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Eating disorders: A journey through psychotherapy and recovery

Updated: Jul 14, 2023

Mentalisation and its Role in Recovery

My psychotherapy room. A safe place for a long journey .
My psychotherapy room. A safe place for a long journey .

Hello again, Today, I'd like to share insights about a concept that is central to my work as a psychoanalytic psychotherapist: mentalisation. It's a term that might sound technical, but its essence is deeply human and relatable.

What exactly is mentalisation? In the simplest terms, mentalisation refers to our ability to understand and interpret our own and others' mental states – essentially, our thoughts, feelings, wishes, and beliefs. It's about recognising that our mental state can differ from others and that these differences are normal and expected. It's a skill that most of us develop naturally during our early years, but its development can be compromised in individuals who have experienced trauma or adverse experiences. It can also be more difficult to achieve for more inherently sensitive children and people who are neuroatypical and have ADHD or are on the autistic spectrum, for example.

Another important concept that ties in closely with mentalisation is alexithymia. This term essentially describes a state of lacking words for emotions, and a lot of people struggling with an eating disorder also are alexithymic. It refers to the difficulty in recognising, describing, and communicating one's feelings. This lack of "emotional vocabulary" can be an indicator of a hindered ability to mentalise. For those grappling with eating disorders, this makes the language of the disorder all the more tempting, as it seems to offer an alternative, albeit destructive, means of expressing their unspoken emotions. In a very simplistic way, one could say that thinking 'I am too fat' is more tangible and accessible to the mind than realising (and mentalising) that 'I am so afraid of growing up'- a much more abstract, deep and complex state of mind. And saying 'I need to be 47 kg to be of worth' is a concrete alternative to 'what if I'm not good enough...I don't have control over so many things...'.

In the context of psychoanalytic psychotherapy, both mentalisation and overcoming alexithymia are crucial. The therapeutic journey involves a lot of introspection and self-reflection, and the ability to mentalise plays a pivotal role here. By fostering mentalisation and helping individuals develop an emotional vocabulary, we can help individuals gain a richer understanding of their own mental states and those of others. This understanding becomes a powerful tool for self-exploration and change.

How does mentalisation fit into the recovery process from eating disorders? When someone is in the grip of an eating disorder, their ability to mentalise often becomes obscured. The disordered eating behaviours might serve as a coping mechanism, distracting from distressing feelings or thoughts. This is where mentalisation-based treatment comes in. By focusing on improving mentalising skills and overcoming alexithymia, we can help individuals better understand their emotions and thoughts, leading to a more nuanced understanding of their eating behaviours.

In my practice, I have observed the transformative power of improved mentalisation. I have seen how it helps individuals gain control over their impulses and react less automatically to emotional triggers. And more than that, it allows them to nurture healthier relationships, both with themselves and with others, by fostering empathy and understanding.

I would like to add here a note for parents and carers. You play a vital role in enhancing your loved one's ability to mentalise. It is through thoughtful conversations, patience, empathy, and openness that you can contribute to this process. Encouraging your loved one to express their feelings, even when they struggle to put words to them, can be incredibly supportive. Additionally, modelling mentalisation—demonstrating your own process of understanding your feelings and thoughts—can provide a helpful guide. It's not easy to do. Sometimes what is needed from you is counter-intuitive, and you need help in understanding how exactly you can support and help. Being part of the treatment process - whether through parental work, family therapy or couples therapy- is crucial.

Enhancing mentalisation is not a quick fix; it's a journey. It takes time and patience, and it requires a safe and non-judgmental space where individuals can feel heard and understood. But the results can be profoundly rewarding.

In future posts, I'll delve deeper into the process of enhancing mentalisation in psychotherapy and how it intertwines with other therapeutic techniques in the recovery journey. Please let me know if you have any questions or if there are certain subjects you would like me to write more about.

As always, I want to remind you that no matter where you are on your journey – at the very beginning, facing a hurdle, or exploring new paths – there's always room for understanding, growth, and recovery. Avital


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