Using a mentalising approach to support relationship-based practice
What is mentalising?
Mentalising is not a new thing. The term may not be immediately familiar, but it puts a name to something many of us are doing on a daily basis without even realising. It is a process that we use to reflect on, explore, and interpret our own and other people’s thoughts, beliefs, experiences and feelings, and how these influence behaviours and actions.
Adopting a mentalising approach can be exceptionally beneficial to support relationship-based practice in a social work context. It enables us to look beyond the external to understand what is going on internally and regulate our emotions, thoughts and responses in order to build strong relationships and working partnerships. Because it promotes understanding of different behaviours, experiences and perspectives to our own, it is useful for social workers who may be working in a variety of settings with a range of people.
So, if it’s not new and if we’re already doing it, is there any need for a formal definition and approach? Does it need a label? Do we need to be taught how to do it well?
Bateman and Fonagy, who carried out research into the use of mentalisation in psychotherapy  and who developed Mentalization-Based Treatment say themselves:
‘We claim no originality for the invention’.
Their focus was on identifying why and how this particular process seemed to work in therapy and how it could be consciously understood and deployed as a technique. Since then, more evidence has been gathered to support the use of a mentalising approach as a means to facilitate positive interaction and relationship-building.
So how does it work?
A mentalising approach is respectful and curious about what makes someone feel, think or act as they do. It involves an awareness of how our own words and actions may have an impact on other people, the conversations we have and the outcomes we generate as a result. It reflects on what people did and said, their feeling, thinking and mental states, and what may have motivated their actions, without making assumptions or judgements. It requires being present in the situation and conversation, actively listening and observing without falling into the trap of either 'overmentalising’ or telling someone what they’re feeling and thinking. This last bit is key - checking in with someone that you’ve understood the situation, so that you can assess how to respond in a way that is most likely to contribute to a positive outcome.
What affects the ability to mentalise?
The ability to mentalise fluctuates within each individual. It can change from day to day, situation to situation and even when dealing with different people. On a good day, it might take little effort. But if we’re stressed, anxious, or not feeling very resilient, our ability to mentalise may be affected. This means that we may not be able to make the attempt to be aware of or understand our own or other people’s emotions and behaviours. It decreases the likelihood of working in partnership effectively, and increases the potential for conflict.
Other factors such as autism, dementia and some mental health problems may also inhibit mentalising ability:
‘These groups of people are more likely to need the support of adult services and supportive professionals who are able to understand the complexity of their needs and experiences.’ (Using a mentalising approach in adult social care: Frontline Briefing)
Poor mentalising might display as a tendency to hold inflexible beliefs, a lack of curiosity, difficulty managing strong emotions and feelings, intolerance of differences, and an inability to assess or interpret other people’s mental states.
In practice, it’s important to be aware of your own and others’ mentalising abilities, and to be willing to make the effort to mentalise even when you can sense someone else has gone ‘offline’. It these instances it can also be very useful for a practitioner to understand how not being able to mentalise might impact upon that person’s thoughts or actions. However, be careful not to make assumptions about people who may lack the ability to mentalise in certain situations – it doesn’t necessarily apply to all situations.
The good news is that mentalising does not require both parties to be doing it at the same time in order to work. In circumstances where another person may be experiencing limitations, maintaining your own approach becomes even more important to support successful outcomes for the interaction.
Outcomes of effective mentalising
An ability to understand and regulate our own emotions, behaviours and responses to situations clearly has powerful potential. It enhances communication and enables us to effectively engage in relationships. It can also support good decision-making with regards to how we respond in a given situation. A mentalising approach helps us to remain grounded and validate someone whilst encouraging them to reframe or question their feelings or thoughts, by creating a secure base from which they can consider alternative possibilities and different perspectives.
The more we practice using a mentalising approach, the better we become at employing it at the point of interaction (rather than as a reflective tool), and this enables us to communicate more effectively in the moment. As such, it is a core element of the practitioner toolkit – by understanding ourselves and others, we are better able to establish and sustain positive relationships and to navigate challenging situations. And if strong relationships are the foundations upon which we can build to achieve positive outcomes for people, then mentalising can be seen to be a vital part of the process of laying these.
About the author
Jen Matthewman is Communications Coordinator at Research in Practice for Adults.
Rayns G, Rickman C and Mountain G (2016) Using a mentalising approach in adult social care: Frontline Briefing. Dartington. Research in Practice for Adults.
Camden and Islington NHS Foundation Trust (2015) What is: Mentalisation Based Therapy? Available online: http://www.candi.nhs.uk/sites/default/files/Documents/what-is-mbt-pdf-a4-version-jan-2015.pdf
Bateman A and Fonagy P (2010) ‘Mentalization based treatment for borderline personality disorder’. World Psychiatry 9 (1) 11-15. Abstract available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816926/
Bateman A and Fonagy P (2006) Mentalization-Based Treatment for Borderline Personality Disorder: A Practical Guide. Oxford. Oxford University Press.