalizing( and 'attahment( in"orm
therapy and parenting
I): *+pport ommon sense #ith siene

The ommonsensial essene o" psyhotherapy,
and other healing relationships
John -o#l!y: the role o" the psyhotherapist is 'to provide the
patient #ith a se+re !ase "rom #hih he an e&plore the
vario+s +nhappy and pain"+l aspets o" his li"e, past and
present, many o" #hih he "inds it di""i+lt or perhaps
impossi!le to thin. a!o+t and reonsider #itho+t a tr+sted
ompanion to provide s+pport, eno+ragement, sympathy,
and, on oasion, g+idane.( /A Secure Base0
Jon Allen: 'The mind an !e a sary plae.(
Patient: '1es, and yo+ #o+ldn2t #ant to go in there alone3(

O+tline
I: Therapy !rands vers+s ommon "ators
II: Mentalizing in relationships
III: Attahment in relationships

Part I:
Therapy !rands vers+s ommon "ators

Psyhotherapy -rands
CPP
ADEP
TPP
TFP
MBT
DBT
CBT
IPT
CFP
DIT
SIT
EMDR
MBCBT
EFT
ERP RLX
PE
PCT

My non4!rand o" psyhotherapy
CPP
ADEP
TPP
TFP
MBT
DBT
CBT
IPT
CFP
DIT
SIT
EMDR
MBCBT
EFT
ERP RLX
PE
PCT
POT

M+h, i" not all, o" the e""etiveness o" di""erent "orms o"
psyhotherapy may !e d+e to those "eat+res that all have in
ommon rather than those that disting+ish them "rom eah other.
—Jerome 5ran. 67897:: Persuasion and healing

There are a!o+t 7;< evidene4!ased therapies, #ith treatment man+als
"or eah$ no therapist o+ld possi!ly learn all o" them, or even many o"
them
%videne4!ased therapies are designed "or spei"i disorders, and most
psyhotherapists are generalists 6li.e general pratitioners in mediine:
Most patients have more than one disorder so, in priniple, #o+ld need
many di""erent evidene4!ased therapies
In pratie, generalist psyhotherapists om!ine elements o" di""erent
approahes, and "le&i!ility is essential
Despite their seeming di""erenes, eviene4!ased therapies are generally
e=+ivalent in their e""etiveness
>hy #e need plain old therapy

Determinants o" Psyhotherapy O+tome?
Patient harateristis 6e.g., severity and d+ration o" illness, soial s+pport,
apaity "or tr+st:
Patient4therapist relationship 6e.g., empathy and therape+ti alliane:
Therapist harateristis 6e.g., e&periene, e&pertise, gender:
Treatment method 6e.g., @-T, D-T, psyhodynami:
?Dis+ssion: parallels to 'o+tomes( o" parentingA
hild harateristis, parent4hild relationship, parent harateristis, parenting
methodBstyle

Therapist2s ontri!+tion to the relationship [email protected] Rogers:
%mpathy
therapist2s sensitive a!ility and #illingness to +nderstand the lient2s
tho+ghts, "eelings, and str+ggles "rom the lient2s point o" vie#$ re=+ires
empathi resonane 6g+t "eelings:, a!ility to omm+niate empathy, and
reeipt o" empathy !y the lient
Positive Regard
aeptane, respet, prizing o" the lient, non4possessive #armth, aring "or
the lient as a separate person
@ongr+ene 6a+thentiity, gen+ineness:
!eing open and honest, transparent, !eing onesel"$ re=+ires mind"+l sel"4
a#areness and sel"4aeptane on the part o" the therapist
These three "aets are highly interrelated
Dis+ssion: Parallels to parents2 ontri!+tion to the relationshipA

Therape+ti Alliane
%&tensive researh sho#s that a positive therape+ti alliane is
assoiated #ith a !etter therapy o+tome, regardless o" the
type o" treatment 6!rand name:
T#o maCor omponents:
D a tr+sting relationship
D ative olla!oration
Repair o" r+pt+res in the alliane 6e.g., disagreements a!o+t the
#or., empathy "ail+res, mis+nderstandings: relates to a
positive o+tome. 5l+t+ations in the alliane as #ell as
r+pt+res are very ommon in therapy.
%mpathy is highly related to the therape+ti alliane.
Dis+ssion: Parallels to parent4hild allianeA

Part II:
Mentalizing in relationships

De"ining mentalizing
D attending to mental states in sel" and others
D holding mind in mind
D mind"+lness o" mind
D +nderstanding mis+nderstanding
D seeing onesel" "rom the o+tside and others "rom
the inside

The territory o" mentalizing
others
"eelings tho+ghts
sel"
empathy

In advoating mentalization4!ased treatment #e laim no innovation.
On the ontrary, mentalization4!ased treatment is the least novel
therape+ti approah imagina!le.
,Allen E 5onagy, Handbook of Mentalization-Based Treatent
ParallelA Mentalizing a "+ndamental ommon "ator in parenting and the least
novel idea a!o+t parenting imagina!le.
Mentalizing is the most "+ndamental ommon "ator among
psyhotherape+ti treatmentsFper"ore, liniians mentalize in
ond+ting psyhotherapies and also engage their patients in doing
so. ,Allen, 5onagy, E -ateman, Mentalizing in Clinical Practice
Mentalizing as a ommon "ator in therapies

A remar.a!le onvergene: Mind"+lness o" Mind
Mentalizing Mindfulness
MF
of
Mind
Developmental
Psychopathology
psychoanalysis
attachment
Buddhism
philosophy
spirituality
ways of contending with suffering

Mind"+l attentiveness: a "o+ndation "or e""etive mentalizing
ma.ing in"erenes a!o+t mental states
re"leting on the meaning o" mental states
onstr+ting !iographial and a+to!iographial narrative
mentalizing
nonC+dgmental attit+de$ aeptane, ompassion, +riosity
a#areness o" mental states as representational?
?Don2t !elieve everything yo+ thin.
overlap
!are attention, present4entered
attentiveness to mental states in sel" E others
mind"+lness

The Mentalizing *tane 6mentalizing mind"+lly:
Psyhologial aspets
 in=+isitive, +rio+s, play"+l, open4minded
 'not .no#ing(
%thial aspets
 good #ill and ompassion
 aeptane and "orgiveness
 respet "or a+tonomy
 love
ParallelA A stane "or parentingA

*trong emotions
 "ear
 anger
 shame
 in"at+ation
De"ensiveness
Indi""erene
5ators that inter"ere #ith mentalizing

Part III:
Attahment in relationships

Attahment is o+r most potent #ay to reg+late distress
!"#eriental situation
*atis"ied marital o+ples !ro+ght into la!$ #i"e hoo.ed +p to reeive
sho.s. @onditions varied: holding h+s!and2s hand, stranger2s hand, or
no one2s hand. M+ltiple !rain areas sanned.
$esult
Go#est levels o" !rain ativation assoiated #ith holding hand o"
h+s!and$ highest levels #ith holding no hand.
Conclusion
Attahment is the most potent and e""iient means o" emotion reg+lation.
O+tso+re yo+r emotion reg+lation and give yo+r !rain a !rea..
—%&ending a Hand' (i Coan, )ni*ersity of +irginia

Every person throughout life confronts two fundamental
psychological developmental challenges:
(a) to establish and maintain reciprocal, meaningful, and personally
satisfying interpersonal relationships, and
(b) to establish and maintain a coherent, realistic, diferentiated,
integrated, essentially positive sense of self.
—Sidney Blatt (2008): Polarities of experience
Compare Immanuel ant!s "two great moral forces#
(a) $ove (relatedness, coming closer)
(b) %espect (autonomy, &eeping distance)
T#o Polarities o" development:
Relatedness and sel"4de"inition 6a+tonomy:

@irle o" se+rity in se+re attahment
e&ploring
see.ing
om"ort
sa"e
haven
se+r
e
!ase
psyhologial se+rity
avoidant
attachment
ambivalent
attachment

relatedness
(efective
dependency
)
self'
de(nition
(autonomy)
secure
attachment)
psychological
security
*+$+,C
E
e-cessive
dependency
diminished
autonomy
ambivalent
attachment
diminished
relatedness
e-cessive
autonomy
avoidant
attachment

Development o" se+re attahment and mentalizing
parental se+rity o" attahment ↔ parental mentalizing apaity
hild se+re attahment 6om"ort see.ing:
mentalizing interations #ith hild
enhaned mentalizing apaity in hildhood

Parallel ontri!+tions to mentalizing: Meeting o" minds in relationships

The essene o" psyhotherapy,and parentingA
John -o#l!y: the role o" the psyhotherapist /parentA0 is 'to provide the
patient /hildA0 #ith a se+re !ase "rom #hih he an e&plore the
vario+s +nhappy and pain"+l aspets o" his li"e, past and present, many
o" #hih he "inds it di""i+lt or perhaps impossi!le to thin. a!o+t and
reonsider #itho+t a tr+sted ompanion to provide s+pport,
eno+ragement, sympathy, and, on oasion, g+idane.( /A Secure
Base0

@onl+sions, #ith parenting also in mind
In pratie, the patient2s and therapist2s harateristis, their
relationship, the alliane they esta!lish, and the method o" therapy
annot !e disentangled$ they all at in onert.
To the e&tent that they an !e disentangled in researh, the relationship
and alliane arry more #eight than the spei"i treatment
tehni=+es or method 6!rand name:.
Rogers !elieved that the relationship is the therapy, !+t this !egs the
=+estion: >hat are the patient and therapist doing #hile they are
relatingA >e need to "ig+re o+t the .ey pro!lems and "ind the !est
methods o" #or.ing on them.
*e+re attahment, #hih re=+ires and promotes mentalizing, provides
a ompelling developmental model "or the psyhotherapy
relationship and alliane, espeially as it !alanes the needs "or
relatedness and a+tonomy. Inreasing the apaity "or mentalizing
and attahment se+rity is a potentially important o+tome o"
psyhotherapy. Mentalizing is the "o+ndation o" relationships.

Menninger -log Posts: *ayHoTo*tigma.om
Is psyhotherapy going to POTA 6J+ly I7, I<7<:
@an #e +ltivate more potent POTA 6A+g+st 8, I<7<:
POT: >hat2s ne# in plain old therapyA 65e!r+ary J, I<7K:
-oo.s:
Allen, J.G. $estoring Mentalizing in Attachent $elationshi#s,
Treating Traua -ith Plain .ld Thera#y. >ashington, [email protected]:
Amerian Psyhiatri P+!lishing, I<7K.
Allen, J.G. Mentalizing in the de*elo#ent and treatent of
attachent traua. Gondon: Larna.

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