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Therapists: Are you struggling with that one client? Here's why mentalizing is a term you need

Are there some clients you really struggle with? You see them week after week and you're not sure if you're getting anywhere? Or does it seem like you're getting somewhere, but even though it all sounds fantastic in your session, the drinking or the arguments or the whatever it is doesn't actually stop? Ever had a patient who could recite all the fancy skills you taught them left, right and backwards, but he or she doesn't use them in crises?

Enter mentalizing. Mentalizing is what the brain is doing when it's thoughtfully reflecting on a problem or a social question, such as "why is he treating me like that today?" or "I know she would never forget my birthday, something must really be going on!" Mentalizing is what the brain is doing when it is trying to understand a misunderstanding, when it's being empathic, when it's b

eing mindful. In fact, empathy and mindfulness, at the level of brain activity, largely overlap! Many of the same neuronal circuits underpin both capacities, though one is pointed outward at other people and the other is pointed inward, for ourselves. Hence, mentalizing is a 'supercapacity' of sorts, encompassing both empathy and mindfulness (and other terms too, but that's a topic for another day).

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Mentalizing is what is NOT going on when we are thinking, "what a jerk!" or "those people are all _____!" or "She's doing this to piss me off, I know she is!" Mentalizing is not going on, at times probably, with that client you struggle with - whether it seems like change may never come, or whether change always seems just around the corner. Non-mentalizing, as it's called, is by definition an uncurious, non-changing stance. It can look like a retreat from change, "people are how they are and nothing I talk about in therapy is going to change them," or it can look like real change is coming, except you find out later it was only lip service to change, or your client says, "I know rationally X, but I just didn't do it/didn't believe it." Either way, non-mentalizing is an obstacle to change.

To get mentalizing going, people need to see that you get what life is like from their point of view. No one will bother to take up anyone else's point of view if they don't feel like their own is being adequately considered. So before you resume your typical challenge of cognitive distortions, before you remind your client, "didn't we talk about this last week?", before you throw up your hands and think some people just can't change, try to see whether you hear mentalizing or non-mentalizing in your session. If you hear non-mentalizing, put a stop to it (gently, gently now). Then kindle some mentalizing by asking, insisting if you have to, what your client's experience of that troublesome moment was. If the client tries to impress you with how they thought about the situation, how they analyzed it, how they knew rationally what was going on (correct! that is non-mentalizing), pursue their emotional experience instead and don't let up until you get something at least different - something you can empathize with.

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