Mentalization Based Therapy - Dr. Bateman
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- Опубликовано: 9 дек 2012
- Empirically Supported Therapies for Borderline Personality Disorder: Common and Distinguishing Aspects of Dialectical Behavior Therapy (DBT) and Mentalization Based Therapy (MBT) - April 14-15 New Haven, CT
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As a trained therapist I can only admire his clinical skills. It is so difficult to be able to work in the moment with a client, but he presents a masterclass.
“You can get away with a lot with a British accent” 😂😂
I'm not sure if this woman is an actor or whether this is public therapy, but in either case what she did here was incredible. This was so gripping.
she is an actor.
for me that is the problem knowing they are both acting. As someone who suffers with a personality disorder having a sense of being real is the main problem i have in life, my whole life feels like it has been an act and i am 70. I dont feel like i am a real person and that at my core is anxiety and fear and it is that core that the lifetime of acting has tried to avoid. now i am battling cancer the sense of urgency and fear has increased .
I need this man in my brain ....
But also... Her boyfriend should give her a hug! I hate these hugless dudes
Wow ~ that was a beautiful session ! Lots of clear, warm, stable, support & leadership from the counselor.
I'm going to trancribe and analyze a bit of this, and see what I can learn from diving deep. :) "T" for therapist; "C" for client.
T: Okay Alice, just as we start, I'd like you to just take us back a little bit to last week, because remember how we were talking about how your last therapist fired you?
C: Yes. And like you're going to do?
T: Well, that's what we were talking about. (Not responding directly at all to the somewhat provocative statement she just made. No mirroring of her tone here at all - he's sitting back in his own chair and seems to be proceeding with his plan regardless of her posture, tone, or responses.) But I just want to know, has there been anything you worried about over the week that led you to think that I was going to fire you? Because remember, I asked you to attend to that in the session.
C: Absolutely.
T: Right? W-w-what may have brought it on?
C: (Notice that she is having an emotional response but it's not contextualized in a clear way to the therapist's behavior right now. She's not actively in this dialogue yet, and seems to be responding more to her own internal thoughts -- his words and manner are almost peripheral to her awareness. This will come through in the charge in her statements here.). The same thing that happened EVERY SINGLE TIME I get fired by a therapist.
T: Mm-hmm. (Pause) -- But what I asked you to do, and maybe you could just do it in this session and let me know if there's any particular time that you sense that I might fire you or you start worrying about that. (He's asking her to respond to HIM in the context of THIS relationship rather than catastrophizing about this relationship based on her prior experience. If she begins to tend to these feelings with him moment by moment, they can reflect together and sort out cause-and-effect between them. It will give more space to reflect rather than simply reacting. It will also bring her more here in the interaction with him.). Will you let me know?
C: The answer is YES, and I will let you know right now. (She's finally looking at him now. We'll see from her response if she's a bit more here with him or not.)
T: You'll let me know right now, okay! (Affirming tonality here, showing engagement.) So what in the moment is it that might have done it. You know? (Great - he wants to help her link her feelings and fears with what's happening here and now between them. And is inviting her to notice how her own feelings get triggered by stuff that's happening right now.)
C: What happened between when I saw you last time and what was happening when I was seeing you this time.
T: (Pauses -- understandably. She's given a response that, while it contains clear emotional charge, isn't clearly linked to his question about what happened in this moment.) I haven't quite followed that -- I"ll need you to clear that up for me.
C: Well, it's hard to talk about. (Her tone is a bit strident here -- it's still not clear that she's arrived in this interaction.) Now she just looks at him. There's a quality in her demeanor here of......challenge, perhaps.
T: (Another pause) Something happened from last time to this time, did you say?
C: (Slight nod)
T: Which is hard to talk about.
C: (Larger nod)
T: Okay. (Pause.) What's so hard about it?
C: We talked about how.....I am scared of you firing me.
T: Mm-hmm
C: Because just a few weeks ago my therapist left me because... I tried to kill myself.... and I think that if I tell you the truth (Pause)
T: Yeah
C: That you're going to do the same thing even though you act like you're not.
T: Right, okay. (Supportive tonality here, looks to be thinking aloud with this next statement and openly reflecting on her experience and how it makes sense.) No, I can understand how you might think I'm going to fire you if you're suicidal. So to me that suggests something around - are you feeling suicidal at the moment?
C: Nods, seeems to be holding back tears
T: Tell me about what's been going on there though that makes you worry about the suicidal. (His intervention isn't so much in his words here. It's more that he's continuing in a calm tone, staying with her, and continuing to invite her to reflect.)
C: When I spent time with John over the weekend
T: Mmm-hmm
C: I had those THOUGHTS!
T: (Very calmly) Oh really?
C: Yes.
T: (Still very calm.) Oh dear. (Pauses) - What sort of thoughts did you have? Tell me a little bit. (He's still sitting back in his chair. He has a little more energy in his arms and his tone with this next thing he says.) I'm not going to fire you because you have the thoughts. We've talked about that.
C: Yeah, but it's hard to talk about.
T: Yeah. Sure. Okay. (He waits for her here -- silence can act as a bit of pressure for her to speak.)
C: WHen I was with him, we were trying to take things slow.
T: Mm-hmm.
T: We were together watching a movie. And I just (head comes forward here) -- I wanted him to HOLD me.
C: And then
T: (Does a stop motion with his hands -- decisive here) Stop there -- Don't go on further here. Just, what was your impression of the whole evening at that point?
(He is seeing her charge go up as she discusses the evening, and it seems that she could cascade into the same vehemence from telling the whole story. So he wants to pause her and help her mindful reflective abilities to come on line so they can think a bit about what her feelings were -- creating a "pause" function for her to reflect.) What were you telling yourself at that point? (Checking for her thoughts at that time. Asking her to reflect back is different from the reactivity she's used to having -- and this is a real challenge for her, as we'll see!)
C: THere's so MUCH going on in my head all the time; I don't know what you're asking!
T: I'm just asking what you were like at that point in the evening. I mean looking at you and from the SOUND of it, you were looking forward to the evening. (He may be trying to slow her down to where things still felt good. He has done a bit of a time shift here though, first asking how she felt before her desire to be held came online, and now asking about if she was looking forward to the evening. It sounds like he's trying to help her rewind to before she got to feeling suicidal to map out her thoughts and feelings from one stage to the next.)
C: I - I mean yes, I was wanting him to hold me
T: Mm-hmm
C: And I was also terrified that he wouldn't, and he DIDN"T!
T: (Pause.) Okay. (Another pause.) Okay -- so I want you to take me back before you met with John because it sounds like you arranged to meet him? (I think he's going now to before they met, because what we're seeing is that she couldn't easily reflect on the first part of the evening. He's going to want to help her find when this fear cascade starts so we can find out if she was actually present for any part of the evening with John, and so they can together map out where the reactivity started.)
This seems like a lot for now, so I'll stop this comment here! As another commenter suggested, slowing down seems paramount in this mindfulness-based modality. He works with his own tone, his own pauses, and his own invitations to reflect and think -- to help her to slow down the quick reactivity in her brain and feelings to make sense of it all. If this is effective for her and she can stay with his spaciousness and his lack of overt emotional responses to much of what she shares, she'll begin to develop more mindfulness herself. This type of dispassionate demeanor can also be triggering to some clients who really are seeking a bigger level of clear emotional engagement -- for their energy to be met/matched so they can redirect it. This isn't happening here, so it's likely to be a challenge to her capacities to be asked to reflect, especially without overt empathy or normalizing. He's supportive and thoughtful without seeming responsive on a meta level to her meta communications. In other words, she seems to have a drive to feel understood and seen in her level of distress -- and he's really not responding to that much at all, redirecting her instead to reflect on her thoughts and feelings step by step. My sense is that, for many with her type of intensity and desire for connection, this could be very challenging. But could also wind up being very regulating and may help her find a calmer way to connect, since her intensity simply fails to get the intensity she yearns for in return.
I really appreciate this, many reasons but as an experiment, I read this first before watching. It was interesting to see how differently the responses from therapist and client read compared to how they were actually said. Tone really does change everything. Thank you for the experiment :)
Great seeing Bateman himself demonstrating!
the problem is that they are both acting.
I really appreciate the value of slowing things down after watching this video. The therapist did a good job with that.
Wonderful! Thanks so much for posting
Thank you - wonderful work.
This was so helpful. I now need to figure out how to live out the slow down moments and read the situation emotionally.
Damn, she’s good! Especially about feeling the emotions and not trying to self-harm. I’ve never had a therapist try this technique. I wish they had!
This is wonderful! She plays 'me' so well. I like his approach - although I'm not sure how I'd feel if I were speaking those things. This is like watching me... But it gives me hope for learning how to mentalise. :-)
How’s your quest in improving the mentalization going? 🙂
Not sure if I am the only person who thinks Mentalization is a modernized form of 1930s, 40s PSYCHOTHERAPY. This type of therapy is interesting, more exciting theories for this illness is long overdue.
It is! It was borm from. Psychoanalytic theory (object relation theory) with a modernized framework, it's a psychodynamic type therapy
I know it's going to be alright with this lady!
Well, if you read about the concept of metallization a lot of your questions would be answered... The reason why it is so important to actually pause this client is that she is not able to do so her self. Sounds like in her mind, stories, feelings and actions are just one big blur, and pausing her gives her a chance to stick to one story, one feeling or one action at a time... Makes perfectly good sense to me... I'm interested, though, in what methods some of you would prefer to this particular client?
Marie-Louise Popp is very awesome technique....!! We study this author is our professor!! I learn a lot of him
I like your question. For me, while I really appreciate the value of him helping her to slow down and sort out cause and effect, I feel like I'd like to see more engagement and energy from him. And more of a sense of regard for her. On the other hand, she has a lot of behaviors going on here that are not conducive to building a solid emotional connection with someone. So I think I can understand why he'd sit back more and try to help her develop some new ways to slow down and think so that a connection based on the current moment becomes more possible with him and with others in her life. So I'm kinda torn -- wanting to see more engagement from him but not sure if that would in fact be helpful in this context.
good video ✅
Watching this is almost triggering LOL... brings back memories of attempts at conflict resolution with my BPD ex that never actually went anywhere and nothing got resolved.
It's upsetting to me how many tissues she's using. On the other hand I am learning.
I'm far from an expert, but I'd validate her as well. Something along the lines of "I'm not expecting you to be able to slow down right away, with practice it will become easier". I'd remind her of this throughout the session to decrease the intense fear of being rejected for not being able to "not go so fast" and not being able to self regulate. I'd also like to see breathing excercises and guided imagery to help her system regulate.
That would be very selfish
I really like your idea of normalizing the struggle with slowing down -- and saying that this isn't a skill that happens all at once. I might like to see a therapist who does this kind of thing even educate the client a bit and with some humor: "I interrupt and ask what can feel like annoying questions sometimes -- and I promise I care about your story and what you're feeling. What I'm hoping to do is make some space for us to really slow down so we can get to know you better -- help you find out what leads to some of those thoughts and feelings -- because sometimes we all have moments where it all zooms by so fast, you know? And if we slow it down, we get to learn how to help by knowing what precisely is causing you this deep pain." I think that could help her understand and it also links the intervention with her desire to be seen, known, "held".
You likely already know, but Guided Imagery *Meditation, Holotropic breathing and Mentalization based therapy are three different forms of therapy. It is unlikely for a therapist to combine. Generally will specialise in one, as there are specific formulas and standards in each.
@@rebekahmarie7665 I think this will change in the future 😊
@@thesessionreviewgal5766 love it! ❤️
A good therapy demonstration of DBT and MBT. This might work for PTSD patients?
I don't think so - got to address trauma memory and/or the consequences of the trauma
I've never heard of the term firing by a therapist. Does this happen in NYC?
Donald Trump done it to his therapist ;)
Wow very great!! This Doctor is annoying sometimes, but his technique is beautiful
Do anyone know where can I find the rest of this? Or maybe some more material of this conference?
You can find lots more talks and materials from these conferences by entering in "NEA BPD" in your youtube search. This wasn't a full session - she's an actress that's playing the role of client just for the sake of this demo so people can see his technique and so they can observe the difference between this modality and DBT in action since there are talks on both modalities at this conference.
I'm currently awaiting MBT which I have a start date for, and all this video makes me feel is irritated by her. I have BPD but this feels insanely selfish and childish on her part, he's there trying to help her and she's just a nightmare.
While listening to this dialog I hear a lot of "you are acting like this," "you JUMP to this," I think presenting other views of what could have happened or other viewpoints is therapeutic in a non-judgemental or labeling kind of manner.
Empathy? Collaboration? Shared meanings? Where is the secured attachment?
YES! I wondered about this too. I've been reflecting on how he is likely sitting back and failing to reflect on her feelings in order to help her to find a "pause" button and to regroup from the intense emotion she's expressing -- intense emotion that isn't anchored in the here and now and may not be helpful to elucidate. On the other hand, I do find myself wanting him to meet her with a bit more intensity and empathy. On the other hand, she's been dropped by multiple therapists, and they may have all been intensely warm and eager to understand her from the beginning, and her behavior may have continued to cascade. It seems to me that there's a balance that needs to be kept/found somehow here, so he doesn't check out from her experience but also doesn't accidentally deepen the crises she finds herself in. I can see how, for some clients, this level of seemingly minimal emotional involvement could support them to find their own thoughts and a calmer place to engage from. Other clients would feel dismissed and unmet by this way that he seems to be observing her rather than being right there with her.
1:18
This is torture. I felt like firing him the whole time. It feels like he is constantly implying how wrong and inadequate she is, with his relentless questioning and demands of her slowing down. Not unlike her boyfriend I might point out. If I was his patient, I would have felt very lonely, angry and misunderstood.
Virtualmint thanks Mint. I have watched a couple of the mentalization therapy sessions and I don't think it's a preferable manner of treatment for me to use with clients at all.
LauraBeth Scibetta
Thanks. Yeah... to be quite honest with you, I haven't seen many therapists whom I think are doing a good job, no matter what the school of thought. From what I've observed, most of them are pretty bad. I think being patronizing and infantilizing is not the right approach. Patients are human beings, wounded human beings, like everyone else. The only difference between somebody who chooses to go to a therapist and most people, is that those who do at least realize they are wounded. Not that therapy is the only way to grow up by any means. I said before that I think most therapists are not that great. Because most therapists are wounded themselves, and not even aware of it.
This guy is definitely someone I would not go to... Some therapists are great though. They are not many, but they exist.
Are you a therapist yourself? Where are you from?
+Virtualmint Yeah, this guy pissed me off. Fruzetti was wayyyyy better.
I liked it and prefer it to diary cards and skills. Although are they even so different? This is a lot like a chain analysis and teaching mindfulness of self and others. The central problem in BPD is distorted and fluctuating perceptions of self and others. That is what is being healed here. But, it is not always totally soothing for the patient, perhaps, who seems to rely on impressionistic ways of describing what has happened in an interpersonal situation. It is an evidence-based treatment of BPD, after all.
You are right. Therapy isn't always about soothing. .It is tough to work on your problems. I am learning to mentalise and my therapy looks a lot like this first one. It helps me to be slowed down, otherwise I go to quick to realise what I feel. And that is what is necessary when you learn to mentalise. You need tot understand and feel your emotions. And that can't be done "quick".
The woman seems to be in distress. There's evidence that this sort of traditional talk therapy isn't helpful as a treatment for people with mental illness. I don't think the therapist is mean in any way. My point is that having the patient re-live painful experiences isn't necessarily helpful for recovery.
Sometimes to have a new meaning on a painful experience help people to mentalize properly since the emotional charge is lowered, so it helps them to trigger their Reflective function
This is meant to be someone with BPD... I find the portrayal a little insulting
Remember people with BPD are all different and the condition has huge variations.
@@uralwong799 exactly! I was going to say the same thing.
I'll be honest. I don't like his wording, approach, comments as much as the other man, Dr. Fruzzetti.
Therapist is not empathic
+Robert Honecker Yes!!!!!!!! Oh, all the words he says - like he's irritated "yeah, I know" and the other one when she said about suicide "oh dear.." the tone. And there felt a judgmental air