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Robert Duschinsky's (2019) interview with Peter Fonagy helps us to appreciate how the theory of mentalization has grown and is continuing to develop. It has evolved from being a theory about the poor mentalizing of patients with severe personality disorders to a theory that has relevance for all psychotherapy patients (and really all human beings). An important shift has occurred in importing the notion of epistemic trust and epistemic vigilance from pragmatics, because mentalizing is understood in terms of the capacity for communication; that is, openness to learn from and respond to others. This provides an illuminating path to advance our understanding of the therapeutic alliance as determined by something beyond a positive attachment relationship.
Mentalizing has a social function; it is not merely an individual or interpersonal activity. Yet, in considering mentalizing in terms of social cognition, a whole series of questions arises, which I expect will be taken up and pursued by mentalization researchers. For example, how can mentalization be construed not merely as reflective of the normative beliefs and expectations of specific social environments? How can it be creative and how might it resist the status quo? Does mentalization vary across cultures? If so, how can we translate mentalization across cultures?
The highlight of the interview for me is the many links that Fonagy forges among epistemic trust, psychotherapy, the political realm, and technology. Epistemic trust is a necessary basis for psychotherapy; without it, a patient can seem to be profiting from the experience, but somehow never actually change. Indeed, there are some patients whose capacity for epistemic trust has been damaged by adverse childhood experiences, so they either have given up on trust or have too much credulity. The mentalizing therapist must be willing to express the desire to understand and help the patient, challenging the patient's certainty that can come either in the form th