A Tale of Two Minds: Mentalization and Adult Analysis

In this article I examine the concept of mentalization, its utility in contemporary psychoanalysis, and the development of a mentalizing capacity as a requisite component of the analytic process with challenging, disregulated adult patients. Mentalization has generally been discussed in relation to child treatment. However, adults who have lacked the experience of attunement within the early infant—caregiver relationship exhibit profound deficits in their capacity for mentalization. These adults typically have a history of disruptive and traumatizing attachments. I propose that, with these adult patients, the development of mentalization within the analytic relationship shapes the initial focus and beginning phase of analysis. The initial analytic process, with a focus on developing a mentalizing capacity, would have a different shape and feel from a process that focuses on interpretive interventions. I use clinical vignettes to illustrate a contemporary analytic process as patient and analyst engage in a relationship that facilitates the patient's experience of being understood and promotes the development of the capacity for mentalization—an implicit, nonconscious process that facilitates self-reflection and the ability to make use of interpretive understanding.