Borderline Personality Disorder

How mentalization skills can help children at risk

Mentalization lets kids consider situations from many points of view

Thinking About Thinking May Help At-Risk Children
Mentalization lets kids consider situations from many points of view
Published on May 18, 2013 by Kristi Pikiewicz, PhD in Meaningful You

Imagine that you have arrived at a museum to view an Ancient Grecian statue. Your experience, including your thoughts, emotions, and physiological reactions, would be dictated by two factors: the nature and quality of the artwork itself, and the space within which it is presented. The statue may be beautiful or frightening, sturdy or fragile, well-preserved or in a state of disrepair. These are immutable properties that cannot be easily changed, but your reaction to the piece will also be informed by how it is presented. The size and layout of the gallery determines whether or not you may move around the statue to see it from all angles, appraise it from afar or up close, or even gain enough distance to see multiple statues at once and compare them.

This metaphor may tell us something important about the social and emotional development of children. Each child carries models of relationships unconsciously — templates about how people will treat and react to him or her — borne out of early experiences with caregivers in infancy. These models are like the statue: old and difficult to change. The gallery represents the internal space in which those models exist: that is, the child’s ability to think about and reflect on the mental states of the self and others. Attachment theorists such as Mary Main and Peter Fonagy have long proposed that the development of such a reflective capacity, also known as mentalization, ought to be protective for children whose early models are problematic. (Children may develop troublesome models for a variety of reasons, stemming from parental, environmental, and genetic sources.) A child with high mentalization would have the space to consider his models from all sides, compare and contrast them, and choose how near or far to “stand” from them. On the other hand, without the ability to mentalize a child may feel trapped with distorted or fractured models, repeatedly entering into new relationships with expectations of painfulness and chaos.

There is now some concrete evidence that mentalization is indeed uniquely helpful for children from adverse backgrounds. In my work with early adolescents, mentalization is assessed through an open-ended interview called The Friends and Family Interview (a.k.a. the FFI). In order to assess children’s ability to mentalize, we ask them questions like, “What do you think your mother thinks about you?” and, “What are your favorite and least favorite parts of your relationship with your father?” We have found that in a broad sense, mentalization breaks down into two important factors: 1) empathy, or thinking about how other people feel and why they behave the way they do; and 2) introspection, or considering one’s own diverse feelings about important others, like parents, friends, and siblings.

In a recent study, we administered the FFI to two groups of children, all around age 11. One group consisted of middle-class, White children from intact homes in London, England. The other group consisted of minority children of lower socioeconomic status from New York City, nearly half of whom lived in single-parent households. All of the New York children were members of an afterschool program that aims to keep at-risk children from dropping out of school.

Our question was whether the children’s mentalization impacted their attachment security, an important component of social-emotional development. We found that for both groups, higher empathy significantly predicted secure (versus insecure) attachment. For the London group, introspection did not make any real difference in their attachment security, suggesting that they did not “need” this aspect of mentalization to develop healthily. On the other hand, New York City children with high introspection were over 15 times more likely to be securely attached than those with low introspection. In other words, for these more at-risk children, the ability to reflect on their own mixed feelings directly related to their presentation as balanced and emotionally stable.

Mentalization-based psychotherapy is an increasingly popular option for treating adults with a wide range of psychological issues, but it is far less commonly used with adolescents and children. Though the above research is preliminary, increasing mentalization may ultimately prove to be an important means of helping at-risk children follow new pathways toward social and emotional health.

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