L4 Attachment, mentalization and epistemic trust Flashcards
(54 cards)
1
Q
Overview of a lecture
A
- The story of Manon and Julia
- The interpersonal approach to personality
- Intentionality and mentalization
- Epistemic trust
2
Q
The story of Manon and Julia
A
slides 4-9 in personality disorders file on my computer
3
Q
Observations from the story
A
- Theoutcomesforeachchildaremarkedlydifferenteven thoughtheyaretwins(monozygoticordizygotic?)
- In the absence of parental support children find ways to take care of themselves and each other - and of their parents (parentification)
- This is certainly not simply a story of an individual with a disorder – it is a system where disordered behaviours are part of the system
- Neither is it simply a story of ‘blame the parent’; it’s also a story of very young parents who have not been cared for themselves - and of a society that did not sufficiently care
- In terms of emotion regulation an absence of well-regulated, reflected, ‘mentalized’ emotions seems to occur in both twins
- In one of themunderregulated, overwhelming emotions dominate. In the other overregulation and staying away from emotions - All of this gets into the personalities Julia and Manon would present in therapy when they seek help
4
Q
Definitions of perosnality
A
- Harry Stack Sullivan (1953; father of the interpersonal approach to personality): “Personality involves the relatively enduring pattern of recurrent interpersonal situations which characterize a human life.”
- Gordon Allport (1961): “Personality isthe dynamic organization within the individual of those psychophysical systems that determine his characteristic behavior and thought.”
- Raymond Cattell (1965): “Personality is that which permits a prediction of what a person will do in a given situation.” (purely about oredictive relationships - most psychology focuses on this - Arjen doesn’t agree with this - mechanisms and certain ways people are produced have to be part of personality)
- Dan McAdams (2012): “Personality encompasses key individual traits and values that are situated in the diverse layers of dispositional traits […], characteristic adaptations […] and life narratives.” (it’s a dynamic perspective, with multiple layers and a growth of multiple layers that is set into stable patterns over time)
5
Q
His (pragmatic) definition of personality
A
- Integrate multiple definitions and systems
- Ideas and storiesabout personality areconcerned with the question: “Who are you and what makes you different from others?”
- Thinking about this doesn’t start in science, rather in our upbringing and culture
- But personality science is also important part of this definition
6
Q
What is personality science concerned with?
A
- observing and explaining
- patterns in experiencing of and interacting with self, world and others
- that show pervasiveness over situations
- and persistence over time
- and that distinguish oneperson from others
7
Q
Note to his definition
A
- Whether these patterns can in the end be attributed to an individual or must be viewed as resulting from broader systemic involvement of the individual in context, groups, society, etc. is an empirical rather than conceptual question
- His definition focuses on the patterns as we can observe them and try to explain them
- '’Are the ongoing patterns that Julia and Manon show part of single person dynamic or part of contextual dynamic?
- Both of these parts are important
8
Q
How can we understand all the different concepts when contrasting them from the perspective of pervasiveness/persistance (1) and the perspective of individual differences (2) that are produced by the mechanisms together?
A
- Traits - Stability over time and aggregation over situations / Variation in OCEAN traits, etc
- Narratives - Memory structures and authorship by the person, also show stability and consistency over time / Codeable differences in themes, structure, plotlines, etc. between persons
- Basic emotional systems - Inborn systems that persist and develop over life / Inborn genetic differences in sensitvity of systems, learned differences in activation pattern, etc.
- Forms of vitality and repeated patterns of self-with-other - Repeated patterns of being with an other are stored in bodily memory and can be reactivated later in time (generalise over situations and persist over time) / Typical types of repeated interactions and self-other-experiences will provide a person-specific dynamic profile (some person is confronted with overemotional unregulated states every week, like julia and some other person will have a pattern where they stay away from emotional states from repeated interactions of not wanting ot be overwhelmed, due to this it will be very difficult to form intimate relationships with others)
- Self as agent - The person will develop certain goals and values that persist through life and guide action / Values and goals appears as consistent and stable individual differences
9
Q
So what can we take away from conceptualizing it this way?
A
We can do this with any concept within the realm of personality and we will see that developmental patterns in developmental psychology and personality differences in personality psychology covary together and they’re not too different psychologies
10
Q
How to think about personality as it appears in clinical practice?
A
- It’s a transition from personality theory to how personality appears in the realm of personality problems
- Useful way to think about it is to have an interpersonal model of personality dynamics as the basis for working with personality in the clinical practice
11
Q
How did the interpersonal model of persobality dynamics come about?
A
- Starts from a critique on personality problems as categorical problems (DSM-5) - while we still use this for pragmatic reasons (insurance, easier communication…), there is some concensus in the scientific field that this is not an adequate description of personality problems
- More sound way is an alternative model of looking at personality problems as traits - traits are discriptives as they look at covariation however that’s not giving any explanations
- So it’s better to look at personality problems as dynamics (e.g. network) and the interpersonal model of personality dynamics think about personality problems this way
12
Q
What is the interpersonal field in the interpersonal model of personality dynamics?
A
- !Exam: Remember the basic schema of the interpersonal field, no need to understand what is in the 5 circles (Picture 1)
- There are two systems occuring at the same time - self system and affect system
- The self system (very complex) - both agentic and communal striving of an individual which interact with how that person is regulating him or herself (e.g. at a certain moment I’m feeling related/unrelated to the other persons, i.e. my communal representation with another person) and this will heavily affect what kind of affects (affect system), both in content (do I feel safe or not) and in arousal patterns that we have
- E.g. You build up a narcissistic self system, if there are signals from the environment that threaten that (you’re not as important), it will affect you, your feelings of understanding yourself and that can trigger you getting vulnerable and might result in narcissistic rage
- The same goes on in the other person
- In between the self and other is perception and behaviour - you give off some signals to the other and those are gonna be interpreted in a certain way by them so you get a dynamic interaction
13
Q
How can we use this in thinking of personality problems in terms of changing them through therapy?
Picture 2
A
- Therapy starts with someone presenting with persistent, pervasive and problematic patterns and these are both at the level of self system and regulation of one self and problems in relating to others (how other percieve, feel…)
- That pattern can be present in the first therapy session from the beggining
- How will the therapist manage that?
- What is unlikely to happen are sudden changes between session 1 and 2 so what we can expect however, that those patterns will be weaker from session to session
- The hope for change (the small chances that one session will change something in new situations) is indicated by the green arrows - so you might start to feel not as threatened by the situation for example - slow process (as the pattern has been build up over the whole life that’s why schema therapy takes 2 years usually) - within therapy small changes can happen
14
Q
Example: Early maladaptive schema and the interpersonal field
A
- Defectiveness/shame: belief that one is defective, bad, unwanted, inferior, or unworthy
- This includes the fear of being exposed to significant others, accompanied by hypersensitivity to criticism, rejection, and blame
- Early maladaptive schema: engrained patters how you are yourself with others and it will as a pattern heavily influence the whole interpersonal field as it gets changed in new interpersonal situations
- Changes: very defensive at the beggining of a the first session which might (through interventions and therapist’s directness/situation clarification) decrease to less defensiveness; however this will not immediately change outside of the therapy session
- So we need a lot of new experiences, new interactions in order to have pervasive change to personality
15
Q
Intentionality and mentalization
What is the self as an agent?
A
Picture 3
16
Q
What is step 1 in the two step model by Thomson?
A
- Humans have developed very strong skills for collaborating with each other
- Crucial in this is the strong tendency of already very young children towards joint intentionality (what we’ll talk about)
- Humans have a great capacity for shared goals and shared mental states (intersubjectivity)
- Within this context shared meanings and shared stories can come into existence
- !Humans are from birth particularly attuned to sharing mental states with other humans
17
Q
What is intentionality (aboutness)?
A
- Introduced into psychology by Franz Brentano (1874) as the mark of mental phenomena
- That is: mental phenomena are about something, i.e. intended at something
- Its not yet a goal, it’s not simply behaviour, it’s behaviour that is caused by something that is about something (arjen huh?)
18
Q
What did Dennett say?
A
- Picture 4
- Rather than just predicting (e.g. if I drop a stone, it will fall), there is no intentional explanation in the stone dropping to the ground (did eli have this in her lecture cause I don’t get it - chatgpt: the quote is how we use intentionality in reasoning about agents)
- Dennett’s quote explains how to predict behavior by adopting the intentional stance: treating the agent as rational, attributing beliefs and desires, and using those to forecast actions
19
Q
What is the example of the stone?
A
- Dualities = ‘immediatenon reflexiveaction-reaction’
1) stimulus -> response
2) cause -> effect
3) action -> reaction - we don’t reason there being some kind of intention or subject in between there
20
Q
A
- When intentionality and later mentalization enters the stage, we go from action to response via intention or meaning
- When a child is growing up, the possibility to attribute intentions to the actions of others and myself slowly develops
21
Q
Example: a relational dynamic
A
- One partner sits at dinner with an angry face (action) -> the other eats quick and silent and leaves the house (reaction) - no intention
- In intentional reasoning dynamic, we get to the single question that sitting at a dinner with an angry face has to have some kind of meaning - intention: ‘‘What is she angry about?’’
- I’m gonna interpret all of the signals and signs as signifying some kind of mental state that my partner is in and then my reaction will be dependent on that
22
Q
What is mentalization?
A
- This capability to look at a mirror face and not just mirror it = mentalizing (mirroring doesn’t include any intentionality as there is no looking for meaning)
- The fact that there is something behind that angry face is something we learned in development
- Our way we learn mentalizing and our capacity to do it differs between people
- Mentalizationis an umbrella concept referringto:
1) the movement from a dualistic (action-reaction)to a triadic perspective (action-intention-reaction)
2) The introduction of ‘the intentional stance
3) The process of learning and applying a ‘theory of mind’ - slowly developing in children, independently of language so can observe it very early on (first we develop intentionality and then that is a building block for understanding language because sounds in language are signifying something) - Psychologists are professional mentalizers - they try to understand where things are coming from, try to put intentionality into mental schemas
23
Q
What is the basic model of mentalization?
Picture 5
A
- At first, there is parental attachment and then the parent is trying to mentalize to understand what the child means when they’re for example crying and when the parent voices this (e.g. you’re crying because you’re angry at me that I took away your bike since you were doing dangerous things with it)
- Through this, the child learns about themselves and learns what mentalizing is about
- The early parental attachment will influence infant attachment - and that will go into the child’s mentalizing ability
- Over time, problems can transfer from generation to generation (e.g. in the story of julia and manon, the mother had very poor mentalizing skills when manon was 5 y.o since she became depressed so she gave very poor mentalizing skills to her children)
24
Q
Is attachment of a child fixed after age of 3 or 4 years?
A
- Nothing in this schema is determined - the data shows there is no evidence to think that the attachment style is fixed after 3 or 4 years old; even though the early age is crucial at determining the attachment style, the interactions and environment (also therapy) the child will continue to grow up in play a significant role in this
- Also mentalizing can be learned - by repeated mentalizing people can learn - there is no stage where people can’t change attachment style or learn to mentalize
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From attachment to mentalizing
1. In mammals and avians offspring strongly attach to caregivers
2. Human babies are particularly sensitive and attuned to the forms of vitaly they can share with others
3. In secure attachment parents use ‘parental reflective functioning’ (i.e. mentalizing capacity) to interact with their child giving rise to joint intentionality (something shared that both the child and the parent have roles in)
4. Via this process the child learns to distinguish the (joint) intention from the particular acts of the participants. And from the distinction between self and other (marking) it learns about difference in intentions between self and other
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What is the second step of the two step model?
Group-mindedness
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What is group mindedness?
- Given the strong possibility of shared intentionality, humans also develop a capability for **conventions** - it's a gradual process
- Thus children from then on are born in a world full of pre-existing conventional structures that they grow into and only later and partially become aware of
- In this they are introduced into a pre-existing ‘**symbolic order**’: the universe of signs and meanings typical for human societies
- E.g. children learn from lot of people and from lot of experiences that whoof whoof signifies a sound for a dog - these are the conventions - it really has to be a group from which the child learns this not two people like the parents because it's symbolic and universal
- Picture 6
- However, for more complex things like empathy or what does it mean to be a therapist, we need more words to describe it
- We cannot point to the outside where the meaning of these words is fixed
- This is important for identity because it means that it's not fixed into something natural in the world
- We might refer to history and stories other people told about these two words to really understand it and make meaning of them - so there is no natural meaning of these words
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What is natural pedagogy?
- Humans possess a **species-specific capacity** for the fast intergenerational transmission of cultural knowledge
- Instead of having to work out cultural knowledge oneself, one can rely on the **authority** and perceived **trustworthiness** of the person communicating that information
- **Epistemic trust** thus enables a particular kind of species-specific learning
- To learn means to take in information from a person we learned to trust
- Whether we trust the person, i.e. assign authority to them, doesn't only depend on the validity of the information they provide us with but also whether we feel that we can trust them - important in therapy to build trusting relationship
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What is epistemic trust?
- It is simply ‘trust’, but then in particular the trust we need to learn from others and to give them a certain authority - we're not able to assess all the evidence of the world ourselves so we rely on trusting others
- We are not inclined to just trust anyone to provide us with valid information
- A situation of epistemic trust enables a particular kind of species-specific learning
- Thus the absence of epistemic trust makes learning (about the world, the self, etc.) really problematic
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What is epistemic hypervigilance?
- if we're not in epistemic trust
- As such vigilance is an important default trait in many contexts: **do not trust anyone**
- **Hypervigilance** becomes likely if we have repeatedly experienced the untrustworthiness of trusted authorities – e.g. parents
- In this situation we tend to **dismiss information** about the world and ourselves from these sources
- If this becomes a central trait it **impedes development** especially if we develop a trait where we can't distinguis between trustworthy and untrustworthy people
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How does the process look like from attachment to epistemic trust?
1. We started with variations in **attachment** and variations in the sensitivity of attachemnt (marks the individual differences)
2. early experiences in the attachment relationship with our parents which will differ between people
3. Different experiences of **attunment** (mirroring and marking in the direction interactions with our primary caregivers and the world around us - experiencing the embodied world)
4. In the context of attachment and attunment we develop the capacity **joint intentionality**, learning our own agency and the other even before we're able to speak about that
5. These developed **mentalizing capacities** that we will be using in the broader social cultural context where we learn to have **epistemic trust** in some people and learn about our own place in the world and learn vigilance for some understandings of the world
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Fragment by Baldwin
- From these sequence/process we can have a deeper understanding of what is going on it the Baldwin story
- From the parental situation and both of the embodied feelings of fear and emotion regulation given by the parents, together with epistemic trust or vigilance to what the parent is saying
- Picture 7
- Through this we see both how much the parents influence a person but at the same time, one can remain the agent and author of one's own life
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Looking at more concepts in the context of the contrasting perspective of pervasiveness/persistance (1) and the perspective of individual differences (2)
- **Interpersonal field** - (1) Persisting and pervasive patterns of interacting in the interpersonal field, (2) Person specific profiles of specific interaction patterns
- **Attachment** - (1) Not fixed, but earlier experiences carry over to new situations, (2) Safe, fearfull, avoidant, etc.
- **Attunment and join intentionality** - (1) Repeated attuned interactions between self and other. Repeated learning in the context of joint intentionality, (2) The person specific experiential world, self and others is shaped through memorized repeated interactions
- **Epistemic trust** (1) Through 'natural pedagogy' the child learns about the world, the self, the others, etc. These form stable features of understanding who one is, (2) Person specific knowledge and understanding of self, world and others is shaped through these interactions
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Core concepts
* Interpersonal model of personality dynamics
* Interpersonal field
* Intentionality
* Intentional stance
* Mentalization
* Attachment
* Natural pedagogy
* Epistemic trust
* Epistemic hypervigilance
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Overview of the article: Mentalizing: Psychopathology, Attachment, and Treatment
- explores the mentalising approach to psychopathology
- discusses how impairments in mentalising are a transdiagnostic vulnerability factor for various psychological disorders, including personality disorders, depression, and anxiety
- traces the development of mentalising from an evolutionarily pre-wired capacity influenced by attachment relationships, to a broader socioecological perspective that incorporates the concept of epistemic trust
- reviewes the evidence for Mentalisation-Based Treatment (MBT), a therapeutic approach focused on restoring mentalising and epistemic trust
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What is mentalizing?
- human capacity to understand oneself and others in terms of internal mental states, such as feelings, desires, wishes, attitudes, and goals
- simply said: the ability to understand oneself and others through internal mental states
- considered a fundamental capacity essential for navigating complex social environments and adapting to changing interpersonal relationships
- helpful transtheoretical and transdiagnostic concept for explaining vulnerability to psychopathology and its treatment
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What are the 4 assumptions of the mentalizing approach?
1. Mentalizing is built into humans by evolution
2. It needs supportive environments to fully develop
3. It's relevant across all mental disorders and therapies
4. Improving mentalizing might be key to recovery, no matter the type of therapy
| They review evidence for each of these assumptions
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# Neurobiology of mentalizing
What are the four connected parts of mentalizing as indicated by neurobiological research?
- Mentalizing is an evolutionarily prewired, species-specific capacity in humans, evident from joint attention and intentionality in infants
- Research shows mentalizing is not one single ability but made up of four connected parts:
1. Automatic vs controlled
2. Self vs Others
3. Internal vs External
4. Cognitive vs Affective
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Automatic vs Controlled
- Automatic is fast, reflexive and instinctive, relying on older neural circuits
- Controlled is slower, conscious, and verbal and reflective, engaging newer brain circuits
- Stress often makes us switch to the automatic mode, which can cause oversimplified and biased assumptions about self and others
40
Self vs. Others
- We use the same brain systems to think about ourselves and others
- There are two “systems” at work:
1) **shared representations system** - a body-based, implicit empathetic processing via mirror neurons
2) **mental state attribution system** - more thoughtful, abstract, symbolic processing
- They are mutually inhibitory, MSA system regulating SR system
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Internal vs. External Focus:
- We mentalize by either looking
1) inward (thinking about what someone feels or thinks - inferring mental states) - **internal**
2) or outward (reading body language or facial expressions) - **external**
- Externally based mentalizing involves less reflective processes compared to internally based mentalizing
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Cognitive vs. Affective
- Balanced mentalizing integrates cognitive features (e.g., perspective-taking, belief-desire reasoning) with embodied affective features
- Cognitive aspects rely on controlled mentalizing, while affective aspects are largely automatic and embodied
- Different neural areas are involved in cognitive and affective mentalizing
43
What other concepts does mentalizing overlap with?
- It's an "umbrella concept" that encompasses and overlaps with other social cognition constructs like empathy, mindfulness, Theory of Mind (ToM), and alexithymia
- It changes with context and stress, so it’s more like a flexible process than a fixed trait
44
How does mentalizing relate to child development?
- At first, researchers thought that a child’s ability to mentalize mainly came from the parent-child attachment
- **Parental reflective functioning** (parental mentalization) - parents being able to think about their own and their child’s inner world
- PRF helps children feel secure and learn to reflect on their emotions
- Secure attachment helps kids handle life’s challenges and develop resilience
- Attachment-hyperactivating and deactivating strategies influence the switch threshold between controlled and automatic mentalizing, the strength of activation of automatic mentalizing, and the recovery time of controlled mentalizing under stress
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How is this reflected in the basic model (picture 5)
1. **Parental Attachment**- influence both infant attachment and socioemotional development in general, both directly and indirectly
↪ When parents have secure attachment themselves, they are more likely to provide a safe and emotionally supportive environment
2. **Parental Mentalizing** - Securely attached parents are better at recognizing both their own and their child’s thoughts and feelings = Parental Reflective Functioning (PRF)
3. **Infant Attachment** - When parents consistently respond in ways that show they understand their child’s internal experiences, the child develops a secure attachment
4. **Child Mentalizing**- In this secure relationship, the child starts to reflect on their own thoughts and emotions
↪ This ability builds over time and helps them handle life’s challenges
5. **Cognitive and Socioemotional Development** - As mentalizing improves, the child becomes better at regulating emotions, solving problems, and relating to others
↪ This leads to resilience, meaning they can cope more effectively with difficulties
46
What three unhelpful ways/modes does poor mentalizing early in life lead to?
1. **Psychic Equivalence**: Thoughts and feelings feel too real and all-consuming (no other perspective considered)
2. **Teleological Mode**: Only outward, observable, goal-directed behavior matters; inner thoughts and feelings are ignored (loss of controlled mentalizing)
3. **Pretend Mode**: Feelings and thoughts feel unreal or disconnected from reality (hypermentalizing/pseudomentalizing), often leading to derealization or dissociation
When children don’t develop mentalizing properly, they may act out their unprocessed feelings in harmful ways, like hurting themselves or others, or misusing substances
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What is the empirical evidence for developmental aspects?
- Mentalizing has both stable and flexible aspects. It depends on relationships and stress levels
- Parents who reflect well on emotions (especially difficult ones) raise children who are better at mentalizing
- Securely attached children tend to have better emotional and social skills
- Childhood trauma and disrupted attachment often lead to impaired mentalizing, but some parents with trauma can protect their kids if they can reflect on their own past
- Problems in mentalizing are linked to many emotional, behavioral, and social difficulties in children
48
Toward a borader socioecological evolutionary perspecitve
- Over time, researchers saw that focusing only on parent-child attachment was too narrow
- Newer models look at the bigger picture: family, culture, and social systems
- This includes the idea of **epistemic trust** - trusting others as reliable sources of knowledge
- This trust helps people learn from their social world and grow
- Without it, people may block out helpful input and become stuck
- In this broader view, insecure attachment or personality traits might be seen as **adaptive strategies** - ways to survive in a difficult environment, not just personal flaws
49
What are the three communication systems within therapy that help people change?
Therapy helps people change through social learning
1. **Lowering epistemic vigilance** - Therapists build epistemic trust by demonstrating an ability to see the patient's perspective
2. **Enabling mechanisms of social learning** - Increased epistemic trust fosters the patient's mentalizing capacity, leading to a positive cycle of social learning and benefiting more from supportive environments (salutogenesis)
3. **Reengaging with the social world** - Being mentalized by another person reactivates the capacity to learn, freeing the patient to seek new experiences and improve relationships outside therapy
Evidence shows that people with early adversity often struggle with trust, which can make therapy harder -> building epistemic trust seems to be a crucial step in effective treatment
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# Mentalizing and personality disorders
Borderline PD
- People with BPD often have trauma histories and disorganized attachments
- Their mentalizing can be unstable—too simplistic, too analytical, or overly reactive
- Confusion of self and others' mental states (identity diffusion) leads to increased susceptibility to emotional contagion
- The "empathy paradox" in BPD is explained by hypermentalizing, where patients may accurately interpret external cues but often jump to negative conclusions, reflecting a negativity bias
- High levels of distrust in BPD patients are also consistent with impairments in epistemic trust, mediated by the reward system
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# Mentalizing and Personality Disorders
Other Personality Disorders
- The mentalizing approach has been extended to Antisocial Personality Disorder (ASPD), narcissistic, and avoidant personality disorders, with specific mentalizing imbalances identified
- **ASPD** involves different patterns
1) high anxiety and reactive aggression linked to a fast switch to automatic, affect-dominated mentalizing
2) callous-unemotional traits linked to hyporeactivity to stress and severe deficits in affective mentalizing
↪ These are seen as adaptation strategies where social learning is fundamentally disrupted
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Mentalizing and other disorders
1. **Depression and Anxiety**: early adversity and poor attachment contribute to vulnerability, negatively impacting mentalizing
↪ Impairments in mentalizing are both a consequence of and exacerbated by mood disturbances, increasing relapse likelihood
2. **Eating Disorders**: Struggles range from emotional overload (affective hypermentalizing) to perfectionistic overthinking (cognitive hypermentalizing)
3. **Somatoform Disorders**: Physical symptoms may come from difficulty processing emotions and hyperreactivity to stress
4. **Autism Spectrum Disorder**: Broad mentalizing difficulties are common, precise role needs further determination
5. **PTSD**: Trauma often leads to major problems in understanding mental states + premorbid deficits increase this risk
6. **Others**: Research is expanding to addiction, ADHD, psychosis, and more
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What are the three core features of Mentalization-based treatment (MBT)?
1. **Improving Mentalizing Capacities**: Focus on the patient's moment-by-moment mental states and active repair of therapist-patient relationship ruptures, with the therapist adopting an inquisitive, "not-knowing" stance
2. **Structured and Manualized**: Delivering coherent, consistent, and continuous treatment, especially crucial for patients lacking coherent self-structure
3. **Fostering Salutogenesis and Resilience**: Emphasizing the development of the capacity to benefit from positive influences
→ MBT is well-supported by research, especially for BPD, and is expanding to other disorders and family or group formats
→ It may not only reduce symptoms but also help people reconnect socially
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Future directions
1. Create better tools to measure mentalizing and trust in real life
2. Study how brains work during real-time interactions
3. Follow people over time to see how mentalizing develops and changes
4. Test how well MBT works across many types of people and settings
5. Explore how therapy changes social learning and mentalizing in daily life
