Mentalisation as a fusion of psychoanalytical and cognitive-behavioural theories

Peter Fonagy definirao je mentalizaciju kao proces kojime zaključujemo o akcijama i mentalnim stanjima (osjećajima, mislima, vjerovanjima i željama) koja ih motiviraju. Mentalizaciju koristimo u svakodnevnom životu kada razgovaramo s drugima i nastojimo vidjeti svijet iz njihove perspektive. Postoji nekoliko konceptualnih preklapanja s teorijom mentalizacije, od kojih su najznačajnije empatija i teorija uma. Teorija uma naziv je za sposobnost koju djeca stječu u dobi od 4-6 godina kada razumiju zadatke „lažnog vjerovanja”. Fonagyjev koncept mentalizacije ima temelje u razvojnoj psihologiji i teoriji privrženosti, a nove neuroznanstvene slikovne metode snažno podupiru taj koncept. Sigurna, privržena veza majke i djeteta koju potiču dopaminski i oksitocinski neuralni sustavi olakšava razvoj sposobnosti mentalizacije. Taj razvoj može biti narušen zanemarivanjem ili zlostavljanjem, što je često vidljivo kod oboljelih od graničnog poremećaja ličnosti. Ova teorijska znanja omogućila su razvoj nove, učinkovite terapije za granični poremećaj ličnosti. Terapija temeljena na mentalizaciji (MBT) zahtijeva angažiranog, empatičnog terapeuta koji će spremno objasniti mentalna stanja u terapeutskom odnosu. Poput kognitivno-bihevioralnih terapija, MBT traje kraće od psihodinamskih terapija i usredotočuje se na promatranje vlastitog ponašanja i razmišljanje o mentalnim stanjima koja su ga potaknula. Ovakva terapija nudi svojim klijentima dobro strukturiranu, sigurnu bazu unutar koje mogu naučiti regulirati svoje nestabilne afekte i ostvariti uspješne interpersonalne veze. MBT je randomiziranim kliničkim ispitivanjima potvrdila svoju uspješnost u liječenju graničnog poremećaja ličnosti, poremećaja hranjenja, obiteljskoj terapiji i tretmanima usmjerenim smanjenju školskog nasilja. Izneseni podaci pokazuju da bi MBT mogla biti uspješna i pristupačna terapija za različite psihičke bolesti.Peter Fonagy defined mentalisation as a process of making inferences about one’s own actions and the mental states (feelings, thoughts, beliefs and desires) behind them. We use mentalisation in our everyday communication when engaging in a conversation with another person. Several concepts overlap with the concept of mentalisation, with empathy and theory of mind being the most notable. Theory of mind refers to the ability which children fully develop at the age of 4-6 when they understand ‘false belief’ tasks. Fonagy’s concept of mentalisation has its origins in developmental psychology and attachment theory, with strong support from the newest neuroimaging studies. A safe, secure attachment relationship between mother and child, facilitated by dopaminergic and oxytocinergic neural circuits, fosters the development of the ability to mentalise. This development can be disrupted by early neglect or abuse, as often seen in patients with borderline personality disorder (BPD). Based upon this theoretical knowledge, a chance of developing a new, effective treatment for borderline personality disorder emerged. Mentalisation-based treatment (MBT) requires a more open-minded, empathic, and engaged therapist who willingly explains mental states in current therapeutic relationship. Similar to cognitive-behavioural therapies, MBT lasts shorter than psychoanalytic therapy, and places emphasis on observing one’s own behaviour and thinking about mental states which motivate that particular behaviour. This treatment offers its clients a well-structured, secure base within which they can learn to regulate their somewhat unstable emotions, and accomplish successful interpersonal relationships. MBT has proven its effectiveness in treatment of BPD in randomized-controlled trials, with successful application in family treatment, eating disorders, and school-based treatments for minimizing violence. The presented evidence shows that one should consider MBT as a new, successful, and accessible treatment for various psychiatric disorders