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The Therapeutic Benefits of Mentalization, Meditation and Hypnosis

Three practices which, together, promote attachment-informed trauma treatment


Alexander who knows on a poster
Alexander poster by Public Domain Media, wall by Waldemar on Unsplash


Since founding the Center for Applied Theory of Mind a couple of years ago, and embarking on our stated mission to introduce the concepts and practices of mentalization and theory of mind to the general public, we see that we still have a bit of work to do.


On occasion, we receive messages from an old acquaintance, usually when she is undergoing mandatory workplace training on meditation techniques. One of her recent messages reads: “Hi guys, we have another competitor of yours at the office training us on meditation skills. Do you want to discuss their techniques once I have finished the training?” Despite our dedicated and repeated (albeit fruitless) efforts to clarify the distinction between mentalization skills and meditation skills, we eventually just gave up with this particular individual. Now, we simply respond, “Sure, that sounds very interesting!”


Also, we regularly encounter people who mistakenly equate mentalization skills with psychic powers (such as Uri Geller’s mesmerizing metaphysical spoon-bending ascendances). Still other acquaintances inquire as to whether, as mentalizers, we have the ability to hypnotize them instantly and help them overcome their unhealthy personal habits.


These captivating and stageworthy performances by self-proclaimed “mentalists” appear to showcase intriguing psychic abilities. People who excel at this sort of “quasi-mentalizing” attract large audiences. For instance, Alexander the Man Who Knows (depicted in the image above) was an American mentalist who, in the early 20th century, made millions of dollars by providing psychic reading services such as crystal-gazing to speculate about the fortunes of his gullible clients. Alexander marketed his psychic performances as a demonstration of mental telepathy or mind reading (1). This form of mind reading, often described as mentalism, is not the type of “mind reading” that is referred to in the field of psychology as “mentalization.”


Mentalization involves our human ability to infer what is going on in the minds of people on the basis of mental state information that we extract from their verbal and nonverbal behavior. 


The fact that there is nothing mystical in the way we mentalize does not mean that it isn’t still one of our most fascinating social abilities. (2)


 


The role of mentalization, meditation and hypnosis in clinical psychology

Within the field of clinical psychology, the enhancement of mentalization competencies is becoming increasingly integrated into therapeutic treatment regimens. The same holds true for the practices of meditation and hypnosis. The dictionary of the American Psychology Association relates the three practices to mental health as follows:

Mentalization is the ability to understand one’s own and others’ mental states, thereby comprehending one’s own and others’ intentions and affects. It has been theorized that this ability is a component of healthy personality development and is achieved through a child’s secure attachment to the parent. The concept has had particular application in the understanding and treatment of borderline personality disorder (BPD), characterized in this context as a disorder marked in part by an inability to mentalize due to poor attachment in early life. (3)
Meditation is a profound and extended contemplation or reflection in order to achieve focused attention or an otherwise altered state of consciousness and to gain insight into oneself and the world. Traditionally associated with spiritual and religious exercises, meditation is now also used to provide relaxation and relief from stress; treat such symptoms as high blood pressure, pain, and insomnia; and promote overall health and well-being. (4)
Hypnosis is the procedure, or the state induced by that procedure, in which suggestion is used to evoke changes in sensation, perception, cognition, emotion, or control over motor behavior. Subjects appear to be receptive, to varying degrees, to suggestions to act, feel, and behave differently than in an ordinary waking state. The exact nature of hypnotic suggestibility, and its possible therapeutic uses, are still being studied and debated. (5)

As the American Psychology Association continues to review research on the effectiveness of hypnosis as a therapeutic tool, its popularity continues to grow. In therapeutic treatment settings, we see that all three practices are starting to become integrated into comprehensive treatment protocols. When all three tools are used together, they can augment the treatment plan, as is the case with attachment-informed trauma treatment.


What is attachment-informed trauma treatment?


In attachment-informed trauma treatment, attachment relationships are examined as a possible cause of traumatic experiences, or as a factor that mediates the presence or absence of support from important others in learning to deal with adversity. When attachment experiences are traumatic, people develop an internal working model, a mental framework that provides them with an understanding of self, others, and the world. These models then serve as blueprints for future attachment relationships, shaping the consistent cognitive, affective and behavioral patterns that ultimately coalesce in the individual’s attachment style. (6)


Understanding a client’s attachment pattern aids the therapist in selecting the most effective and suitable intervention, as different attachment styles call for particular approaches that are tailored to their specific patterns. For example, clients with insecure attachment styles employ behavioral strategies linked to fight, flight and freeze reactions, which commonly surface when interactions go awry. Such clients often find it difficult to trust the therapist, or they are not accustomed to asking for or receiving support, or they are uncomfortable with closeness and self-disclosure.


Attachment-informed trauma treatment endeavors to empower clients in establishing or re-establishing secure attachment relationships grounded in trust and support. These relationships serve as crucial mainstays in preventing or addressing mental health conditions, such as anxiety and depression.


Enhancing attachment-informed trauma treatment through mentalization, meditation, and hypnosis

Studies show that both mentalizing and affect regulation are moderators of attachment. In our book, Mastering Mentalization, (2) we examine four prototypical attachment styles proposed by scholars (7) and relate them to mentalization abilities and affect regulation skills:


A “secure” attachment style is found in people who hold a positive view of themselves and others, and who possess well-developed mentalization abilities and affect regulation competencies. 
An “insecure-anxious” attachment style is found in people who have a negative view of themselves and a positive view of others. Their affect regulation competencies are often underdeveloped and their affective responses are likely to be influenced heavily by the conduct of those with whom they interact. Their mentalization efforts are often centered on their interactional partner rather than on themselves, and most likely are biased due to their anxious feelings. 
An “insecure-avoidant” attachment style is found in people who have a positive view of themselves, but a negative view toward others. Such people often present with affect regulation competencies that are well-developed, but rigidly applied. These people are less likely to apply much effort when it comes to mentalizing about others, however, when they do mentalize about others their inferences will most likely be biased due to their negative view of others. 
An “insecure-disorganized” attachment style is found in people who have an unstable, fluctuating, or confused view of themselves and others. Such people display elements of both anxious and avoidant attachment behavior in an inconsistent manner. These fluctuations are also reflected in their mentalization efforts, and in their affect regulation strategies. (2)

Mentalization techniques


By virtue of the foregoing, therapeutic techniques drawn from the “playbook” of Mentalization-Based Therapy can be adapted to enhance attachment-informed trauma treatment. As proposed by Malberg et al. (2023), the fundamental principle of a mentalization-based approach involves cultivating a mentalization stance, characterized by:

active “wondering” and “not knowing”
monitoring of one’s own mistakes
genuine curiosity
staying in the here and now
identifying mentalizing impasses and lowering arousal levels
paying attention to nonverbal ways of communicating
keeping a developmental focus as the main exploratory lens (8)


Throughout the therapy trajectory, the therapist encourages the cultivation of this mentalization stance. However, trauma often triggers intense emotions and psychological distress, impeding the client’s ability to sustain this sort of balanced mentalization stance. When the therapist observes that mentalization is disrupted by overwhelming emotions, the therapist, in conjunction with the client, redirects the client’s attention to the present moment. Employing affect regulation techniques, therapists assist their clients in regulating their own emotions. Therapeutic meditation and hypnosis techniques are effective in supporting relaxation and inducing a state of “absorbed attention” directed to what is happening in the present. Once clients are able to calmly remain in the present, and discuss their thoughts and feelings, mentalization efforts are reinitiated.


Meditation and hypnosis techniques


From a research paper by Penazzi and De Pisapia, (2022) (9), the following commonalities and differences between meditation and hypnosis come into clear focus. Both meditation and hypnosis are states of altered consciousness achieved by induction procedures that improve relaxation and absorbed attention, with corresponding physiological effects.


Hypnosis and meditation differ, however, when it comes to the experience of dissociation. Hypnosis is marked by involuntary action, with hypnotic suggestions from the therapist diminishing the client's sense of agency and metacognitive control. Meditation, on the other hand, is experienced as voluntarily employing metacognitive control, increasing and integrating the meditator’s sense of presence into a unique and personal experience.


Another distinction lies in the different processes involved in each modality: During a hypnotherapy session, clients effortlessly return to an emotionally balanced state of absorbed attention as guided by the therapist. Prior to initiating hypnosis, therapists must assess a client’s susceptibility to hypnosis. On the other hand, meditative practices demand training and effort on the part of the client. Consequently, at the onset of therapy, therapists must evaluate whether the client has prior familiarity or experience with meditation techniques. This assessment guides therapists in determining the level of meditation training required for a given client in order to facilitate affect regulation during treatment.


What is the right time to incorporate meditation and hypnosis techniques?


Therapeutic hypnosis induced by the therapist might be the preferred attention redirection and affect regulation technique when a client is too overwhelmed to achieve any sense of personal calm. Alternatively, if the therapist determines that additional meditation training is needed, the use of hypnosis may be delayed. The fact remains, however, that hypnosis requires the client’s trust in the therapist as a person and as a skilled professional, which might take a long time to establish, particularly with clients who react in keeping with an insecure attachment style.


Meditation presents its own timing considerations. Initially, meditation techniques require some form of client training, and therefore use of this mode of treatment as means of redirecting attentional focus and regulating affects might not be available at the outset of therapy. Nonetheless, integrating meditation training into the therapeutic process is highly recommended, as it empowers clients with a sense of agency and metacognitive control. Moreover, clients can utilize these relaxation techniques beyond the therapy session, offering a significant advantage over hypnosis techniques that require a therapist’s guidance.


 

In conclusion, mentalization, meditation and hypnosis all implicate distinct advantages and considerations. Unfortunately, these practices have often been sensationalized for entertainment’s sake, leading to misconceptions in the general public regarding their true practicability and appropriate application. From a therapeutic standpoint, these three practices, employed in conjunction with one another, can advance attachment-informed trauma treatment. A mentalization-based approach improves the capacity of clients to explore their own and others’ mental states with genuine curiosity and openness. This mentalization stance is crucial for assessing attachment relationships and bolstering the client’s ability to adopt a secure attachment style. Navigating through traumatic experiences is emotionally challenging, with overwhelming feelings often operating as an impediment to mentalization efforts. Meditation and hypnosis techniques serve to bolster affect regulation and shift attention to the present moment, facilitating the client’s ongoing mentalization processes.


 

References:


  1. Charvet, David. Alexander — The Man Who Knows. 2nd revised and enlarged edition, September 2006. Via Wikipedia: Alexander (magician)

  2. van der Putten, A. A. J. T. (2022). Mastering Mentalization. ToM PRESS.

  3. American Psychological Association. (n.d.). mentalization. In APA dictionary of psychology. Retrieved April 8, 2022, from https://dictionary.apa.org/mentalization

  4. American Psychological Association. (n.d.). Meditation. In APA dictionary of psychology. Retrieved April 8, 2022, from https://dictionary.apa.org/meditation

  5. American Psychological Association. (n.d.). Hypnosis. In APA dictionary of psychology. Retrieved April 8, 2022, from https://dictionary.apa.org/hypnosis

  6. Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28(5), 759–775. doi:10.1037/0012–1649.28.5.759

  7. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226–244. https://doi.org/10.1037/0022-3514.61.2.226

  8. Malberg, N., Jurist, E., Bate, J., & Dangerfield, M. (2023). Working with parents in therapy: A mentalization-based approach (pp. 29). American Psychological Association. https://doi.org/10.1037/0000341-000

  9. Penazzi, Gabriele & De Pisapia, Nicola. (2022). Direct comparisons between hypnosis and meditation: A mini-review. Frontiers in Psychology, 13. 10.3389/fpsyg.2022.958185.

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