Darren: Hi there, and welcome to Attach Together, the podcast where we explore attachment theory and what it really means for counselors, psychotherapists, and psychologists in practice. Created by the team at Optima, providers of the Level 5 and Level 7 diplomas in attachment-based psychotherapy, this podcast is a space to deepen your understanding, reflect on your work, and stay connected to the heart of attachment-informed practice. I'm Darren, a counselor. and attachment-based psychotherapist in private practice. Alongside hosting this podcast, I teach on the level five courses at Optima. And a quick note before we begin, our episodes now come with a CPD certificate. If you'd like to access it, simply head to our website or check the show notes Joining me today is Joanne Kay, a psychodynamic and attachment-based therapist who is a trainer and teaches the level five attachment course at Optima. Jo, you have selected one of my favorite elements of attachment theory for us to look at today. I'm really looking forward to this one. So you've chosen mentalization. It's a big topic. Where should we start? Joanne Kay: ⁓ good. I have. It's a huge topic. Darren: do we actually mean the term mentalization? Joanne Kay: Okay I'm probably kind of here but I'll have a at you Peter kind of succinct ⁓ definition of mentalization. So Peter Fonagy's like the the big name attached to mentalization. and he describes it as finding our minds in the minds of others and holding the minds of others in our minds as well it's that word mentalisation you know when I first ⁓ learnt word in my training I was kind of you know thinking well what does that mean what can I map you know what do I already know that I can Darren: Mm-hmm. Joanne Kay: of map that word onto. You is it empathy? it insight? You know, it's kind of connected to theory of mind as well. there's definitely a Venn diagram that overlaps, ⁓ but there's this, do we need this extra word? why won't these other terms quite do ⁓ to ⁓ describe what mentalization is? And then... Darren: Mm-hmm. Joanne Kay: when you learn more and more about mentalisation you realise 'oh, yeah' it this other thing that kind of encompasses parts of of those ⁓ like empathy, theory of mind, perspective maybe as well. So it's a lot of ⁓ different but fundamentally it's an achievement of the attachment process. So mentalisation Darren: I like that an achievement of the attachment process Joanne Kay: ⁓ you like? Yeah it's something is from ⁓ the early attachment relationships. it's a process. ⁓ Darren: it is definitely a process. I have to say, the first time I heard the term mentalization, it took me to somewhere like Derren Brown. And I was thinking this was like, you know, some kind of magic thing that's hard to grasp. And actually, when I hear your definition it's central to what we're offering as therapists, isn't it? That's what's going on in the room all the time. But having a grasp on what mentalization actually is, I have found has made my work with my clients so richer because I bring more knowledge to the room. Joanne Kay: Absolutely. Yeah, it's kind of the way I see it and the reason I'm bit obsessed with mentalization. for me it kind of acts as a bridge between ⁓ the sort of hard theory of attachment you Bowlby's attachment theory and kind of translates that in a way to what we're actually in the room with Darren: What would that look like? if I saw you in the room. Joanne Kay: So...yeah, so supporting ⁓ in the is kind of ⁓ a not-knowing stance, which can be little bit a or a little of a conflict, ⁓ because when we are working with... theories like attachment theory that on paper can feel really deterministic. You know it can feel like X happens that means Y ⁓ and for me as a psychodynamic therapist you know having that as my core training that's really deterministic. You know and mentalization reminds us that if we're holding a mentalizing stance ourselves we're not we know things about the client there's no certainty when we're mentalizing so there's something kind of paradoxical about it because mentalization is about mirroring it's about to understand ⁓ one another and to understand what's happening in each other's minds on that two-way street but it's also knowing that we we know You know, it's also realising that we can't truly know, we're just trying to find that connection and get it right enough, get it right enough of the time. If makes sense. Darren: does, and you say it's a two-way process. Joanne Kay: Yeah So in infancy and in childhood, mentalization first of all ⁓ is something that's done by ⁓ the caregiver. So the child kind of starts at zero and can't do any mentalisation, know, stimuli are kind of just objects ⁓ And caregiver, in an ideal scenario, marks the emotion that child feeling and then mirrors it. So there's research done into this. ⁓ micro-moments of mirroring between mothers and babies by Beebe. And those ⁓ that these minute moments of what their best guess is what the baby is feeling. So for example, the baby cries and the mother or the caregiver might respond ⁓ with kind of open expression maybe a soft tone of you know sad or ⁓ wrong so they're kind of mirroring that emotion they're marking what's happening ⁓ internally for ⁓ child then the child perceives that in their external environment their emotions are reflected. So there's this kind of two-way street where the caregiver is kind of lending their mentalization ability to the child and over time the child begins to understand that they have a mind that they have this sense of self their internal feelings are mirrored in their external environment. So ⁓ over time the child becomes to kind of internalize that and that ⁓ I'm kind of you probably hear I'm getting the territory of the internal working model so it's overlapping with that as well. So it's this process of development that happens and then depending whether or not that happened and whether that enough Darren: Mm-hmm. Joanne Kay: the mentalization ability of then the older child and then the adult has this of baseline level. there is ⁓ something interesting about mentalization which ⁓ I've in some research doing at the moment. and there's mentalization can kind of be described in two different ways so it's kind of operating on different levels as well so there's this baseline level of mentalization which i've just talked about that kind of comes from primary attachment so depending on whether the mirroring happened whether it was right enough of the time there'll be either a higher or lower ability. So the measure of that is called reflective function because it's kind of your ability to reflect on your own emotions and on the emotions and thoughts of others. kind of into ⁓ what we in the room as well. So I will come back to that. ⁓ But there's this second ⁓ way that kind of appears for us. And there's this trait, there's this kind ⁓ state level of as well. So there's a baseline, but there's also a fluctuating up and down. ⁓ Darren: Mm-hmm. Excellent. Joanne Kay: ⁓ dynamic of mentalization that happens as well and that's the bit that's important to us as therapists in the room because that can turn on a sixpence that can change and there have been studies into this that can the level of mentalization can change within sessions you know it can change month to month day to day week to week within ⁓ ⁓ to minute Darren: be that quick. Joanne Kay: within a counselling session, for example. Yeah, and that actually has been measured. So it kind of exists on these two planes. And I guess we could, you know, the whole trait versus state thing kind of comes into attachment in general as well, because you could sort of say that about attachment style as well, or internal working models, that there's a base, there's a sort of structural base part. ⁓ Darren: Wow, okay. Joanne Kay: that is part of the personality but then there's this fluctuating kind of surface level response to what's happening that might change under stress or in different relationships. So it's... Darren: but it's the response that's on that level rather than the inner reaction. Joanne Kay: yeah exactly so that that ⁓ baseline level can change slightly very slowly in long-term therapy it doesn't change much but what what can change in a moment in ⁓ a or across shorter period of time that has real sort of therapeutic effects is that more surface level mentalizing. So what affects that in the moment is the the ⁓ bodily state that we're in in that moment. And you know, the golden rule that you will Darren when we teach mentalization. on the level 5 is you cannot mentalise if you are not regulated. That's kind of ⁓ frame it because it's so intrinsically linked to bodily regulation and mentalisation starts to collapse ⁓ we get activated, as we get out of our window of tolerance. So for us as therapists this kind of golden rule in this, you know, in all of this ⁓ world of mentalization where there's all of these concepts and theories overlapping, bit that's really important ⁓ regulation has to come first ⁓ we can reflect on why we're having those feelings or ⁓ someone else's was as we experienced it. So we kind of have to focus on helping our clients to regulate. ⁓ and then get into that reflective discussion part of therapy. Darren: And herein lies the risk of this discussion because my mind has gone off to the neuroscience side of our teachings where I'm thinking actually it's about the fight or flight response, the amygdala, the reptilian brain, and then what we describe as flipping the lid. know, actually, if in fight or flight, you can't possibly put into action all these other elements. So Joanne Kay: Yeah. Darren: we can look at it from that regard as well, as in you're not gonna be able to mentalize unless the conditions are right. actually, if you're in a survival mode, you're just not gonna be able to turn that on ⁓ how much you wish to. Joanne Kay: Yeah, it's a complicated process. Being that mentalizing state or being in a state where mentalizing can happen, there's a lot of demand on ⁓ different of brain to be working together. They have to be ⁓ integrated, different parts of the brain. So yeah, if we're in a fight or flight state, we just can't access that. And those can be some of the times when, we have ruptures in therapy, when maybe there's a push to... start reflecting or start mentalizing or there's a demand placed on mentalizing ability before the client is actually regulated enough to do that. Darren: And I've seen that in action in my own room, I have to say. We do have these ruptures and you can kind of swoop in and think, well, this has worked before, so let's it. ⁓ actually it's working the client's pace always, isn't it? It's always working at their pace, which can quite destabilizing sometimes. As the therapist in the room, you feel like, this is my space and I know what I'm doing. actually is about grounding yourself and reminding yourself, it's the client's process ⁓ we go at their rate. Joanne Kay: Yeah and a lot to be said ⁓ for in having awareness mentalization we need to have ⁓ the awareness of where at in ourselves and whether we're able to get there as well ⁓ and often ⁓ a of not mentalizing or a sign that gone offline ⁓ an extent. Darren: Mm-hmm. Joanne Kay: is when we find ourselves as therapists holding a lot of certainty. mentalisation lives in knowing that we don't know for sure. So once we start slipping into feeling really certain, for example, about what's going on for the client, or really certain about what needs to happen next, we can maybe... Darren: Mm-hmm. Joanne Kay: have a little alarm bell going off on there actually I need to be ⁓ holding openness this of actually no I'm maybe not sure ⁓ but I can offer my mind to you, can maybe share what I'm hearing in this and be really, really tentative and we are tentative anyway, we know to be tentative anyway as therapists but coming from a stance that's supporting mentalizing in ourselves and them Darren: Yeah. Joanne Kay: We need to know, we need to really know that we don't actually know what's going on in their minds. And we also need to communicate that and really double down on that tentativeness and kind of offering something in saying, well, this might be wrong, saying that I might have got it wrong here. So feel free to throw this away. But that sounds like there's something around. being really overwhelmed in that moment or whatever it is we're offering, we're really saying, this is to support you wondering and being curious about it. This isn't me steamrolling my ⁓ interpretation. Darren: Mm-hmm. Mm-hmm. really interesting. ⁓ we ⁓ head to a break, I just wonder, is there a final takeaway that if, for those that are listening, Is there one message that you'd like them to really hear from you regarding mentalization? Joanne Kay: I suppose it would be ⁓ in terms of definition that mentalization is moving into thinking about feelings rather than just feeling them. Darren: Wonderful. Yeah, I love that in a nutshell. take break and then we'll be with our dilemma. Welcome back. Still with Joanne. And we are looking at our dilemma. So Joanne, what are we making of this? A therapist feels like their client is resistant to the therapy. Joanne Kay: Okay. And that's a... that's a familiar feeling for me, is my... is my knee-jerk response. We've all... we've all been there, haven't we? Darren: You Absolutely. Joanne Kay: ⁓ but yeah, it does link to what I talking about with regards to, you know, having, having certainty as because there's around having that of, you know, the, client's just not, client's so or this client's just not engaging. ⁓ if we're slipping into that we do slip into that you know it happen it's we're that place certainty and from a mentalizing perspective there's there's a place where being to with just wondering gets that ability gets collapsed once you're holding something as the truth that's supervision comes in you need a really good supervisor who's gonna sit and wonder with you rather than them thinking ⁓ yeah client's really avoidant as otherwise you get into a parallel process of everyone being sure what's going on as well And The client might be thinking ⁓ with certainty well, the therapist doesn't like me ⁓ or the thinks I'm hard work. So it's kind of, how do we out of that place where wondering and collapses back into... that place where we're we can be okay with being unsure again Darren: ⁓ It seems surprising to me that the is really about the client being resistant to therapy, but yet our focus and our solution on that is actually from ⁓ within the therapist rather than looking at to fix or change the Joanne Kay: Yeah and it can be and again you know it's tempting do that and think okay why are they being resistant? What I do about that? ⁓ know like said how can I fix or change that? But actually the only data we have is how we're feeling. Darren: Yeah. Joanne Kay: you know all we've got to go on when we get those moments where we feel like the the client is resistant it trigger things in us around Darren: Yes. Joanne Kay: imposter syndrome or that we're not doing a good enough job you know I heard Georgina talking about this when she was talking about avoiding attachment on the podcast so it kind of ties into that response ⁓ there's something wrong ⁓ with how I'm performing as a therapist and then we're we're spiraling that down that road into not good enough etc. it's kind of how do we bring how do we bring us both back online and again maybe it's about Darren: Yeah. Joanne Kay: getting regulated together. and then going there being curious, bringing that back in. You know I'm wondering, got this sense that there's tension here or tell me how you're feeling, what's going on, know bringing it back to what's happening between us in this room right now. Darren: Hmm. Yes, yeah, what's playing out, what's going on. And every message you receive is a isn't it? It's a clue to be looked at and it's really for the therapist to maybe it in the room or maybe just take it away, reflect on it. Joanne Kay: Yeah. Darren: Because supervision is key for this answer in my mind, ⁓ to unpick. Joanne Kay: absolutely. ⁓ Yeah. Yeah and again it's another place where mentalization lives. You know that's what our supervisors want to do and that's what I want to do now I'm a supervisor. I'm trying to create an environment where okay let's our heads together ⁓ wonder about this. You know it's trying to create that environment of we don't know but we're gonna try. We're gonna we're gonna try based on Darren: Mm-hmm. Yes, yes, yeah. Joanne Kay: based on the facts we do have, which is what I'm feeling right now. And let's try and strive. There's a lot of striving in mentalization, I think. And I kind of like that. It's not about perfection. Darren: Mm-hmm. Mm-hmm. And actually dare I say I think it a Bit of bravery as well a bit of bravery to really look inward and a bit of bravery to then voice that externally You actually I've got a real sense that I'm feeling Whatever that is and bringing that into the space be that in unpicking that in supervision or Even in the room with the client, you know, as you said that I had a real sense of this Joanne Kay: Yeah Darren: and I'm just wondering that means to you. ⁓ I think that general sense of wondering is important, but before we can even get to wondering, we've got to be honest with ourselves and have the courage to go to those places. ⁓ Joanne Kay: Yes absolutely and that you've kind of wrapped it up beautifully back to Bowlby haven't you there because it is back to that being able to explore Darren: ⁓ thank you. Okay, Joanne, it's been so much fun having you on the podcast today. thank you for joining me. And if, good. Joanne Kay: Thanks Darren. I've loved it. I've loved rambling and wondering with you. ⁓ Darren: Yeah, it's been fun. It's been really good fun. if you think this sounds like fun and you wanna know more about our level five or level seven diplomas in attachment-based psychotherapy, ⁓ you find full details at OptimaHealthServices.co.uk. We'll see you next time.