Mentalization for Whom?: Commentary on Article by Heather MacIntosh

This is a brave paper. Brave, not only because it attempts to review the vast literatures on trauma, attachment theory, and emotionally focussed therapy (EFT) within a few short pages; but brave, because it puts forward a proposed direction for future therapies without being in the position fully to describe them; and brave, because it also presents a situation commonly faced by all therapists, couple and individual, that of the patient who does not get better, together with an example of a therapy that does not seem to work.

Carol and Mark are presented as being in EFT with an experienced therapist. As much as can be gleamed from the vignette, the therapy was conducted in keeping with the fundamental principles of EFT. Based on attachment theory, relationships are conceptualised as attachment bonds and the security of the relationship and that of each partner becomes the focus. As such, change is based upon the therapy providing and facilitating a new experience of the self and of the other for both partners. Rather than viewed as pathological, partners are viewed as stuck in rigid patterns of interactions, driven by emotional states. The therapist is therefore a consultant to this process of interaction, and as described in the paper, attempts to orchestrate different and better cycles of interaction between the couple. As also described, repeated attempts to aid Carol in a process of change are all to no avail. Something is not working, something is missing, and it is suggested that the missing ingredient is mentalization.

Through considering the paper, from my perspective as a psychoanalytic couple psychotherapist with an interest in attachment theory and research, a number of points regarding theory and technique emerged. These are all too briefly summarised and lead to a brief consideration of mentalization with regard the clinical situation described.

Fonagy (1999) argued convincingly that attac