Kategori: MBT Couple

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Mentalizing, Epistemic Trust and Couple Therapy

Replacing a purely emotional or behavioral focus in couple therapy as the main goal with an intention to facilitate the core function of couple relationships, enables a fresh view in Mentalization Based Couple Therapy, more in line with MBT theory.

You will find the previous posts on MBT Couple Therapy here and here.

Mentalizing is not the main goal in Mentalization-based Couple Therapy. Even Fonagy, Campbell and Allison (2019) shifts the weight in the their stand on MBT towards the capability to learn and explore with the actual people in the client’s life where it is being lived.
They write:

Improving mentalizing is not the main goal, but the improved mentalizing that results from the process enables the patient to start to approach and learn from his or her wider social context.

In this vein, we are proposing for MBT-CO that the main goal of promoting mentalizing in the couple is to reestablish the psychological function of a couple relationship, i.e. the couple being able to use each other as sources of information to understand experiences and events in their shared life. In relation to the above quote, the main difference between couple and individual therapy, is that the couple relationship present in the room is the wider social context for the clients, the very social context that partners should be able once again to approach and learn from.
More succinctly put, MBT-CO should adress the bio-social core function of a couple relationship, which is adaption to a changing environment to optimize chances of survival.

Epistemic trust and mentalizing

Hence, the main goal should be to support the function of being a couple, to function as a unit of two, capable of using knowledge and skills from each other as important perspectives on the social world they inhabit and must act in.
If the couple stops trusting information they get from each other as relevant and useful – as said previously when the partner by appearing incomprehensible feels unreliabel – then they will be poorer equiped to counteract the darts and arrows life throws at them.
This is the ‘System 3′ of psychotherapy, making the client able in situations of problemsolving to utilize cultural information presented by trustworthy others in the natural settings of the clients’ life, that Fonagy through several pieces of writing are proposing under the heading of fostering epistemic trust.

The goal of MBT-CO is to mobilize the relationship to be that safe haven in the sense of attachment and soothing, but to do that in order for the partners to support each other in exploration, problemsolving and cultural interpretation. In MBT-CO we help the couple move closer together, in the sense of being able to use each other as sources of support and comfort, and to be together to appraise, interpret and act in their everyday life. The use and appreciation of perspectives and knowledge from your partner, rest on epistemic trust in the relationship.
Shifting the thinking on mentalizing and MBT – as Fonagy and colleages (2018, 2019) do – towards epistemic trust in the service of learning and thriving, casts out a double effect of mentalizing in a couple:
One is the fact, that mentalizing makes each partner seem less monstrous, more humane to the other partner, through explicating intentions, dilemmas, inner struggles, emotions etc.
The other is how the ostensive cues of active mentalizing awake the experience of being seen from within, of being comprehended as I comprehend myself, and how this signals safety and promotes more epistemic trust.

Resilience and MBT Couple Therapy

Looking at the way MBT are presently being formulated on the basis of attachment theory, appraisal theory, and the developmental view on non-mentalizing modes, it is apparent how much the approach focuses on the psychological fit between individual to its environment. Fonagy, Campbell and Allison (2018, 2019) emphazise mentalizing as a component of developing resilience – the inner and outer ressources to appraise and act relevantly towards social adverse events – and in this clearly move MBT and the ability to mentalize right into its functional relation to surviving and navigating in the social world.
Understanding behavior, imagination, emotions etc. as being about adaptation to the social environment you happen to be living in, and appreciating how social communities are functional units enabling individuals to adapt to changes in the environment, puts the emotional life and the attachment behaviour of couple relationships and indeed couple therapy in an interesting and different light.
The application of couple therapy might be better off by asking how mentalizing in the couple enables them to function as a unit of two, accessing cultural knowledge together, and hence sustaining a relationship that functions in relation to adaptation to changing conditions in the environment of the couple – child rearing, finansiel investments, conflictual social relations, career choices etc.
In this context, mentalizing works to foster epistemic trust in the couple, that must work in order to make couples resilient.

In this MBT-CO line of thinking, couple therapy should help couples understand each other og continually be able to do good enough repair of breaches in trust and in emotional connection. This should facilitate for them the use of each other and the relationship as ressources when they are facing problems, and on the emotional side to feel contained by the relationship:

The aim of MBT-Couple Therapy intervention is to enable couples increasingly to be able to regulate the affect between them, as well as within themselves, so that the relationship can be experienced as a potentially containing and benign ressource rather than as a state which threatens the stability of their minds. (Nyberg og Hertzmann 2019: 134)

Mentalizing and we-ness in couple relationships

As a way of grounding MBT-CO more firmly within MBT theory, mentalizing in the couple relationship should be regarded as a ressource for affective containment and for building the epistemic trust necessary for depending on the partner as a ressource for continual social adaptation. In other words, connecting mentalizing and resilience, as do Fonagy, Campbell, and Allison, and to see that connection mediated by the individual’s use of cultural information from trustworthy others, binds together conceptually the emotional and cognitive sense of being a couple – the we-ness of couple identity, predictive of couple satisfaction (Cruwys et al 2022) – with the bio-social functionality of the couple bond.
One should not speculate for long on how much our ability for mentalizing and forming emotionally meaningful bonds to other’s has been a massive advantage in the evolution of the human species, to see the couple relationship and its emotional quality in its functional context.

The ability in a couple relationship for social communication and learning should be facilitated in MBT-CO by ‘doing’ mentalizing, discover and show interest in the other’s and your own mind behind behaviour again and again, to know the difference between interacting with your partner in mentalizing and pre-mentalizing modes, and to both step into the relationship and still keep the reflexive distance to the relationship as the ‘third’.

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When the One You Love Becomes Strange to You

Couples seek therapy when they are unable to access their own and their partners mind to investigate problems in their relationship. As said previously, they find themselves in a situation where their partner’s behavior is unintelligible and they feel he or she cannot understand them.

When other people behaves in ways that seems disconnected with and incomprehensible in relation to the social context, we generally experience them as being unpredictable and hence potentially threatening. Developmentally, mentalizing is the ability to decode and use social communication about the inner life of other beings – their intentions, needs, feelings, motives, thinking. When we learn to do that, we re-establish the sense of the other person as understandable and thus as predictable – hence distress is diminished. That enables us to act meaningfully in the social world we inhabit.

Mentalizing couples

In couple therapy it is striking how often and fundamentally this incomprehensibility of the partner disintegrates the sense of couple identity, and basicly the possibility of acting, thinking and feeling together. Being with your intimate partner and experiencing how he or she becomes oblivious to your mind – or the other way round with whom you completely loose touch – renders your partner unpredictable as a social actor. That activates terror, anger and a sense of abandonment.

In MBT couple therapy we are most centrally trying to handle and ameliorate the terror of ‘the person I love and depend on is strange to me’-experience, the variations of which Virginia Gouldner beautifully lays out:

When the one you love keeps hurting you, when the one who hurts you doesn’t try to make it better, when the one you need abandons og frightens you, when the one you know becomes impenetrable or unknown to you, when the one who knows you no longer recognizes you – these are the ubiquitous traumas of love lost (page 156)

When this experience of the partner as psychologically impenetrable precludes genuine trust and curiosity in the mental states behind behavior, a hyper-vigilant state dominates minds and words and touch. A state of reservation and scepticism, a mistrust towards using their partner’s words and perspective on the relationship and the social world they inhabit together pervades their communication on all levels. It is a mistrust towards new information about both their minds and especially towards the kind of perspective on their own behaviour that an outside view can bring.

Hypervigilance

That mistrust is in one word the emotional oversensitivity pointed to by Asen and Midgley:

Epistemic hypervigilance manifests as oversensitivity to difficult social interactions. When family members find it difficult to interpret the reasons for the actions of others, they may not be able to set aside og put out of their mind potentially upsetting memories of experiences within the family, leaving them even more vulnerable to experiencing emotional storms. (page 137)

Just like experiencing your beloved as strange and incomprehensible closes off the mind, so does the experience of not being understood congruently with your own sense of yourself. Hence epistemic mistrust is turned up even further, and that is desperately painful since couple relationships are attachment relations. When each partner seeks the proximity of the other in the face of percieved danger, they meet non-contingent mirroring in the fright or fight of their partner, with the option of either remaining alone, or of identifying with the distorted image of themselves held in the non-mentalizing mind of the other.

This pattern of relating is as Virginia Gouldner shows structurally one of disorganized attachment, since the attachment figure is also the source of terror.

Stopping non-mentalizing

As I will come back to in a later post, MBT Couple Therapy revolves around noticing, stopping, handling and reflecting upon pre- and non-mentalizing operational modes of the mind – teleological, psychic equivalent and pretend mode – that the couple operates from, trying to deal psychologically with this disorganizing situation. It is at the heart of the approach to be »transforming nonmentalizing cycles into mentalizing conversations, particularly at the points of stress and vulnerabilitiy in which their ability to trust is most compromised.« (Bleiberg og Seifer 2019: 155)

The MBT-model for couple therapy that we are proposing is then at it’s simplest based on the three assumptions presented by Fearon and colleagues (2006):

1) That difficulties in couple relationships resulting in non-mentalizing interactional cycles come from limitations in mentalizing capacities when the couple is dealing with problems and challenges in life.

2) That emotional arousal hinders mentalizing.

3) That the couple context being one of attachment and dependence, leads to interactions that are unsupportive and unsatisfying for the couple.

What we hope to do is to make the relational world click back into that place of trust and support, again, and again, and again if non-mentalizing occurs:

If only my partner softened, welcomed me back into the familiarity of our relational space, my world would click into space in a nanosecond. (Virginia Gouldner p. 156)