2013.04.18 Peter Fonagy Creating Connections

8/22/2019 2013.04.18 Peter Fonagy Creating Connections

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Mentalizing and the

attachment process

Peter Fonagy FBADirector, Mental Health Program, UCLPChief Executive, Anna Freud Centre

Menninger Clinic, 22nd March 2013


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Some of the Mentalizing Mafia UCL/AFC/Tavistock

Prof George Gergely

Dr Pasco Fearon

Professor Mary Target

Prof Anthony Bateman

University of Leuven

Dr Patrick Luyten

Dr Liz Allison

Professor Alessandra Lemma

Professor Eia Asen

& UCL/AFC

Dr Trudie Rossouw

Dr Dickon Bevington


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Some more mafiosi (The USA branch) Menninger Clinic/Baylor Medical College (The USA branch)

Dr Jon Allen

Dr Lane Strathearn

Dr Brooks King-Casas

Dr Read Montague

YaleChild Study Centre

Prof Linda Mayes

Dr Carla Sharp

Dr Efrain Bleiberg

Professor Nancy Suchman

Professor Flynn OMalley


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And European recruits to the Family

Dawn Bales

Dr Mirjam Kalland

And Rose Palmer for help with the preparation of this presentation.

Professor Finn Skrderud

Professor Sigmund Karterud

Cindy Decoste

Catherine Freeman

Ulla KahnMorten Kjolbe

Benedicte Lowyck

Tobi NolteMarjukka Pajulo

Svenja TaubnerBart Vandeneede

Annelies Verheught-PleiterRudi VermoteJoleien Zevalkink

Bjorn Philips

Dr Peter Fuggle


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Numberofa

rticlesonWebof

ScienceDatabase

Source: http://apps.webofknowledge.com, Data collected 10.3.2013

Articles using mentalization in title or abstracts
http://apps.webofknowledge.com/http://apps.webofknowledge.com/


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The latest from the Mentalizing Mafia

American Psychiatric Publishing, Inc 2012

JUST RELEASED!

NEW!IMPROVED!

Washes brains

whiter!

Longer than all

previous

versions!


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Let the boy

dream Ivan,

He is a born

dilettante!

You will never

amount to anything

if you hold a balllike that!

I want to write my

PhD on the Use

of low signal-to-noise ratio stimuli

for highlighting the

functional

differences

between the two

cerebralhemispheres.

You look smug

now but youwill lose yourhair just like

Dad


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Mentalizing: Cognitive vs. Emotional

Emotional MentalizingThe capacity to experience affective reactions

to the observed experiences of others

Cognitive MentalizingRole-taking ability: The capacity to engage in the

cognitive process ofadopting anotherspsychological point of view.

Makinginferencesregarding the others

affective and cognitive mental states


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Distinguishing Emotional and Cognitive Mz

Level of

Comparison

Emotional Cognitive

Behaviors

Emotion recognition,emotional contagion,motorempathy, sharedpain

Cognitive ToM, AffectiveToM, Perspective-taking

Neuroanatomical

networksIFG, IPL, ACC, AI

vmPFC, dmPFC, TPJ,

MTL

Phylogenesis Rodents Primates

Developmental

stageInfants Adolescence

Neurochemical

mechanism

Oxytocin Dopamine

Shamay-Tsoory 2011


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Mentalizing brain networks

Shamay-Tsoory 2011

M

E

NT

A

LI

ZI

N

G


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Neurochemistry of Mentalizing

Cognitive empathy is related todopaminergiccircuits

This neurotransmitter plays a crucial role in thematuration of the frontal lobe from preschoolyears (Lackner, et al., 2010)

Emotional empathy is related tooxytocinergicfunctioning (Hurlemann, et al., 2010)


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Emotional Mentalizing and Oxytocin

Facilitates empathic facial recognition and in-group trust(Bakermans-Kranenburg, in press)

It increases perceived salience ofsocial cues(Shamay-Tsoory etal., 2009)

It improves empathic accuracy for less socially proficientindividuals (Bartz et al., 2010)

Emotional empathic approach recruits mainly lef t frontalareas. Oxytocin improves altruistic behaviorinindividuals with relatively higherr ight fron talactivity(Huffmeijer et al., 2012)

By enhancing activity in the Insula and IFG, it improvesunderstanding of others emotions, and reducesanxiety by decreasing amygdalaractivity, facilitating

contingent responses of help and compassion(Bakermans-

Kranenburg, in press)


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The Empathic Brain MechanismsEmotional empathy: Simulation

Inferior frontal gyrus

(IFG)

Inferior parietal lobule

(IPL)

Both zones are rich in mirror neurons

Implied in emotionalcontagionsince infancy

Implied in emotion recogni t ion


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The Empathic Brain MechanismsEmotional empathy: Shared emotion and pain

Anterior cingulate

cortex(ACC)

Insula

These areas respond to bothobserved and feltpain

Their intensity of theiractivation correlates with the explicitjudgment aboutseverity of pain

Observed pain activation decreases depending on the context: unfamiliarpeople, people ofdifferent race, alexithymia, and in medical practitioners


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TemporoparietalJunction (TPJ)

Medial PrefrontalCortex (mPFC)

Gweon, et al., 2012; Shamay-Tsoory, 2011

Mainly responsible for

transient mentalinferences aboutother people, their

goals, desires and

beliefs.

Attribution ofmore enduringtraits and qualities.

dmPFC: understandingothers beliefsvmPFC: others emotions

and the difference betweenself and others

The Empathic BrainCognitive mentalizing: Theory of Mind

Mainly responsible

autobiographicalmemory:past usedto understand

events happening to

the self and others

Hippocampus (HC)


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Other brain areas

implicated in ToM

Superior Temporal Sulcus

STS

PrecuneusTemporal Poles(TP)

The Empathic BrainCognitive empathy: Theory of Mind, Mentalizing


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The Mentalizing Brain

Inferior frontal gyrusThe mirror neuron

system is a first step:

Emot ional Con tagion

Temporo-parietal junction

& superior temporal sulcus

Visio-spatial and cognitive

perspective-taking

Temporal poles

Integration of perceivedinformationabout others,

learnt information about

unique persons andcontextual informationFrontal and prefrontal Cortex

Frith & Frith, 2006

mPFC: Anticipating what oneself or others will feel andbehavior predictionMedial orbital cortex: Emotional perspective-takingVentral regions of the medial frontal cortex: thinking aboutcommunicative intentions


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Mentalization and Overlapping Constructs

(Choi-Kain & Gunderson, Am J Psychiat 2008)


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Implicit-Automatic-Non -conscious-Immediate.

Explicit-ControlledConsciousReflective

Mental

interiorcuefocused

Mental

exteriorcuefocused

Cognitiveagent:attitudepropositions

Affectiveself:affect state

propositions

Imitativefrontoparietalmirror neuronesystem

Belief-desireMPFC/ACCinhibitorysystem

AROUSAL

Mentalizing Profile: A multidimensional modelFonagy, P., & Luyten, P. (2009). Development and Psychopathology, 21, 1355-1381.

amygdala, basal ganglia,

ventromedial prefrontal

cortex (VMPFC),

lateral temporal cortex (LTC)

and the dorsal anterior

cingulate cortex (dACC)

lateral and medial prefrontal cortex

(LPFC & MPFC), lateral and medial

parietal cortex (LPAC & MPAC),

medial temporal lobe (MTL),rostral

anterior cingulate cortex (rACC)

Associated with several areas

of prefrontal cortex

Associated with inferior prefrontal

gyrus

the medial prefrontal cortex,

ACC, and the precuneusfrontoparietal mirror-neuron

system

medial frontoparietalnetwork activated

recruits lateral fronto-temporalnetwork

AROUSAL

AROUSAL

AROUSAL


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Implicit-Automatic-Non -conscious-Immediate.


Mental

interiorcuefocused

Mental

exteriorcuefocused

Cognitiveagent:attitudepropositions


propositions



AROUSAL

Mentalizing Profile Associated with ArousalFonagy, P., & Luyten, P. (2009). Development and Psychopathology, 21, 1355-1381.



cortex (VMPFC),












gyrus



system

medial frontoparietalnetwork activated

recruits lateral fronto-temporalnetwork

AROUSAL

AROUSAL

AROUSAL


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That handkerchief which I so loved and gave theeThou gavest to Cassio.By heaven, I saw my handkerchief in's hand.

Dimensions of mentalization: implicit/automatic

vs explicit/controlled in Othello

Controlled Automatic

Why, how now, ho! from whence ariseth this?

Are we turn'd Turks, and to ourselves do that

Which heaven hath forbid the Ottomites?

For Christian shame, put by this barbarous brawl:

Love

Spurned/Arousal


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vs explicit/controlled in Othellos brain


Lateral PFC Medial PFC

Lateral

temporal

cortex

Amygdala Ventromedial PFC

Arousal


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vs explicit/controlled

Psychological understanding drops and is

rapidly replaced by confusion about mental

states under high arousal



Arousal


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vs explicit/controlled

Arousal

Psychotherapists demand to explore issuesthat trigger intense emotional reactions

involving conscious reflection and explicit

mentalization are inconsistent with the

patients ability to perform these tasks when

arousal is high


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Early Development of Mentalizing

6 and 10-month-old infants show preference forcharacters that help others over characters that arenot cooperative or hindering (Hamlin, Wynn, & Bloom, 2007)

Infants as young as 12 months of age begin tocomfort victims of distress (Warneken & Tomasello, 2009)

Children aged 14-18 months display spontaneous andunrewarded helping behaviours (Warneken & Tomasello, 2009)

Children aged 18-25 months are inclined tosympathize with others in strife, which implies anearly form of emotional perspective-taking (Decety, 2011)


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Development of empathy: Regression?

At 17 months of age,34.6% of children helpedanother child who was

feeling sick

A year after, 17% of boysand 12% girls stoppedshowing this behavior

19% of children who do notshow empathic behavior at 29months of age, had shown it 1

yearbefore

Ceasing to exhibit prosocialbehaviors during toddlerhood is anormative aspect of early socialdevelopment

Prosocial behaviors becomeregulated during preschool years

Children learn to inhibit

prosocial behaviors as theybecome aware of the implicitrules of social and moral conductThey learn where, when and

whom to help: reciprocity,

equity and deservednessBaillargeon et al., 2007; Baillargeon et al., 2011; Brownell, 2013; Hay, 1994


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Development of Empathy

Moral behavior

Empathic behaviortowards others

Rule-compatible behaviorwithout supervision

Empathic behaviorduring toddlerhoodprevents externalizingpathology and predictsdevelopmental

adaptation

It causes greaterpositive reciprocityin the relationship with

close figures

Positive relationshipfoster mental healthand positivesocializationtrajectories

Kochanska et al., 2010


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Development of empathyEmotional empathy develops very early It relies on somato-sensoriomotor resonance and mimicry

Newborns and infants become distressedshortly afteranotherinfant starts crying

Mimicry of facialexpressionsstarts around 10

weeks


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Development of EmpathyCognitive empathy develops later

It relies on more sophisticated functionsTheory of mind (ToM)

Executive function

Self-regulation

This allows for regulated responsesto others distress, without feeling

distressed oneself These are implemented in the prefrontal cortexIt develops more slowly than the rest of the brain

Reaches maturity during adolescenceGreimel, et al., 2010; Decety, 2011


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Sensitivity to others state of mind

M Kovcs et al. Science2011;330:1830-1834

False belief for babyTrue belief for Smurf

True belief for babyFalse belief for Smurf


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Published by AAAS

The infant but not theSmurf believes thatthe ball should be there

Infant knows ball is not thereBut Smurf believes it shouldbe there

Neither infant northe Smurf believe thatthe ball should be there

Neither infant northe smurf believethat ball is there

Ball Not There Ball Not There

M Kovcs et al. Science 2010, 330:1830-1834

The two key conditions in Smurf Study: Infant of 7 monthsconsiders what agent (Smurf) believes about the status of ball

Sensitivity to others state of mind

False belief for babyTrue belief for babyFalse belief for Smurf


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The social brain: pSTS/TPJ

mPFC

pSTS/TPJ Seeing the otherspoint of view

Prediction

o Biological motion, eye

gaze

o Predicting complex

movements

Perspective-taking

o Joint attentiono Different physical points

of view

Pelphrey et al., 2004a,b; Kawawaki et al., 2012 (review); Mitchell 2013


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Brain Regions forPerceiving and Reasoning AboutOther People in School-Aged Children (Saxe et al.)

Right TPJ

mPFC

Precuneus

Left TPJ


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Grace and her friend are taking a tour of a chemicalplant. When Grace goes over to the coffee machine toour some coffee, Graces friend asks for some sugarin hers. There is a white powder next to the coffee in acontainer marked toxic and Grace gives two spoonfulsto her friend.


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Disruption of the right temporoparietal junction withtranscranial magnetic stimulation reduces the role of

beliefs in moral judgments (Young et al., PNAS)

*


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Mentalizing can be taught Prosocial behaviors in children emerge around the 2 years of

age and are largely non-heritable(Deater-Deckard, 2003; Brownell, 2013)

They are linked with positivity in the relationship withparents(Spinrad, 2009)

Maternal responsivenessat childs 9 months of age predictschilds empathy at 22 moths of age(Kochanska, 1999)

Mothers with negative preconceptions about parenting havechildren who show less empathy towards their mothers(Kiang,Moreno & Robinson, 2004)

Punitive and harsh parenting is negatively related to prosocialbehaviors (Asbury et al., 2003)

Warm and sensitive attachment relationship encourages

empathy and perspective taking(Farrant et al, 2012)


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Empathy and Attachment

Avoidant attachment shows a characteristic way ofdetachment that impedes mentalization andtherefore empathy:

Avoidant children aged 4-5 years in play with peers,are eithermanipulative and exploitative or victims ofa manipulative relationship. They oscillate betweenbeing victims and victimizers

Empathy requires regulation of negative emotions:

Fearful and insecurely attached 16 and 22 monthsold girls show progressively less empathy forstrangers in distress

During that time span, empathic concern fortheir

mothers distress increasedVan Der Mark, Van Ijzendoorn & Bakermans-Kranenburg, 2002; Troy & Sroufe, 1987


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The development of empathy

requires an early attachment relationwith a warm and responsive adult

Reactivity to stress is present in youngchildren, but only some can regulateit and react empathically

Children ofresponsive mums showmore concernedattention and lowerpersonal distress when confronted to

distress of the motherand of a strangerKiang, Moreno & Robinson, 2004; Novartis Foundation, 2007; Spinrad & Stifter, 2009


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The Development of Affect Regulation

Closeness of the infant to another humanbeing who via contingentmarked mirroringactions facilitates the emergence of asymbolic representational system of affective

states and assists in developing affectregulation (and selective attention) secureattachment

For normal development the child needs toexperience a mind that has his mind in mindAble to reflect on his intentions accurately

Does not overwhelm him

Not accessible to neglected children


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High congruent & marked mirroring


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This effect of positive attachment is also observed in adults:

Primingattachmentsecurity in adults Empathic

reactions

Personal

distress

Gillath, 2005; Mikulincer et al., 2001; 2005

Attachment avoidance andanxiety are inversely related toempathy

Attachment anxiety is positivelyrelated to personal distress

When perceiving distress, insecurely attached people failto recruit cortical brainareas normally used to down-regulatenegativeemotions (ACC and MPFC), which

hinders empathic behaviors of help and comfort


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Empathy and Attachment Dismissively attached women when empathizing:

Show more activation in motor, limbic, and mirrorsystems Implies implicit andunmodulatedemotional involvement Impairment in self-other differentiation

Deactivation of fronto-medial areas: ACC and medialpre-frontal cortex

Implies emotional disinvestment towards social emotions,typical ofdismissive subjects

It compensates the overactivated implicit involvement

Emo tional overact ivat ionin dismissive subjects does notresult in empathy, butin the retrieval ofautobiographica l

memoriesofpainful attachment experiences, which t r iggeravoidance strategieswhen observing pain

Lenzi, et al., 2012


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Theory:Birth of the Alien Self inDisorganized Attachment

The caregivers perception is inaccurate or unmarked or both

Absence of a

representation of

the infants

mental state

Attachment

Figure The nascent selfrepresentational

structure

The child, unable to find himself as an intentional being, internalizes a

representation of the other into the self with distorted agentive character isticswhich disor anizes the self creatin s li ts within the self structure

Mirroring fails

Internalisation of a non-contingent mental

state as part of the self

Child

The Alien

Self


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Theory:Self-destructiveness andExternalisation Following Trauma

Attack from within is turned against body and/or mind.

Perceived

other

Unbearably painful

emotional states:

Self experienced

as evil/hateful

Torturing alien self Self representation

Self-harm state


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Self experienced

as evil and hateful

Theory:Self-destructiveness andSelf-destructive relationships

Projective identification is used to reduce the experience of unbearably painful emotional state of

attack from withinexternalisation becomes a matter of life and death and addictive bond and

terror of loss of (abusing) object develops

Perceived

otherUnbearably painful

emotional states:

Self experienced

as evil/hateful


Container Self experienced

as hated and attacked

ExternalizationTorturing alien self

Addictive bondSelf-harm state Victimized state


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Self experienced

as evil and hateful

Externalisation & Violence Following Trauma

Projective identification is used to reduce the experience of unbearably painful emotional state of

attack from withinexternalisation becomes a matter of life and death, the violent act protects

against experience of intrusion and addictive bond and terror of loss of abused object can

develop

Perceived

otherUnbearably painful

emotional states:

Self experienced

as evil/hateful


Container Self experienced

as hated and attacked

ExternalizationTorturing alien self

Addictive bondSelf-harm state Violent state

Self experienced

as righteously vindicated

Violent act


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Empathy deficits and attachmentIn children with disruptive behavior disorders

Children with higher levels ofcallous/unemotional traits

are more likely to show

disorganizedattachment

In line with impairments inattending to, recognizing andresponding to otherpeoples

emotions

Early attachmentdisturbancesimpair

childrens ability to reflect onand respond to other peoples

emotional states

Disrupted attachment amplifynegative effects of

temperamental aspects oncallous/unemotional traits

These traits are associated with emotionalrecognition deficits and lowlevels ofprosocia l

behaviorPasalich et al., 2012


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Implicit-Automatic-Non-conscious-Impressionistic


Mentalinteriorcuefocused

Mentalexternalcuefocused

Cognitiveagent:attitude

propositions


propositions



BPD

BPD

BPD

BPD

Mentalizing Profile of Prototypical BPD patientFonagy, P., & Luyten, P. (2009). Development and Psychopathology, 21, 1355-1381.



cortex (VMPFC),












gyrus



system

medial frontoparietal

network activated

recruits lateral fronto-temporal

network


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Prementalizing Modes of Subjectivity Psychic equivalence:

Mind-world isomorphism; mental reality = outerreality; internal has power ofexternal

Intolerance of alternative perspectives concrete understanding Reflects domination ofself:affect state thinking with limited internal focus

Pretend mode: Ideas form no bridge between inner and outer reality; mental world

decoupled from external reality dissociation of thought, hyper-mentalizing orpseudo-mentalizing Reflects explicit mentalizing being dominated by implicit, inadequateinternal

focus, poor belief-desire reasoning and vulnerabilty to fusion with others

Teleological stance:

A focus on understanding actions in terms of theirphysical as opposed tomental constraints Cannot accept anything other than a modification in the realm of the physical

as a true index of the intentions of the other.

Extreme exterior focus, momentary loss of controlled mentalizing Misuse of mentalization for teleological ends (harming others) becomes

possible because of lack ofimplicit as well as explicit mentalizing


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Implicit-Automatic Explicit-Controlled

Mentalinteriorfocused

Mentalexteriorfocused

Cognitiveagent:attitude

propositions


propositions

Imitativefrontoparietalmirror neurone

system

Belief-desireMPFC/ACCinhibitory

system

Impression driven

Appearance

Certainty of emotion

Treatment vectors in re-establishing mentalizing

in borderline personality disorderControlled

Inference

Doubt of cognition

Emotional sensitivityAutonomy


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Mentalizing and the

pedagogic stance and a

general theory for

psychotherapy?

Th d f h t l


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The need for human natural

pedagogy

We are born into a world populated with man-

made tools whose functional properties,

appropriate manner of application or method of

(re)production often remain in many respectsepistemically opaque

The cognitive opacity of kind or category-relevant

aspects of human-made functional artifacts raises

a learnability problem (of relevance-selection) for

the nave juvenile observational learner


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The Theory of Natural Pedagogy (Csibra &

Gergely, 2006; 2009, in press)

A human-specific, cue-driven social cognitiveadaptation of mutual design dedicated to ensure

efficient transfer ofrelevant cultural knowledge

Humans are predisposed to teach and learn

new and relevant cultural information from eachother

Human communication is specifically adapted to

allow the transmission of a) cognitively opaque cultural knowledge

b) kind-generalizable generic knowledge

c) shared cultural knowledge

D fi iti f O t i Sti li


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Definition of Ostensive Stimuli

(Sperber & Wilson, 1995)

The signals whereby an agent makes manifestto an addressee hercommunicative intention:to manifest some new relevant information for

the addressee (i.e. her informative intention). Infants display species-specific sensitivity to,

and preference for, some non-verbal ostensivebehavioral signals(see Csibra, 2010, Csibra & Gergely, 2009 for reviews)

Examples ofostensive communication cueseye-contact turn-taking contingent reactivityspecial tone(motherese)

S


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The Pedagogical Stance is triggered by

Ostensive-Communicative cues

Ostensive cues have in commonInfant recognized as a self

Paid special attention to (noticed as an agent)

Ostensive cues function to trigger:

Open channel to knowledge about social and

personally relevant world (CULTURE)

Go beyond the specific experience and acquireknowledge relevant in many settings

Triggers opening of an epistemic

superhighway for knowledge acquisition

O t i f ti l


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Ostensive cues referential

expectation in infant

6-month-olds followedan agents gaze-shift to one oftwo objects but only when it had been preceded by eithereye contact orinfant-directed speech (ostensivesignals) addressed to the infant (Senju and Csibra, 2008).

An automated eye-tracker based study used an infant-induced contingent reactivity paradigm to demonstratethat 8-month-olds gaze followan unfamiliar objectsbodily orientation response towards one of two targets,but only when the object had been reactingcontingently before (producing self-propelled bodymovements such as tilting) to being looked at by the infant(Deligianni et al., 2011).

E i t l ill t ti f t i


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Subjects : 4 groups of 18-month-oldsStimuli: Two unfamiliar objects

Experimental illustration of ostensive cues

Gergely, Egyed et al. (in press)

1 B li t l


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1: Baselinecontrol group

No object-directed attitude demonstration

Simple Object

Request by

Experimenter A

Subjects: n= 20 Age: 18-month-olds


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Ostensive Communicative Demonstration

Requester: OTHERperson (Condition 1)

Otherperson


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N O t i (N C i ti ) D t ti


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Non-Ostensive (Non-Communicative) Demonstration

Requester: OTHERperson (Condition 2)

Otherperson


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C diti 4 N O t i (N C i ti )


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Condition 4: Non-Ostensive (Non-Communicative)

Demonstration Requester: SAME person

Sameperson


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Epistemic trust and secure


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Epistemic trust and secure

attachment

Secure attachment is created by a system thatalso induces a sense ofepistemic trust thatthe information relayed by the teacher may be

trusted (i.e. learnt from) Evidence

Cognitive advantage of secure attachment

Contingentresponsiveness to the infants own (at first,automatic) expressive displays in secure attachment

During mirroring interactions, the other will mark

her referential emotion displays in a manifestative

manner to instruct the infant


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How Attachment Links to Affect Regulation

DISTRESS/FEAR

Exposure to Threat

Proximity seeking

Activation of attachment

The forming of an attachment bond

Down Regulation of Emotions

EPISTEMICTRUST

BONDING

S i l C th t C t E i t i T t


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Social Cues that Create Epistemic Trust Attachment is special condition for generating epistemic

trust

Generally any communication marked by recognition of thelistener as intentional agent will increase epistemic trustand likelihood ofcommunication being coded as Relevant Generalizable To be retained in semantic memory

Influential communicators use ostensive cues to maximum create illusion ofrecognizing agentiveness of listener

o Looking at audienceo Addressing current concerno Communicating that they see problem from agents perspectiveo Seeing Recognizing individual struggle in understanding

Massive difference in ability of individuals to influence(teachers, politicians, managers) explicable in terms ofvar in ca acit to enerate e istemic trust


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M t l ti t di f t h ff ti


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Meta-analytic studies of teacher effectiveness

John Hattie is Professor of Education at the University of

Auckland, New Zealand. 15 years research and synthesises over 800 meta-analyses

relating to the influences on achievement in school-agedstudents.

Builds a story about the power of teachers and of feedback,

and constructs a model of learning and understanding. Is there a set of predictors to good teaching outcomes based

on: The child?

The home?

The school?

The curricula?

The teacher?

The approaches to teaching?

Meta analytic studies of teacher effectiveness


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Things that do not work:

Mobility (shifting schools) -0.34

Television -0.14

Summer vacation -.09Ability grouping 0.10

Ability grouping .10

Individualized instruction .20Homework .30

Meta analytic studies of teacher effectiveness


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What makes a teacher most effective?

It is teachers seeing learning through the eyesof students; and students seeing teaching as thekey to their ongoing learning

The key ingredients are:Awareness ofthe learning intentions

Knowing when a student is (feels) successful

Having sufficient understandingofthe students

understandingKnow enough about the content to provide meaningful

and challenging experiences

Passion that reflects the thrills as well as awareness of the

frustrations of learning.

Implications: A mechanism of change


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Implications: A mechanism of change Mentalizing(seeing behavior

in terms of mental states)entails collaborationSeeing from others

perspectiveTreating the otheras aperson

Recognizing them as an

agentAssuming they have things

to teachyou since mental

states are opaque

Implications: The nature of psychopathology


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Implications: The nature of psychopathology Social adversity (most deeply trauma) is the

destruction of trust in social knowledge ofall kinds rigidity, being hard to reach

Cannot change because cannot accept newinformation as relevant (to generalize) to

other social contexts Personality disorderis not disorder of

personality (except by old definition of beingenduring) but inaccessibility to cultural

communication from Partner

Therapist Epistemic Mistrust Teacher

}

Implications: The nature of psychopathology


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Implications: The nature of psychopathology Epistemic mistrust follows experiences of

maltreatment or abuse Therapists ignore this knowledge at their peril

Personality disorder is a failure ofcommunication

It is not a failure of the individual but a failure of arelationship It is associated with an unbearable sense of

isolation in the client generated by epistemicmistrust

Our inability to communicate with client causesfrustrationin us and a tendency to blame thevictim We feel they are not listening but actually it is that

they find it hard to trust the truth of what they hear

Implications: The nature of psychotherapy


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Mentalizingpatients may be a common factorto

psychotherapy not because we need to learnaboutourminds to learn about those of others

Mentalizingis a generic way of establishingepistemic trust and achieving changeOur subjectivity being understood is necessary key to

open up wish to learn about world including socialworld

Open a key biological route to information transmission

and possibility of change epistemic super-highway

Experience offeeling thought about makes us feelsafe enough to think about social world



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Implications: The nature of psychotherapy Therapy is not just about the what but the

how of learning:Opening the persons mind via

establishing epistemic trust (collaboration)so he/she can once again trust the social

world by changing expectationsIt is not just what is taught in therapy that

teaches, but the evolutionary capacity forlearningfromsocial situation is rekindled

CAMHS interventions are effective becausethey open the child to social learningexperience which then feed back in virtuouscycle

Psychotherapy may be effective for two reasons


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Learning content by focusing on trustworthyaspects of context

We may have some wisdom that is worthcommunicatingOnce epistemic superhighway is open the client can

learn from us

Learning about sources of knowledge

byproviding a clearsocial illustration of trust weundo epistemic isolationBy using ostensive cues and establishing a sense that

we are concerned to see the world from the clients

standpoint we model a situation of interpersonal trustImproved understanding of social situation Leads

to better understanding of attachment figure moretrusting (less paranoid) interpersonal relationships itopens up the potential to feeling sensitively responded

to in virtuous cycle

Psychotherapy may be effective for two reasons

Implications: Learning beyond therapy


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Implications: Learning beyond therapy What is theprocess at work:Limitless therapies - 1,246 different ways to

understandBut each model capable to provide a content to

treatment that makes person feel understoodThe rationale of the treatment and the model of

pathology and the model oftherapeutic effectgives the treatment the content to create theprocessMentalizing by itself is not a realistic therapy it doe

not tell the therapist what to focus on,just focusingthe patient on theirthoughts and those of othersaround them will not achieve changeImprovement based on learning from experience

beyond therapy

Implications: Learning beyond therapy


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Implications: Learning beyond therapy The specific frame of the therapy around which

mentalizing occurs

the model ofmind, the model ofinteraction, the model ofunderlying dysfunction, the model oftherapeutic goals

The enhancing of mentalizing is also a common factothat achieves improved social relationships Improved sense of epistemic trust enables learning

from experiencechange due to what happensbeyond CAMHS

The enhancing of epistemic trust may be achieveby treatment but also a consequence of improvedsocial relationships and consequent on whathappened in the social world.


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Gaps in Therapy Outcomes Research


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Gaps in Therapy Outcomes Research

No solid evidence forwho will benefitfrom what type of psychotherapy

Inexact therapies partial

effectiveness

Attachment to methods

guildification of interventions


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To Sum Up


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Adapting to the social world is a steep learning curve

Getting comfortable in the social world

G i f bl i h i l ld


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Me playdrums??

For example, it is not obvious what is the true function of all

the objects we use.



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8

Luckily, humans have evolved to teach and learn fromeach other quickly and efficiently



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9

-..quickly and efficiently if certain conditions are met



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but this special interpersonal channel for learning

about the social world is not always tuned in.


Tuning in to the interpersonal channel


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Trust opens up the social communicationsuperhighway, enabling us to learn and change

9

When there is abuse, there is no trust, the mindis blocked and it is impossible to move forward




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Trust opens up the social communicationsuperhighway, enabling us to learn and change

and they will tune in to you!

9

Win the other persons trust by respondingcontingently to their feelings and thoughts, showingthem that you are hearing and thinking about whats

going on in their mind



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MBT IS CHEAP AND COMFORTABLE

AND HELPFUL IN A RANGE OF WAYS!!!


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Documents

2013.04.18 Peter Fonagy Creating Connections