Everything You Need to Know About Mentalization and Children’s Development
Over the past fifteen years, the concept of ‘mentalization’ has become important in child development and psychotherapy. Mentalization is the ability to understand that people behave in meaningful ways according to their feelings, needs, and perceptions. Peter Fonagy, a British psychologist, and Anthony Bateman, a British psychiatrist coined the term to denote the ability and process by which we make sense of ourselves and others. Building on attachment theory, Fonagy and Bateman suggested that children need parents, not only for safety, but to introduce them to the world of relationships and provide the keys to social/emotional intelligence (See our article on Attachment Theory).
The Importance of Mentalizing
Mentalization is an essential social cognitive skill with wide ranging consequences for the way children function and interact with others. The ability to mentalize is fundamental to satisfying relationships as well as success in the classroom and on the playing field.
Mentalizing is a vital parenting skill, so much so, that it is possible to predict, whether or not, a child will be securely attached simply on the basis of whether or not, parents are able to mentalize. Unlike language or music skills, however, there doesn’t appear to be a window within which individuals need to acquire mentalization.
Psychotherapy research shows that mentalization can develop later in life. Older children, adolescents, adults and prospective parents can learn to reflect on their own feelings, thoughts, and behavior, and those of others, improving the quality of their relationships and their ability to parent.
Mental States come before mentalization
Infants discover mental states through contingent mirroring interactions with caregivers. Frequent interactions with caregivers who are calm, curious, and sufficiently attuned allow the infant to develop awareness of his mental states. The accurate mirroring responses of the caregiver to the infant’s expressions of concern, curiosity, alarm, joy, hunger, and fatigue inform the child that he a) has a mental state, b) that it corresponds to a particular facial expression, and c) that it calls for a particular behavioral response such as reassurance, investigation, soothing, laughter, feeding, or sleep.
Emotion regulation and attention are required for children to explore mental states, to observe, and interact. When parents frequently misread their infant’s mental states or respond inconsistently, the infant becomes confused and irritable, and is slower to identify and communicate his/her needs.
At about the age of four, children are capable of comprehending that they have feelings, intentions, and desires, that other people have feelings, intentions and desires and that these may be the same, or may be different. This is a key social/emotional skill because it allows children to realize that a) my friend might not have intended to hurt me when he knocked into me, b) my teacher wasn’t being mean when she kept us in from recess during a thunderstorm, or c) daddy doesn’t dislike me because he said I needed to say sorry when I was mean to my sister.
The ability to mentalize helps children be less reactive when they are frustrated by the actions of others, be curious about others’ thoughts and behaviour rather than assuming that they know, and begin to understand that the entire world is not about them. It is a skill which promotes friendship and intimacy, and allows for resolution of conflict. “Oh, that’s why you didn’t want to play with me.”
Mentalization is not mind reading
Mentalization is not the ability to know the contents of other people’s minds but the ability to know that others have minds and that those minds are different from one’s own. For example, ‘I don’t know why you are screaming but I know that it is for some reason, and the reason is probably not that you want to give me a headache.’ Or, ‘I see that you are crying and I wonder what sad event has happened to you.’ Mentalizing acknowledges that people’s actions are not random. They are meaningful and connected to their underlying mental states.
Mentalization versus empathy
Empathy is the ability to understand what someone else is experiencing. Empathy requires one to know a person’s circumstances and feelings, usually as a result of being told by that person, whereas mentalizing just assumes that the person is experiencing something. The ability to mentalize promotes empathy because it involves being curious about another’s thoughts, feelings and intentions and, being curious, stimulates questions. ‘You look upset-what has happened?’ ‘I can see you are angry-what’s going on?’
Understanding the effect of our behavior on others
In addition to considering the feelings and intentions of others, mentalizing involves a recognition of the ways in which our actions, words, tone, and body language are perceived and interpreted by those around us. When communication goes awry, we need to consider the possibility that we were we loud, whiny, angry, threatening or sarcastic. Is that why our message failed to get across?
Preconditions for the development of mentalization
Mentalization develops slowly in a nonlinear fashion over the course of a lifetime. It can operate well when provocations are minimal but be lost when they are more severe, work well when someone is generally content but not when someone is stressed. Most of us can consider the internal state of a sobbing child telling his mother about an event at school. We think, “Something really upset him, I hope his mom can help.” However, most of us would not be able to reflect upon the internal state of a driver who just cut us off on the highway and almost caused an accident.
We think, “what an idiot, he should be arrested.” In the first instance, we are not directly involved or personally affected. In the second instance, we are frightened and threatened. Later, we may realize that the driver was probably distracted but, at the time, it felt like a personal attack. Divorcing couples may have enormous difficulty contemplating the needs and wishes of their spouses, and sometimes even the needs and wishes of their children. When we are angry, and especially when we feel betrayed, even the best ‘mentalizers’ can only contemplate their own wounds and outrage. Long periods of calm reflection are a precondition for the development of mentalization.
It cannot develop when children are upset, frustrated, or fearful much of the time. When children are preoccupied with their own safety or unmet needs, they have little mental energy to consider anything else. It is also difficult for children to develop mentalization skills in a relational environment characterized by blame and shame. Children who experience shame about their feelings or actions have difficulty reflecting on them because it’s too painful. They tend to try to forget, which means they have a harder time learning from their mistakes than children who aren’t shamed.
Mentalization and attachment
Fonagy proposed that attachment is not only a requirement for safety but is necessary for the development of social intelligence. Children who are securely attached to their caregiver are more likely to develop the ability to mentalize. Securely attached infants and children who have been reliably soothed and appropriately responded to over the course of their first months and years tend to be calmer, happier, and more curious and alert, which are prerequisites for mentalization. Parents who have securely attached infants tend to be able to mentalize, that is, to wonder about and reliably predict, what their infants need. Parents’ mentalizing ability is predictive of secure attachment in their children.
Demonstrating mentalization
The development of mentalization in children is much enhanced when their parents and caregivers have the capacity to mentalize which they regularly demonstrate. When parents ask their children why they disobeyed, rather than just reproach them, they are demonstrating mentalizing ability. When a teacher wonders whether a distracted, unfocussed student is hungry rather than merely uncooperative, she is showing mentalizing ability. When a small child says his classmate “needs space” after being shoved by the classmate, he is demonstrating his mentalizing ability. Although mentalizing is often preconscious and automatic once achieved, it is an ability which was actively taught, over many months, even years.
The non mentalizing parent
Parents who lack the capacity to mentalize are very challenged as caregivers. They tend to think that their infants and children deliberately provoke and frustrate them, attribute hostile intentions to their infants before their infants are capable of forming intentions, and are unable to recognize the needs of their infants as separate from their own. For example, a mother who is awakened in the night by her crying ten month old child may feel harassed and persecuted but the mother who can mentalize knows that her child needs a diaper change, is teething, or has had a bad dream.
She gets over her feelings of persecution and attends to her child. A mother who can’t mentalize doesn’t reboot, doesn’t recalibrate, and continues to feel that her child is harassing her. Such mothers say, “He knows I need my sleep and he wakes me anyway,” or “I can’t take this anymore.” She may shout at her infant, shake him, or force him to lie down in the crib. The children of non mentalizing parents are more likely to be insecurely attached and less likely to develop the capacity to mentalize.
Pseudo mentalizing versus real mentalizing
People who can’t mentalize often speak in definite terms about others motivations and intentions to justify their own actions or words. Such statements as, “You always try to bully me, I have to defend myself; “you’re so greedy, you’re never satisfied with anything I give you;” “you’re so selfish, you never consider my needs,” or “you are just so stubborn and you never do what I ask you to, so why would I ask nicely?” are all statements which attribute hostile intentions to, and humiliate and belittle the other.
General statements about a child’s age or stage are often used by non mentalizing parents such as, “he’s in the terrible two’s,” “or teenagers are always a pain.” These pronouncements are dismissive of the child’s needs and allow the parent to ignore messages from their child which might require self-evaluation, or change. Parents who can mentalize attempt to look beyond their children’s behavior to understand what they are feeling, needing, and trying to achieve.
For example, a parent might feel exasperated by her child’s demands for a particular type of running shoe but after reflection, wonders if it’s not the shoes but her child’s need to ‘fit’ in his new school which is the real issue. She begins conversations about what he could do, and how she can help. Another parent who is outraged at the way his daughter is treating her sibling stops to consider all that has gone on and hypothesizes that his daughter feels threatened by and inferior to, her sibling. Rather than scolding and shaming her, he reassures her that she is important and loved (while still maintaining that her behavior is wrong).
Failure to develop mentalizing
Children who can’t mentalize tend to be reactive and volatile, as well as self-referential, even more self-referential than their developmental level would predict. They assume that whatever frustrates them was done intentionally by someone to hurt them or deny them. For example, if a child isn’t allowed to use the computer because it isn’t his turn, or given an assignment that is too difficult, he concludes that he is being punished or humiliated because that is how he feels.
When a non mentalizng person has a reaction to an event, he or she believes it is because someone intended to make them have that reaction. Additionally, children who can’t mentalize lack awareness of their behavior and its effect on others. They have a hard time realizing that when they are loud and protesting with their whole bodies, they are perceived as threatening. It is difficult for children or adults who can’t mentalize to maintain friendships because they take offense so easily, have difficulty tolerating not getting what they want, and tend to feel attacked when others disagree with them or criticize them.
It is also difficult for these children to function in the classroom or participate in organized sports or activities. Without the capacity to understand other’s behaviour or intentions, these children are unable to mature emotionally, to manage conflict, or function in groups.
Fantasy play and mentalizing
Fantasy play is an ideal way to explore the whole range of people’s feelings, motivations, and desires and thereby, promote mentalization. During fantasy play, children adopt different roles, which allows them to develop different perspectives; they often have characters with competing agendas or conflict which gives rise to compromise and conflict resolution. When parents interact with their children during fantasy play, they have the opportunity to offer suggestions, ask questions, and make observations which open new avenues of exploration and new possibilities for understanding what people want, how they think, and how to communicate effectively.
Play therapy and mentalizing
Many children who are referred for treatment lack the ability to mentalize and a big focus of play therapy is the promotion of this critical skill. After establishing a place of safety and assisting the child to feel calm, the therapist engages him or her in the exploration of thoughts, feelings, reactions and motivations, showing interest and acceptance, encouraging the child to say more, express more, and enact more.
As parents do with their children in fantasy play, therapists ask questions, make observations, validate feelings, and put into words what children are attempting to convey. Later, therapists suggest that children wonder about others’ behavior, others’ feelings, others’ needs and wishes to stimulate mentalization. “Why does he want to punish her?” “Do you think she wanted to be mean?” “Do you think you could say something to get him to change his mind?” Therapists often take the role of one of the characters in the play and express another point of view, a reaction to being punished, banished, or annihilated.
An important aspect of play therapy is the communication between therapists, parents, and teachers to further understanding about the child’s thinking and behavior, to investigate new strategies to help the child and most importantly, to increase the mentalizing capacities of teachers and caregivers who often feel exasperated and exhausted by these challenging children. It helps teachers to have greater patience with a child who is uncooperative and disruptive in class when they understand that the child’s misbehavior is likely due to trauma; the child may seem angry and obstinate but is probably terrified. It is even more helpful when the teacher is given real information, for example, that the child has been up all night listening to a violent altercation between his parents. It’s informative for parents (who think their children are asleep and don’t hear the fights in the night) to know that they do, and the effect that it has.
Mentalizing and mental health
There is a strong connection between mental health and the ability to mentalize for the reason that satisfying relationships are a powerful determinant of mental health and satisfying relationships require the capacity to mentalize. Certainly, it is optimal that parents have this skill but when they don’t, we can teach this skill, we can expand parent education and support programs to enhance parents’ knowledge and help them put their knowledge into practice. Promoting secure attachment and mentalization in children is an investment with huge returns.
Resource
Anthony Bateman, M.A., F.R.C. Psych. and Peter Fonagy, PhD., F.B.A., Handbook of Mentalizing in Mental Health Practice, American Psychiatric Publishing, Washington, DC, 2012.
Nick Midgley, Karin Ensink, Karin Lindqvist, Norka Malberg and Nicole Muller, Mentalization-Based Treatment For Children, a Time-Limited Approach, American Psychological Association, 2017.
About The Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.