Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

BACKGROUND
THE THEORY OF MENTALIZATION
Anthony Bateman and Peter Fonagy have extended
attachment theory to try to explain the problems associated
with borderline personality disorder: emotional, relationship and
identity instability. They have coined the term ‘mentalization’
to refer to an individual’s capacity to think about and reflect
on their own mental state (thoughts, emotions, action urges)
and the mental states of others. They believe that this is
vulnerable to disruption in people with borderline personality
disorder, leading them to quickly become over-aroused, when
they misinterpret the thoughts and feelings of others, and
therefore experience extreme ups and downs in relationships.
Poorly established capacity for mentalization occurs when the
attachment relationship has been inadequate to the child’s
needs. A carer who bursts into tears when they see the baby
crying will offer no comfort; the carer who expresses concern
through her eyes and her tone of voice, shows that she knows
the baby is upset, but is not so upset herself that she is
overwhelmed. The child takes this experience of a responsive
carer into him or herself and can later in life become a good
‘carer’ to him or herself. This gradually enables the child to
manage their own emotions and to experience inner stability.
Where the caregiver is unavailable, preoccupied or incapable of
responding sensitively and accurately, the child will internalize a
response which does not match his feeling. For example, if the
carer laughs mockingly when the child cries, the child will
internalize a sense of an uncaring or dismissive ‘carer’. If there is
no internalized ‘in tune’ carer, the infant will continue to feel
anxious or upset, and, because the carer has not been able to
soothe his anxiety, the anxiety may have a quality of being
impossible to think about or moderate. It feels like something
in the mind which does not quite belong to the self. This can
lead to an urge to get rid of the experience. People who act
impulsively or who self harm, often describe these behaviours
as a way of trying to get rid of an internal feeling of tension
that they cannot understand, can’t change, and can’t bear.
The child and the adult may then lack resilience in the face of
life stress, and can be vulnerable to emotional collapse when,
as often happens, further trauma occurs.
Broader social
and environmental
factors
There are a range of factors
that will contribute to the
development of personality
disorder and these factors also
interact with each other, so
that there can be a circular
quality to the process. A child
who has been disturbed by
traumatic experiences or poor
care, may have difficulty
controlling his own behaviour
or emotions, and then be seen
as ‘difficult’ or ‘demanding’,
and so evoke a negative
reaction from some teachers or
family members. The social and
cultural environment of the
extended family, schools, peer
group, and community or
religious groups, also play a
part, either for better or for
worse. We know that one
good relationship with
someone like a grandparent
or teacher can do a great deal
to offset the bad effects of
a difficult home life.
Inequality, whether this be in
terms of poverty, access to
good schools and housing or
social prejudice, can have a
major impact on people’s lives.
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