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
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(
I: Therapy !rands vers+s ommon "ators
II: Mentalizing in relationships
III: Attahment in relationships
Therapy !rands vers+s ommon "ators
My non4!rand o" psyhotherapy
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"
%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
Therapist2s ontri!+tion to the relationship [email protected]
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
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
%&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
Mentalizing in relationships
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 territory o" mentalizing
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
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
nonC+dgmental attit+de$ aeptane, ompassion, +riosity
a#areness o" mental states as representational?
?Don2t !elieve everything yo+ thin.
!are attention, present4entered
attentiveness to mental states in sel" E others
The Mentalizing *tane 6mentalizing mind"+lly:
in=+isitive, +rio+s, play"+l, open4minded
good #ill and ompassion
aeptane and "orgiveness
respet "or a+tonomy
ParallelA A stane "or parentingA
5ators that inter"ere #ith mentalizing
Attahment in relationships
Attahment is o+r most potent #ay to reg+late distress
*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.
Go#est levels o" !rain ativation assoiated #ith holding hand o"
h+s!and$ highest levels #ith holding no hand.
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) $ove (relatedness, coming closer)
(b) %espect (autonomy, &eeping distance)
T#o Polarities o" development:
Relatedness and sel"4de"inition 6a+tonomy:
@irle o" se+rity in se+re attahment
Development o" se+re attahment and mentalizing
parental se+rity o" attahment ↔ parental mentalizing apaity
hild se+re attahment 6om"ort see.ing:
mentalizing interations #ith hild
enhaned mentalizing apaity in hildhood
Parallel ontri!+tions to mentalizing: Meeting o" minds in relationships
The essene o" psyhotherapy,and parentingA
John -o#l!y: the role o" the psyhotherapist /parentA0 is 'to provide the
patient /hildA0 #ith a se+re !ase "rom #hih he an e&plore the
vario+s +nhappy and pain"+l aspets o" his li"e, past and present, many
o" #hih he "inds it di""i+lt or perhaps impossi!le to thin. a!o+t and
reonsider #itho+t a tr+sted ompanion to provide s+pport,
eno+ragement, sympathy, and, on oasion, g+idane.( /A Secure
@onl+sions, #ith parenting also in mind
In pratie, the patient2s and therapist2s harateristis, their
relationship, the alliane they esta!lish, and the method o" therapy
annot !e disentangled$ 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:
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.