[MUSIC PLAYING] We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hello, my name is Emma Morris. I'm a clinical psychologist. I use mentalization-based therapy with children, young people, and families. I'm founder of the Multifamily Project and I'm co-director of the Trauma Recovery Space. So I'm going to be talking here today about mentalizing in work with children and families. It's very much a brief introduction. I've called it here a whirlwind tour. That's because we don't have much time, so I'm going to cover some of the core concepts and ideas, but I'm not able to go into much detail or to expand much. So if you are interested or inspired to learn more, then I really recommend these three books. One is on MBT with children, one with MBT for young people, adolescents, and one for MBT with families. So what is mentalizing? Mentalizing is the capacity to understand our own reactions and those of others as motivated by inner mental states such as feelings and intentions. It's an imaginative capacity in that to mentalize, I have to imagine, for example, what's going on inside the mind of another person, their feelings, their intentions, maybe the impact of my behaviour on them. And it's also an interpretive capacity in that I have to-- if I'm going to mentalize fairly accurately-- pull together a lot of different information from inside myself, feelings, thoughts, my environment, what I know of the other person, their history, what I can see, what I can, what's implied. Have to pull all of this information together in order to make sense of another's behaviour. Mentalizing can be thought of as a process, as a way of being where we're looking past behaviour to the mental states that underlie that behaviour. So it's not about an end result. It's not about finding an answer. It's about being interested and trying to understand somebody's behaviour in terms of their intentional states and feelings, and so on, and the ability to attune and reattune and adjust that understanding in the light of new information and feedback. Why is mentalizing so important? Well, it provides the ability to symbolically represent and to think about our feelings instead of just reacting to them as they happen. And this in turn helps us regulate and communicate our emotions effectively. So, for example, if I've had a bad day at work, if I come home, maybe something difficult happened, I'm very tired and my partner seems a bit oblivious, despite my attempts to drop hints and not particularly interested in me, I might in that moment feel a bit hurt or a bit uncared for. However, if I'm able to think about those feelings and think, well, I am tired, so I'm probably a bit more sensitive than I normally am. And he wasn't there today. He doesn't know what a difficult day that I've had and actually, I've been married to this person for lots of years, and objectively, I know he does care about me. I can think about my feelings in that way. I can regulate them. And then I might make a proactive decision to talk to him about how I'm feeling, and maybe even tell him what I need from him in that moment. If I can't do that, I'm just left with my feelings and it becomes my feelings of being hurt or uncared for that drive my behaviour. So I might challenge him or withdraw or retreat in some sort of way. Mentalizing also helps us predict and react to other people, enabling social cooperation and the maintenance of relationships. So if you take that example again, my partner, I might know that they need a good half hour when they get into work from work to decompress and relax. So I might make the decision. Actually, I'm going to tell him all about my terrible day in half an hour when he's had that time, because I know I'm going to get a better response out of him that way. So in these ways, sometimes mentalizing is very central to making good decisions. So how does mentalizing develop? It's an innate capacity that develops initially through early caregiving relationships, where an infant experiences feeling seen and having their agency marked. So an infant or a child might experience their caregiver as interested in their behaviour and their thoughts and their feelings, and experience them as mirroring those thoughts, feelings, behaviours back to them in a way that helps them make sense of themselves, and in future, other people, and the world around them. Mentalizing capacity is further shaped by relationships and experiences beyond the caregiving relationship. Extended family, community, friends, work colleagues, teachers, partners, and broader influences, social, political, cultural influences, they all impact on the developing capacity to mentalize through childhood and into adulthood. One idea that is talked about a lot in mentalizing is the idea of epistemic trust. So we can't take in all the information about our social world. We need to have a certain amount of vigilance because some of it is inaccurate and irrelevant. And besides, anyway, there is just far too much to learn it all. So we need a way of identifying trusted sources of information. We think that feeling mentalized is a key signal that it's safe to learn in this way. And this is where the idea of epistemic trust comes in. So it increases epistemic trust. And with epistemic trust comes the opening of channels to learn vast amounts of information quickly on an explicit and an implicit level about the other and the social world and the self. It increases the likelihood of communication being coded as relevant, generalizable, and to be retained. So attachment to a person who has responded sensitively mentalized in this way in early development is a special condition for generating epistemic trust, which makes sense if you think about it. If you've had somebody who has mentalized you well, and by that I mean in a way that has felt safe and helpful and useful, in a way you've benefited from, you're more likely to recognise opportunities to learn in that way in the future, and to be open to learning from those opportunities. And it's in this way that there's thought to be a cognitive advantage of attachment security, because it is likely to increase engagement with social learning opportunities. So epistemic trust enables social learning in an ever changing, very complicated social and cultural context. And it allows individuals to benefit from their social environment. With this in mind, winning trust and recognising individual agency is essential if you want people to be open to what you have to say and to benefit from what you have to say. And this is relevant. If you're a parent or a carer or a teacher or a therapist or a politician or a manager. Generating epistemic trust is a foundation for learning and cooperation. So then what happens if your early experiences of communication with your caregiver can't be trusted in that they are unavailable, inconsistent, inaccurate, maybe harmful? Children who have experienced a consistent lack of safe, reliable care can become quite guarded to social communications, something that is called or referred to as epistemic mistrust or hypervigilance. This is a way of protecting themselves. It makes sense. If what you've had communicated to you is unreliable or inaccurate or unhelpful, it makes sense to protect yourself or to be guarded against such communications. That's adaptive in a caregiving relationship like that or in a home environment like that. But the problem is it can become maladaptive outside of that environment. And that's what this picture here is about. If you imagine this little person here, maybe they need to wear a suit of armour at home to protect themselves from inaccurate, harmful, or inconsistent communications and care in the way I described. But when they get into the classroom, this isn't going to be so helpful for them. It might keep them very safe, but they don't need to be safe necessarily. It's not always the case, obviously, but let's imagine they don't. And it's going to get in the way of them moving around the classroom. They're going to be clumsy and bump into things. The other children might be a bit scared of them or think they're strange. They can be hot and uncomfortable. And if you look, you can see they're only going to be able to see a very small amount of the world, and they're definitely not going to be able to hear much with that helmet on. So in this way, what were adaptive responses can come to block social learning and the development of mentalizing capacity outside of that context. In the same way, a consistent lack of safe and reliable mentalizing can lead children to be socially naive because they have difficulty gauging the trustworthiness of communications. It's important to realise that threats to epistemic trust can extend beyond the care giving relationships. We talked already about other relational contexts, friendships, extended family, community, and so on. But also broader social influences and experience can impact on the development of epistemic trust and therefore mentalizing capacity experiences such as prejudice, discrimination, and oppression. Another idea that's talked a lot about in mentalizing is this idea about we-mode. So by that, we mean co-representing the viewpoints of others and generating a psychological collective, which can lead to an emerging sense of shared perspectives and shared minds. And you will I think probably you will recognise this experience of being in a we-mode, where you're in it together and you're all on the same page. It can be in a therapy room. It can be in a home, in a family, in a classroom, in a friendship group, in a workplace, in a broader social and community-based context, this feeling of cocollaboration and really moving in the moment. And this is really what we think is at the heart of relational mentalizing and social learning. In mentalizing, another really important idea is the link between emotional arousal and mentalizing capacity. So mentalizing capacity, mentalizing is quite fragile and can easily be knocked offline. The part of our brain that we use to mentalize isn't available to us. We just can't access it when emotional arousal is too high. So in this diagram, you can see a window of tolerance. You might have heard this term used in different ways, in different settings. But in MBT, we want to be working within this window of tolerance. And we want to be helping people to recognise when emotional arousal has gone so high that they're not able to mentalize anymore. So mentalizing happens within this window of tolerance. Similarly, when affect is too low and you're disconnected from affective and emotional states or even disassociated from them, you can't access them in order to make sense of someone's behaviour or your own behaviour. And so similarly, you're outside of your window of tolerance. So the window of tolerance is where affective mentalizing happens. And it's important to note that people have different windows of tolerance, different kind of bandwidths on different days, in different situations. If you're very tired, if you're going through a stressful period, your window of tolerance is going to be smaller and your mentalizing capacity is therefore going to be more fragile, more easily knocked offline. The window of tolerance might also differ between people. So if you've experienced trauma, for example, you may have a narrow-- a more narrow window of tolerance, a more fragile, less developed mentalizing capacity. Sometimes as well people who are neurodivergent can have smaller windows of tolerance at different times. So if we think then about the development of mentalizing across culture, and it's linked with well-being, first thing to say is that there is very limited research, so we don't know a lot about it. What research there indicates that there's potentially cultural differences in the way mentalizing develops that process of development across cultures, for example, between individualist and collectivist cultures. We also think that there's probably individual differences in the way mentalization develops related to factors such as neurodivergence and adverse life effects. However, it does seem to be so far based on that the link between emotional well-being and mentalizing is fairly consistent across contexts. So finally, then, how do we understand that link between mentalizing capacity, resilience, and emotional well-being? As I said at the beginning, there seems to be this recursive link between emotional regulation and mentalizing. If you can mentalize your affective states, then you are able to make sense of them and regulate them. But similarly, if you just think back to that, slide around emotional arousal and mentalization, if you're able to stay regulated, you're able to keep your mentalizing capacity online and to mentalize better. So in that way, there's a kind of circular relationship between emotion regulation and mentalizing capacity. The second probably main way that the two are linked is, as we've already described, because mentalization seems to open channels for social learning by generating epistemic trust and allowing the absorption of vast amounts of relevant information about our social and relational world. Mentalization-based therapy can look different, depending on who you're working with and why you're working with them. It can be one to one. It can be in a family, a dyad. It can be group based. However, mentalization-based therapy broadly aims to promote the recovery of mentalizing when it's broken down and over time to develop mentalizing capacity so that it becomes more robust and less easily derailed. This is with the assumption that improve mentalizing is associated with improved emotional regulation, interpersonal functioning, and generally, improved mental health. That's the kind of core idea behind mentalization-based therapy. So thank you for listening to this webinar today. I hope that you have become interested and inspired to find out more about mentalizing and mentalization-based therapy. I'm also going to be providing a live webinar on mentalizing with complex clinical presentations in children and families, a systemic and trauma informed approach for the Association of Child and Adolescent Mental Health on the 14th of October from 1:00 to 5:00 UK time. Thank you very much. [MUSIC PLAYING]