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Affect Regulation, Mentalization and the Development of the Self

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In a brilliant examination of the frontiers of human emotion and cognition, four prominent psychoanalysts combine the perspectives of developmental psychology, attachment theory and psychoanalytic technique. The result of this marriage of disciplines is a bold, energetic and ultimately encouraging vision for the psychoanalytic treatment.

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Chapter 1 - Attachment and Reflective Function: Their Role in Self-Organization

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Attachment and Reflective Function: Their Role in Self-Organization

This chapter introduces the idea of a relationship between attachment processes and the development of the capacity to envision mental states in self and others—the capacity that is referred to in this book as mentalization or reflective function. Throughout this book, we develop the argument that the capacity to mentalize is a key determinant of self-organization and affect regulation, and we maintain that this capacity is acquired in the context of the child's early social relationships. Here we give an overview of the evidence for an association between the quality of attachment relationship and reflective function in the parent and the child. We offer some hypotheses about the development of reflection in the context of the infant-caregiver relationship. We then interpret these data and speculations in the context of current models of theory-of-mind development.

REFLECTIVE FUNCTION OR MENTALIZATION: A HISTORICAL CONTEXT

 

Chapter 2 - Historical and Interdisciplinary Perspectives on Affects and Affect Regulation

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Historical and Interdisciplinary Perspectives on Affects and Affect Regulation

In this chapter, we follow out the implications of the argument in the first chapter concerning the developmental mechanisms that produce mentalization and reflective function. Here we examine the relationship of early object relations with mentalization through the lens of affects and affect regulation. This chapter provides a historical overview of academic traditions concerning affects and affect regulation from the perspective of mentalization. The chapter is not intended as any kind of exhaustive review—an ambition that is substantially beyond the scope of this work. Our aim here is to point to key controversies in the study of emotion. The review highlights the fact that analogous dichotomies exist across a number of disciplines. Both philosophical and psychological traditions tend to regard affects in one of two ways: (a) ideally as integrated with cognition, and (b) as inherently independent of, opposed to, and out of the control of rational thought. Certain neuroscientists have suggested that both traditions may have strong foundations in the brain structures assumed to mediate emotional experience. Psychoanalysts, including Freud, have also pursued both lines of thought, with notable individual exceptions. We review the contribution of attachment theorists in some detail, since this framework represents the starting point for many of the ideas in the current monograph. In the attachment theory tradition, there is a commitment to explore precisely how affective experience contributes to the acquisition of self-regulation by virtue of coregulation between caregiver and infant. The present chapter places our approach, which is also based in the developmental tradition already outlined briefly in chapter 1, into a historical frame of reference, insofar as we attempt to integrate the two major intellectual traditions concerning affect.

 

Chapter 3 - The Behavior Geneticist's Challenge to a Psychosocial Model of the Development of Mentalization

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The Behavior Geneticist's Challenge to a Psychosocial Model of the Development of Mentalization

In this chapter, we consider the recent challenges to the psychosocial approach taken in this book. The assumption that the quality of mentalizing is related to the quality of early object relations is a common thread throughout the volume. We argue that many of the known consequences of sensitive as opposed to neglecting and maltreating early environments might be understood as having an impact on the child's capacity to mentalize. However, such assumptions concerning the influence of the child's family environment have recently been challenged by evidence from behavior genetics. Findings from studies of twins and from children adopted early in life are used to claim that past work has exaggerated the influence of parenting on child development. If substantiated, these critiques would remove the logical foundation of most psychodynamic or psychoanalytic approaches, rendering the present proposals, among others, untenable.

 

Chapter 4 - The Social Biofeedback Theory of Affect-Mirroring: The Development of Emotional Self-Awareness and Self-Control in Infancy

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The Social Biofeedback Theory of Affect-Mirroring: The Development of Emotional Self-Awareness and Self-Control in Infancy

In many ways this chapter forms the core of our thinking about the role of affects in self-development—a theoretical and conceptual problem that we tackle more fully in chapter 5. We start this chapter by placing the construct of emotions within the framework of the development of intentionality and mentalization, the concepts that lie at the core of our theoretical and clinical work. We then focus on the nature of the developmental processes involved in the emergence of understanding of emotions in self and other. The development of emotions during the first year of life is outlined and placed in the context of one of the organizing concepts of this book: the infant's sensitivity to contingencies between his actions and their perceived environmental effects. We describe the social biofeedback theory of emotional development, which we see as the key to understanding the link between early experience and later vulnerability to psychosocial stress. We also point briefly to a number of pathological modes of early infant-caregiver interaction that could give rise to later psychological disturbance and the vulnerability of the self as agent. Chapter 5 then attempts to integrate the particular view of emotional development described in this chapter within our more general theoretical approach to the early development of self and agency.

 

Chapter 5 - The Development of an Understanding of Self and Agency

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The Development of an Understanding of Self and Agency

The aim of this chapter is to present the most important discoveries from developmental research over the last twenty years that in our view pertain directly to the psychoanalytic understanding of self-development and have clear clinical implications for the treatment of individuals whose primary disturbance is rooted in disorganized self-representation and affect dysregulation. We wish to distinguish the model of self-development and affect regulation proposed in this volume from other contemporary developmentally grounded psychoanalytic views. We trace the development of mentalization from infancy and engage in the developmental debate about exactly when the intentional stance is achieved. In our view many recent contributions have overstated the case for early intersubjective processes in self-development. We argue that intersubjectivity is an emergent phenomenon whose establishment is a function of early interactive processes within an attachment context. In chapter 3 we laid the foundations for a model of self-development rooted in interpersonal understanding; in this chapter this model is elaborated, and five stages in the development of the self as agent are distinguished. The chapter also lays the crucial groundwork for the explorations of borderline personality disorder in terms of an early nonmentalistic perception of causality in social actions—the teleological stance. Finally, the chapter gives a relatively comprehensive summary of the developmental literature concerning the development of an understanding of self and others as intentional mental agents.

 

Chapter 6 - “Playing with Reality”: Developmental Research and a Psychoanalytic Model for the Development of Subjectivity

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“Playing with Reality”: Developmental Research and a Psychoanalytic Model for the Development of Subjectivity

This chapter concerns changes in the child's perception of psychic reality during normal development, culminating in the major shift in the child's understanding of minds (theory of mind) at the oedipal stage, which we equate with the qualitative shift in the development of mentalization whereby the self becomes a representational agent (see chapter 5). We integrate empirical studies of this transition with material from the analysis of a 4-year-old girl. We propose a psychoanalytic model of the development of an awareness of mental states, which conceives of the very young child as using two modes for representing internal states or—using psychoanalytic terminology—psychic reality; we have called these “psychic equivalent” and “pretend” modes, which differ primarily in the assumed relationship between internal and external realities. We argue that the integration of the dual modes into a singular reflective mode is normally completed by about the age of 4, with the mentalization of affect leading the mentalization of belief states or cognitions: the child first understands that people have different feelings, then that they may have different thoughts about the same external reality. We link Freud's classic notion of psychic reality and current psychoanalytic formulations of symbolization. This chapter describes normal psychological growth in childhood; the next offers a further clinical example, which applies the model outlined in this chapter and chapter 4 to a young child. Chapter 8 concerns the changes that occur in adolescence, and the following two chapters, using the same developmental model, consider failures of these crucial cognitive transitions as seen in adult personality disorder.

 

Chapter 7 - Marked Affect-Mirroring and the Development of Affect-Regulative Use of Pretend Play

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Marked Affect-Mirroring and the Development of Affect-Regulative Use of Pretend Play

Chapter 6 proposed a psychoanalytic model for the development of full subjectivity, closely linked to the quality of interaction between parent and child. A clinical illustration was offered to show that, for internal reality to be experienced as truly representational rather than as either totally real or totally unreal, the object's mirroring of the child's internal reality, preferably in a playful manner, was a prerequisite. In this chapter, the psychological underpinnings of the processes involved in playful mirroring interactions between child and caregiver are elaborated in the context of a further case report. It is argued that the specific features of interactions that effect a change in the quality of internal representation involve the caregiver creating “marked externalizations” of the child's internal states with the key qualities of separating or decoupling internal experience from physical reality, offering a sense of control over the experience and potentially modifying the content of the experience in the direction of increased pleasure or wish fulfillment. Marked parental mirroring in the context of pretend play or empathic pro-social actions offer early opportunities for the infant to encode features of markedness of expressions (signaling “nonconsequentiality” and decoupling from physical reality), content modifications (leading to reduction of unpleasure and wish fulfillment), and the enhancement of agentive aspects (which exert control and mastery over affective experience). Such interactions may provide important experiential preconditions that facilitate the emergence of the active use of these features for emotional self-regulation by the infants themselves.

 

Chapter 8 - Developmental Issues in Normal Adolescence and Adolescent Breakdown

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Developmental Issues in Normal Adolescence and Adolescent Breakdown

In previous chapters we have considered the development of mentalization up to about the age of 5 years, when the autobiographical self first emerges (see chapter 5). While certain developmental disorders are already apparent at this age, many do not emerge until adolescence or later. This chapter adds a further stage to our description of the development of reflective function, considering the implications of the cognitive developments associated with adolescence for the ontogeny of mentalization. The key question addressed in this chapter concerns the increased frequency of various kinds of mental disorder at this developmental stage, the worsening of preexisting conditions, and the emergence of new conditions specifically linked to adolescence, as well as the onset of many that are lifelong problems but whose onset is linked with this age. That is, we attempt to answer the deceptively simple question of why breakdown occurs relatively often in adolescence. We suggest that this might be understood partly in terms of the vicissitudes of reflective function during this developmental phase. The chapter begins with a summary of the view of self-development advocated in this book, which pulls together the threads of the argument so far.

 

Chapter 9 - The Roots of Borderline Personality Disorder in Disorganized Attachment

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The Roots of Borderline Personality Disorder in Disorganized Attachment

THE ATTACHMENT SYSTEM AND THE DISTORTION OF INTERPERSONAL RELATIONSHIPS IN PERSONALITY DISORDER

There have been many attempts in the past to illuminate the symptomatology of borderline personality disorder using attachment theory. Implicitly or explicitly, Bowlby's suggestion that early experience with the caregiver serves to organize later attachment relationships has been used in explanations of psychopathology in BPD. For example, it has been suggested that the borderline person's experiences of interpersonal attack, neglect, and threats of abandonment may account for a perception of current relationships as attacking and neglectful (Benjamin 1993). Others have suggested that borderline individuals are specifically characterized by a fearful and preoccupied attachment style reflecting “an emotional template of intimacy anxiety/anger” (Dutton, Saunders, Starzomski, and Bartholomew 1994). In studies of AAI narratives of borderline patients, the classification of “preoccupied” is most frequently assigned (Fonagy et al. 1996) and, within this, the “confused,” “fearful,” and “overwhelmed” subclassification appears to be most common (Patrick et al. 1994). Not surprisingly, such patients also tend to be unresolved with regard to their experience of trauma or abuse.

 

Chapter 10 - Psychic Reality in Borderline States

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Psychic Reality in Borderline States

This chapter is a contribution toward understanding the difficulties of severely borderline patients as they are uncovered within the psychoanalytic process. We consider how the pattern of behavior and relationship—including the transference relationship—characteristics of borderline patients may be understood in terms of an inadequate integration of the two early modes of experiencing psychic reality, as elaborated in this chapter and summarized below. Specifically, we suggest that the borderline patient's failure to mentalize adequately is compounded by the persistence of an undifferentiated mode of representing external and internal experience. It is rooted in a childlike understanding of mental states, where feelings and ideas are construed as direct (or equivalent) representations of reality with consequent exaggeration of their importance and extension of their implications. The persistence of this mode of functioning is a self-perpetuating consequence of the failure of mentalization. The experience of unconscious as well as conscious feelings and ideas as equivalent to physical reality inhibits individuals' capacity to suspend the immediacy of their experience and create the psychological space to “play with reality.”

 

Chapter 11 - Mentalized Affectivity in the Clinical Setting

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Mentalized Affectivity in the Clinical Setting

In this chapter, we focus on the idea of mentalized affectivity, which will allow us to elaborate on a form of affect regulation that is particularly relevant for adults. As introduced in chapter 2, mentalized affectivity is a sophisticated kind of affect regulation that denotes how affects are experienced through the lens of self-reflexivity. It would be mistaken to assume that all adults are capable of such affectivity; yet neither is it a rarified achievement. As we demonstrate in this chapter, mentalized affectivity is a concept that can be enhanced by psychotherapy and thus pertains to a phenomenon that is especially relevant to the clinical realm. In the first section of this chapter we begin with a description of mentalized affectivity as a concept, in the second we delineate three elements of mentalized affectivity, and in the third we turn to four clinical examples to illustrate its importance.

THE CONCEPT OF MENTALIZED AFFECTIVITY

 



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