Mentalizing and Neurodivergence |
Mentalization can be a useful way to think about theory of mind or social perspective-taking.
Mentalization is the ability to understand others’ behaviors by considering mental states and intentions.
Mentalization is also the ability to consider the impact of one’s own emotions and behaviors on others.
Goals can include mentalizing well and deliberately when in interpersonal conflict.
I recently came across a new (at least to me) term for social perspective-taking or theory of mind: mentalization. Midgley et al. (2017) use this terminology while working and writing in the Netherlands, focusing on children and adolescents with attachment, social anxiety, post-traumatic stress disorder, and personality disorders.
It seems to me that their mentalization terminology and their descriptions of what this is might be very useful to neurodivergent children, adults, and their families here in the United States. I think their way of thinking can lead to clear and specific, thus more attainable, therapeutic, interpersonal, and personal growth goals for autistic people or people diagnosed with autism.
Defining Mentalization and Mentalizing Well
Midgely et al. (2017) define mentalization as the:
“Ability to interpret the meaning of others’ behavior by considering their underlying mental states and intentions” (p. 15)
“Capacity to understand the impact of one’s own affects and behaviors on others” (p. 15)
“In simpler language, mentalizing is about understanding oneself and others on the basis of what’s going on inside us; it involves keeping mind in mind and seeing oneself from the outside and others from the inside.” (p. 15)
“In simpler language, mentalizing is about understanding oneself and others on the basis of what’s going on inside us; it involves keeping mind in mind and seeing oneself from the outside and others from the inside.” (p. 15)
Midgley et al. write that “when we are mentalizing well,” we are somewhat or mostly able to:
Be aware of our feelings in the present, and our personality traits and behavior patterns in general, and thus have some sense of how we look to others “from the outside.”
Consider the emotions and motivations of others and see their reactions and behaviors with this perspective in mind.
Be curious about how the world looks from other people’s perspectives while also having some awareness of the limits of our ability to know what is in their minds, such as their perceptions, emotions, and intentions.
Be curious about how our own perspective may influence what we do, or color how we see someone else’s behavior. Be mindful that we might get it wrong when we try to understand why others behave in the way they do.
Understand that trying to make sense of, and even repairing, these misunderstandings can improve our interpersonal functioning and enrich our relationships.
I think these definitions and descriptions of mentalizing well are accurate and accessible. I am beginning to share them with patients in my practice.
I especially like seeing oneself from the outside and others from the inside. This can be a concise and powerful prompt.
I think these descriptions of what we may be doing when we are mentalizing well can be readily transformed into specific and clear treatment and personal growth goals.
When We Struggle to Mentalize and Neurodivergence
Midgley et al. (2017) write that:
“When we are able to make sense of the behavior of others (and ourselves), the interpersonal world becomes a more predictable, safe, and meaningful place. But when we misread the intentions of others, or struggle to make sense of our own internal states, this can lead to confusion, misunderstanding, and difficulties in interpersonal relating, contributing to escalating conflict or bottled-up anger and fear.” (p. 18)
I have seldom read a better summary of what theory of mind and social perspective-taking struggles mean to real people in their day-to-day lives.
I want to add that many people can mentalize, but not easily or automatically, which I find to be the case for many of the neurodivergent people in my practice. They become cognitively depleted by the interpersonal demands of school, work, social gatherings, etc. “Exhausting” and “exhausted” are the words most often used by neurodivergent patients in my practice.
Note that when hungry, tired, or cognitively depleted or after a long day at school or work, explicit, deliberate, controlled, “slow” social information processing systems are the first to go “offline.” This is true for all of us, and even more so for many neurodivergent people and for autistic people.
Automatic Versus Deliberate Mentalizing
From an evolutionary psychology perspective, being able to quickly identify a cooperative friend or ally helps with resource acquisition and joint completion of complex tasks. In other words, survival. Being able to quickly identify potential foes and threats to resources was likely, at times, a matter of life and death in environments of evolutionary adaptation.
From a cognitive psychology perspective, automatic processing also has disadvantages. It is quick and agile and not always accurate. It is based on and thus biased by prior experiences. The parts of our brain involved in the fight-or-flight response may be activated, even when we are actually in low-threat social contexts.
There are times when explicit, controlled processing, “thinking slow” rather than “thinking fast,” might be a better fit for a social situation. Sometimes deliberate and effortful reflection on the emotions, thoughts, and intentions of others, and how they may be perceiving and reacting to us, is worth it.
I think these evolutionary and cognitive psychology perspectives overlap well with Midgley et al., who write:
“Such processes may be slower than the more automatic modes of mentalizing, but they make it possible for us to more carefully and deliberately make attributions about emotions, thoughts, and feelings of self and others. This allows us to consider whether our immediate reactions are actually warranted after we have considered the situation, and then we can override or adjust our first impressions to be in line with these reflections.” (p. 21)
“Such processes may be slower than the more automatic modes of mentalizing, but they make it possible for us to more carefully and deliberately make attributions about emotions, thoughts, and feelings of self and others. This allows us to consider whether our immediate reactions are actually warranted after we have considered the situation, and then we can override or adjust our first impressions to be in line with these reflections.” (p. 21)
“We often make use of more controlled or explicit mentalizing when there has been a difficult situation that demands some kind of active reflection to help make sense of it.” (p. 21)
“We often make use of more controlled or explicit mentalizing when there has been a difficult situation that demands some kind of active reflection to help make sense of it.” (p. 21)
In other words, sometimes it’s best to slow down, stop and think, step back and cool down, ask questions, and actively listen.
It can be helpful to be aware of and pause our universally human tendencies to blame other people for their problematic behaviors (see them as deliberately choosing to behave badly) and ignore or not give enough weight to physical and social context, personal and family history, biology, or neurodevelopment (i.e., how their brain works).
Remember: We are a part of others’ interpersonal contexts—our affects and behaviors influence their affects and behaviors. And theirs can influence ours. On and on.
Intentionally (deliberately) mentalizing can help us work through interpersonal conflicts.
We are more likely to mentalize well when we are getting enough sleep, and we are eating regularly and healthily.
Each and every one of us, and our communities and society more generally, benefit when we mentalize well.
Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., & Muller, N. (2017). Mentalization-based treatment for children: A time-limited approach. Washington, D.C.: American Psychological Association.