Intro to Mentalization & Anthony Bateman (Co-Creator of MBT)

I'm going to just say something to every to our audience um which is that I've wanted like I've wanted we have Peter fine on our Channel Anthony is one of the master clinicians who's sort of evolved and developed the practice of mentalization in America we don't have as many practitioners I as someone who had the opportunity to get treated for borderline and probably narcissism um I might be more on that Spectrum but um I got DBT mentalization tfp and God knows what else is mixed in CBT but I have found mentalization to be almost the most flexible of the modalities um and the most interpersonally and intra-personally usable and effective and also in the moment and so this is the person that practices it and is one of its sort of Founders creators or developers of it so it's a total awesome gift to have you here and I'm hoping people can learn more about it because we need it real bad so in the world so I think the first thing is to introduce yourself and who you are and what you do okay well uh thanks for inviting me as I said I I'm Anthony Bateman um I actually trained initially at University as a vet so that's really a long way from the mind in a sense but I transferred to medicine and then eventually trained as a psychiatrist now my interest though actually sort of began to focus during that training time on people who presented having tried to harm themselves or or make suicide attempts and so on in the emergency departments and that's really where I became interested in what would make people do that to themselves and so on particularly when many of them seem to have their life ahead you know that it was quite problematic to understand really so that was where my interests began but it was also around that time that I became the clinical lead really of a a hospital unit for people with high risk borderline functioning narcissistic functioning anti-social functioning and so on and we set up the system so could also be research based and that's where I linked with Peter fonnegue at the University so we had a clinical Center we had an academic center as it were and in the academic center there was a lot of work on the development of mentalizing in terms of Personality functioning and we were treating people with personality difficulties and problems and so on at the severe end of the spectrum so that's really how it all began we just continued to research it change it according to the data that we we got and so on and that's how MBT really developed MBT standing foreign based treatment that's what it became and when you say personality functioning can you explain what you mean by that maybe that's too broad in question but it's kind of a broad question but I mean it's an interesting one because you know that we're all develop traits and characteristics don't we over time you know from both our genetic sort of uh complement that we're we're born with as it were and then the environmental factors that influence the expression of those genes and so on so we build a sort of character structure and a personality structure whether that's neuroticism openness agreeableness those sorts of things conscientiousness these sorts of characteristics and when those join together they tend to form a particular way of relating to the world so in a sense personality and personality difficulties and disorder and so on is actually how we relate and position ourselves in the world and how the world then relates to ours and when that kind of goes wrong it can go wrong in all sorts of ways so in a sense we ended up seeing mentalizing as this sort of um higher order mental processing system of the individual as being core to personality functioning I.E how we position ourselves in our social environment before we go on to what is mentalizing I'm just I'm curious what it was that what first of all when you were a vet where we were training to be a vet why you switched to people and then also what was it for you and about you or that interested you in Psychiatry versus I don't know Cardiology or something like that well it's a bit difficult isn't it but that second bit the first bit's not so difficult because in a way it was people that um converted me as it were from Veterinary to Medicine um it's possible that that in a way I was a little bit people anxious and therefore actually you know having relationships with animals were really was quite soothing to me so my sort of anxieties generally were managed and adapted and so I was interested in them and I still do like uh animals you know it's one of one of my sort of things you know I like dogs and so on and things like that but um we were training with Medics and vets were trained together and I kind of related better to the Medics than I did to the vet's as people in a way so I thought well why am I doing this they're doing that and I was interested in both it wasn't but so I kind of was influenced by other people a little bit in a way I continued them with my friendship group so I think that was had a strong influence in other words the people that you were going to end up surrounding yourself with were the people that you felt you connected with and so your choice to move there yeah had everything to do with the people you wanted to put yourself around yeah to a large extent I think and that was when I was 20 21 you know that was trying to operate in a way quite naturally as we all do our peer group and how we relate and who we relate to where where we're comfortable and things right I mean and that was like in a way a very adaptive yeah life choice absolutely you know not a bad choice clearly well it worked out it worked out because I did have quite a range of interests and um one of my jobs that I did enjoy funny enough you just brought it up randomly was Cardiology I enjoyed that and then I also did quite a long period of time in urology but each time at that time I sort of thought there's a person behind all this you know we're doing all this sort of Science and I wasn't that convinced by some of the science I should add at the time but um you know we did all sorts of things that I did wonder what the evidence was for them and things like that and then I really enjoyed a sort of general practice that was in the community with people and that had some saskatche in it I thought oh this is quite nice this is actually trying to engage in helping people in their lives and adapt maybe to other illnesses but also to then their mental illnesses and so on and I I just enjoyed it and then when you started working in Psychiatry where there is many drugs as there are today I mean where psychosocial interventions more the norm in those those days than just drugs for Psychiatry well they sort of were and it's a great question because um in the early 80s one of the things that I thought was on the rise as it were was social Psychiatry you know the sort of you know depressed mums in the community the sort of uh social interventions in trauma circumstances you know within the community and things it was quite a lot and I was really interested in that and I thought that was the future only to find that by the time I'd been there around for a few years there seemed to be a whole shift to organic Psychiatry or to medication and Psychiatry so biological Psychiatry and the sort of Psychosocial Interventional process actually got relegated to an also rant really because it was a great hope that somehow this would and to be honest I think that great hope has been completely dashed you know I I never really had that hook because my interest was in this broader sort of Interventional system really psychological psychosocial and so on you know although there's a place for medication I think it got over um played um and now we're getting back I think to somewhere where I hoped would have been in the 1980s but there we are yeah when you I mean because I think mentalization is so much dependent on the collaboration that you have had with probably many people yeah notably Peter vanity maybe you should first Define mentorship so you did ask me that and then we'll go back because I'd be curious to understand the origins of how that definition came to evolve or materialize yeah in a way it's not just Peter and me at all uh you know we've we've got our names there as well but this a lot of other people who've been involved over time you know have gone off on their own lines and so on this is a it's a sort of focused effort with a range of people but around sort of mentalizing development especially and developmental psychology by a huge number of people the first thing in sort of defining it is to remember that it's a developmental sort of process that builds over time so we're talking about Child Development here we're talking about the context in which these capacities develop for human beings for you know for us and and they develop within the context of attachments and so on so you know this is all in the context originally of attachment research and Child Development and so on and mentalizing was uh certainly you know I was miles away from it in a sense but it was there with Peter fonagi Meritage Josh gagging many other people as a sort of Developmental process of significance that seemed to lead through along with other sort of processes to personality problems or to behavioral disturbance and so on later on in life as it were so we were just interested in this this process which was called mentalizing and that term was already in the literature it's been in the literature we just pulled it out and redefined it more um carefully so it was no longer just used either in a psychoanalytic specific way um or in um a sort of cognitive form of theory of mind and so on it was actually a um a mental process within a wide aspects of human functioning mental function so it became defined as actually the ability that we have to actually consider that through behaviors and so on that there are mental States behind that so we can consider our own mind States and those of others and actually explain to ourselves as it were what makes someone behave as they do or present as they do and think as they do and why was that an important concept to sort of evolve so that you could work with people who you felt were struggling like yeah well you know in a way a hypothesis was generated which was that and again we're talking about the 80s early 90s in which borderline personality disorder which was now was much better defined as this sort of uh Confluence of relationship problems instability about one's own self-experience and those sorts of things along with some impulsivity and inability to control emotional sort of processing really and then the sort of pain that that led to could this be actually seen as a problem of mentalizing so that the difficulty was as it were within the mentalizing that that high level mental processing system and the Fallout was you saw the Fallout of it all in the behavior and the pain that the person but actually the problem was somewhere else in a sense all right so it's top down rather than bottom-up sort of consideration and we focused on the top part um can you track the developmental process of mentalizing as it begins in infancy or just giving us a little taste of what it is and well go ahead I'm not getting anything okay I'll I'll try and give you a little little pricey maybe but this is obviously the sort of development of mentalizing in a way over time you're asking about um so developmentally in a way mentalizing begins of course at a sort of zero level if you like and it has to be built over time so in a sense we actually learn about ourselves through others so our inner experience is transmitted to others as it were our caregiver mother let's just take it as that Prototype at the moment and actually it's reflected back and given some sort of structure to it and I actually take that in and actually begins to form a self so the self is created if you'd like through the mind of another in a way originally so that's what we call in Social mentalizing terms eye mode but imode is in this context of me mode sort of how I am seen or how I express something to someone else and then how they see me and so on can I back so if you're talking about the set like taking it in as a self as in the eye mode yes so if you're a baby yeah and uh you're hungry or something hurts you cry yeah and then your mother holds you and does something to respond to that stimulus of cry yeah and that over time gets big you know grows so that the Expressions become more representational yes you move from that sort of physical sort of soothing as it were to a sort of representational level of soothing in a sense so they start building together um the example you're given I'm crying so I have an experience and actually the person responds in a way that matches that need of that experience so when it sort of maps that's really nice that soothes me and that's exactly what happens in the attachment process this physical proximity seeking you know behavioral system where I have an experience which is in general fearful or make anxious so high proximity seek and that person responds in a certain way which actually manages my anxiety I'm soothed and that builds a sort of trust in that relational system and does it also give the person that eye exact sense of whatever's going on inside of them this outside thing is responding to and so they know that it's sort of real I guess absolutely this is actually a real experience and it has meaning and it's communicated and so on so we've got a whole series of things in it you know how do I learn and label something anger or hurt or upset or uh you know pleasure you know excitement and so I do that through actually the calibration system that we're just describing so it's Incorporated if you like into the self I said builds that sort of picture that map that I have and it also allows me to build a map of relationships what they're like and actually can I trust in them and so on if this goes well of course I build quite a stable mentalizing picture of myself because it's coherent it's continuous and it gives me prediction and expectation of what I get back and what I might get back when I express something so it you know it's good predictor and it's kind of when I don't get back what I expect her hang on a minute there's something funny going on and so I can then reflect on that or see what it is and so on so this is how we build what we call really an eye and it is eye mode in terms of clinical practice and so I think also then what you're saying in terms of functioning predictively for you for someone in a situation is if you have an environment that responds you know when you cry you get held versus sometimes you get held sometimes you get yelled at or ignored yes or I get smacked until I'm in nuisance and all sorts of things and then my state is not taken seriously if you see what I mean I don't get a response that actually as it were joins with it in order for me to begin to be soothed I get more sort of adverse experience I get more anxious and you know George Gage very creatively showed that um the responsiveness in the in the attachment processes actually is really quite complex do we all do it relatively naturally that's the great thing um in a way there has to be a matching response to the need for whatever is being expressed so there's a sort of accuracy to it and then the second bit was that the um responder actually uh shows that that this is the the sort of mental state of the other person it's not them it's my baby so they do a complex marked thing which says so if I can just imitate it you know the baby's crying because and you're not quite sure why but you pick them up and go oh oh so you represent hurt or something like that but you show that it's the baby's hurt not your hurt which is this very nuanced thing to actually do yeah but we just intuitively intuitively do it the the this is from your perspective this is your this is you or how your experience now yeah but I'm not taken over by it and also right you're not also then crying yeah and once we're crying then I need to be soothed as well and then everyone needs to be soothed and that's a message would generate a messy situation yeah yeah so then the person the baby begins to generate this experience of their feelings or their Sensei itself yeah they'll understand the effect that that feeling has when externalized yes on how their environment can respond and they begin to trust in the environment if it's a sort of secure attachment process but then a later development occurs of course where they're able you know because they've got the mental capacities to actually see things from someone else's perspective so for example that could be just in the physical world initially so they become aware that I can see something but you can't because I know there's an object in your visual field line so I know that you can't see that and so on so I begin to be able to represent what you can see or what you know or what might be in your mind so I can see things from other people's perspectives both in the physical environments initially but then in the mental environment okay so they can imagine where your mind is coming from right yeah and this is building perspectives okay but mental perspectives it's not just about knowledge it's actually about experience outside your head yeah they get inside your head and we do it incredibly well actually we do it just automatically right

Channel: BorderlinerNotes

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Id: fV7a2gcZeco

Length: 20min 18sec (1218 seconds)

Published: Tue Feb 14 2023