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Book Review   |    
Jeffrey S. Barkin
Psychiatric Services 2009; doi: 10.1176/appi.ps.60.2.271
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by Jon G. Allen, Ph.D., Peter Fonagy, Ph.D., and Anthony W. Bateman, M.A., F.R.C.Psych.; Washington, D.C., American Psychiatric Publishing, 2008, 433 pages, $55

Dr. Barkin is a psychiatrist with a private practice in Portland, Maine.

Every so often a book comes along that synthesizes so much information as to inspire true intellectual and epiphanic awakenings within the reader. Such is the case with Mentalizing in Clinical Practice. The authors convincingly propose that mentalizing is the cornerstone of understanding both human experience and the full range of psychotherapies.

Mentalizing is the activity of understanding behavior as it pertains to the human experience of thoughts, feelings, and perceiving mental states. Mentalizing, as proposed by the authors, is "attending to mental states in oneself and others—the most fundamental common factor among psychotherapeutic treatments." Within the context of a therapeutic relationship, psychotherapy is fundamentally engaging our patients in mentalizing.

We are treated by the authors to a journey of mentalizing. This process facilitates awareness in multiple domains, including the dynamics of self versus others and developing insight into the emotions of the self and others. Mentalizing past experience and emotions relates the past with the present, a fundamental process in psychotherapy that is often transformative. Our patients' capacity to mentalize in their own mental states from the past yields insight into maladaptive behaviors that can then be changed.

The book elucidates mentalizing as it is applied to fundamentals of development. This becomes relevant in numerous areas, such as attachment and early traumatic experiences. The chapter on neurobiology demonstrates synthetic thinking at the highest level, with cogent and informative discussions on the neuroanatomy of social cues, emotionality, and interpersonal experiences, as well as the pathology of autism and psychopathy. This chapter is as thought provoking as it is enjoyable.

The next part of the book is the direct application of practicing mentalizing. The reader is offered a discussion of the "how-tos" of mentalizing and directly applying this technique to psychotherapy. An explicit example is presented that readily demonstrates the process of mentalizing in a psychotherapeutic formulation. This formulation is shared with the patient in writing, described as a process of "holding your mind in mind." I particularly enjoyed the discussion of the "pretend mode," where the authors posit intellectualizing, rationalizing, and engaging in psychobabble as "bullshit." It is in fact critical to the therapeutic process that this "bullshit" be identified for therapy to occur, lest the illusion of therapy blindside the process of positively affecting functioning.

The chapter that discusses the interventions of mentalizing is a very helpful application guide to working with patients. It encompasses mentalizing the transference process and offers specific pointers in a section appropriately called "Top Tips," which include maintaining an active stance, making contrary moves, and using common sense.

The chapters on treating attachment trauma, parents and family therapy, and borderline personality disorder all provide excellent examples of mentalizing in action. The chapter on borderline personality disorder is particularly helpful in understanding the clinical utility of mentalizing in borderline pathology. This very useful how-to chapter relates mentalizing to other psychotherapies commonly used in treating borderline patients, including dialectical behavior therapy. This chapter is particularly helpful in concretely applying mentalizing to a severe disorder.

The remainder of this volume applies mentalizing to social systems and psychoeducation. The chapter on social systems extends mentalizing into the area of violence, discussing the prevention of violence in schools and violence in global conflicts. It is fascinating reading.

This volume represents new concepts as well as discussion of older ideas provided in both an engaging and enjoyable fashion. It is of interest to anyone who practices psychotherapy or anyone with an interest in human behavior. I recommend this work without reservation. You will not be disappointed.

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