What is Mentalizing and Why Do It?

Editor's Note
Patients, family members, and clinicians have every reason to be heartened by recent advances in biological psychiatry. A wide range of methods from genetic research to neuroimaging studies of brain activity have demonstrated convincingly that mental illnesses are also physical illnesses. The recognition of mental illness as physical illness helps us all understand the challenges of recovery and also brings the promise of more effective physical treatments—not only improvements in psychiatric medications but also in the development of innovative treatments such as vagus nerve stimulation and transcranial magnetic stimulation. Partnerships with the Baylor College of Medicine and Methodist Hospital enable The Menninger Clinic to keep abreast of advances on all fronts.

Yet providing the best psychiatric care will always entail balancing innovation with conservation, that is, staying in the forefront while preserving what is most valuable from the past. In 2003, we published two issues of the Bulletin of the Menninger Clinic under the theme of “preserving the mind in contemporary treatment” with the aim of keeping the mind in mind as we also aspire to offer the most effective physical treatments. Recognizing that physical and mental health are inextricable, we must keep in mind the whole person with a complex life and life history.

In preserving the mind as we aspire to do the best by the body, we have embraced a concept that is both new and old: “mentalizing.” This new and admittedly ungainly word refers to an ancient human capacity, that is, the natural inclination to interpret the behavior of other persons and oneself as based on mental states such as desires, beliefs, and feelings. Research over the past 15 years is demonstrating the central role of mentalizing in mental health, and we now recognize that mentalizing on the part of clinicians, patients, and family members is central to the effectiveness of all psychiatric treatments. Reflecting the burgeoning interest in mentalizing, The Menninger Clinic is fortunate to be part of an international consortium comprised of the Anna Freud Centre, University College London, the Yale Child Study Center , and the Baylor College of Medicine. As an introduction to this exciting new development, the following article explains mentalizing in everyday language.

For further information about mentalizing, you may also want to read the article, Mentalizing as a Compass for Treatment.

What is mentalizing and why do it?
You are mentalizing when you’re aware of what’s going on in your mind or someone else’s.  You’re mentalizing when you puzzle, “Why did I do that?” or wonder, “Did I hurt her feelings when I said that?” Your ability to mentalize enables you to make sense of behavior. You hear a car door slam shut and it draws your attention. Then you see the man who slammed the car door reaching into his pocket and coming up empty handed. He starts to get agitated, tries unsuccessfully to open the door, looks through the car window toward the ignition, and starts cussing. All this behavior would be bewildering if you didn’t automatically infer that he’s frustrated because he locked his keys in the car.

Mentalizing, you automatically interpret behavior as based on mental states, such as desires, beliefs, and feelings. The man wanted to be able to drive his car, believed that he’d have a hard time getting back into it, and felt frustrated—perhaps also helpless.  Sometimes you need to mentalize to interpret your own behavior: “How could I have been so gullible as to loan him money when I knew full well that he’s totally undependable?” Often you need to mentalize to understand your emotional reactions: “Why am I this upset about her not calling me back right away? Why am I so sensitive right now? I’ve been feeling like a lot of people have been letting me down lately…”

A shorthand idea for mentalizing: keeping mind in mind. Mentalizing requires attention and takes mental effort; it’s a form of mindfulness, that is, being mindful of what others are thinking and feeling as well as being mindful of your own thoughts and feelings. Thus mentalizing is similar to empathy. But mentalizing goes beyond empathizing, because it also includes awareness of your own state of mind—empathizing with yourself. Thus, you’re mentalizing when you’re going in to ask your boss for some time off and you’re thinking, “I’m feeling anxious. It makes sense that I’d feel anxious right now, because he may feel put out. Well, I can tolerate that.” If your boss unfairly gives you grief about taking some time off, you’d be mentalizing in thinking, “I’m getting frustrated, so I need to choose my words carefully. I need to acknowledge that this makes his life more difficult and let him know how important the time off is to me.”

The following situations call for mentalizing:

• Comforting a friend in distress
• Calming down a child who is having a tantrum
• Persuading an employer to give you a raise
• Proposing marriage
• Clearing up a misunderstanding with a friend
• Developing strategies to refrain from overeating
• Describing symptoms and problems to your psychiatrist

As all these examples attest, mentalizing is common sense; we are natural psychologists in trying to understand behavior and figuring out why people think and feel the way they do. Mentalizing is like language in being innate: we all develop the capacity to mentalize, barring genetic conditions such as autism. Yet, like language, mentalizing develops best in an environment conducive to learning.

Like using language, you mentalize naturally; most of the time you don’t need to think about it. You don’t need to be a linguist to use language, and you don’t need to become a professional psychologist to mentalize. Yet mentalizing is a skill that can be more or less well developed. Failing to mentalize can contribute to serious problems in relationships. Your friends, family members, or spouse will be unhappy if you’re oblivious to their needs and feelings or you continually misinterpret their actions.  Psychiatric disorders such as depression and substance abuse notoriously interfere with mentalizing. When such problems arise, you can benefit from learning about mentalizing, paying greater attention to doing it, and becoming more skillful at it.

Developmental psychologists have been researching mentalizing over the past few decades, so we now know a lot about how it develops and how we can improve it. This article describes different aspects of mentalizing, conditions that affect mentalizing, skillful mentalizing, and the benefits of mentalizing. We conclude by revealing our main goal: to influence your attitude toward mentalizing.

Aspects of Mentalizing
Mentalizing involves awareness of yourself as well as others. Our colleague, psychiatrist Jeremy Holmes at the University of Exeter in the UK , puts it this way: mentalizing is seeing yourself from the outside and others from the inside. Mentalizing with regard to others takes effort: you cannot merely assume that others think and feel the way you do, although they might; you must shift perspectives and try to take their point of view. Thus the more you know about another person, the more accurate your mentalizing will be.

You cannot take for granted your ability to mentalize with respect to yourself: even though you live in your own mind, you don’t necessarily always know how your mind is working. All of us are capable of self-deception. It’s common for others to see aspects of ourselves to which we are blind. Often, we know ourselves best through dialogue with others: you might start out just feeling vaguely “upset” and, over the course of the conversation with a trusted friend, come to recognize that you’re feeling hurt, ashamed, and resentful. Thus others, seeing us from the outside, can help us see ourselves more clearly from the inside.

You can mentalize in different time frames. You can mentalize about specific mental states in the present: “I’m getting all worked up for nothing.” “She’s starting to get impatient with me.” Also, you can reflect on past mental states: “Now that I’ve calmed down, I can see that she intended her criticism to help me, not to belittle me.” In addition, you can mentalize by anticipating future mental states: “If I don’t let her know that I’ll be late, she’ll worry and then I’ll feel guilty.” Most important, you can transform hindsight into foresight: mentalizing about problems in the past can enhance your ability to mentalize in the future. “I know I’m extremely sensitive to criticism and I get so defensive that I can’t listen to her point of view. Next time, I’ll try to think about where she’s coming from, listen carefully to what she’s saying, and avoid another blow up.”

Just as you can mentalize about the present, past, or future, you can mentalize with a narrower or broader perspective. You can focus narrowly on a person’s feelings at a given moment: “She looks irritated.” In addition, you can be aware of the broader context of that mental state: “she thinks I lied to her.” You can even take into account a broad swath of the person’s history: “She’s extremely sensitive to any sign of betrayal because of her father’s recurrent untrustworthy behavior.” Thus, expanding the scope of mentalizing may take into account a broader time frame as well as the wider network of interactions and relationships that influence an individual’s mental states.

The same applies to your own mental states: self-understanding often requires you to consider the wider context beyond the present moment. You might wonder, “Why am I so upset that he didn’t acknowledge how much work I did on this project?” Mentalizing, you might realize that you’ve been feeling unappreciated for a long time, and not having this particular project recognized was the last straw. You can take this line of thinking all the way back to your childhood, for example, connecting your current feelings with repeated disappointments in the past, when a parent routinely failed to attend school plays or sports events. Your feelings about the present invariably are colored by your past experiences, and mentalizing involves being aware of this coloring—the “baggage” from the past—so that you can see the present for what it is.

You can mentalize more or less consciously. Mentalizing explicitly is a conscious process in which you think deliberately about the reasons for actions—often when you are puzzled: “Why would she have said that?” “How could I have forgotten to do that when I knew it was so important to him?” You mentalize explicitly when you put your feelings into words, whether you’re trying to make sense of yourself in your own mind or needing to express what you’re feeling to someone else.

Most often, however, you don’t have time to mentalize explicitly when you’re interacting with others; you’re mentalizing implicitly, that is, spontaneously and intuitively, without thinking about it. Mentalizing implicitly, you’re guided by your gut feelings. When your friend tells you about a major disappointment, you automatically adopt an expression combining sadness and caring, leaning forward to make emotional contact. Thus the natural empathy you have for others is based on your ability to mentalize implicitly. You also mentalize implicitly when you engage in conversation, keeping the other person’s perspective in mind and taking turns naturally without having to think about it. You’re likely to find conversations annoying when others fail to mentalize, mentioning names of people you don’t know without taking into consideration that you have no idea who they’re talking about.

When all goes well, you can get by with mentalizing intuitively and implicitly. Using language naturally, you don’t need to think about your choice of words until you’re misunderstood. Similarly, you need to mentalize deliberately and explicitly when you hit a snag in a relationship. Much of your explicit mentalizing takes the form of narrative, through which you make your own and others’ actions intelligible. You ceaselessly create stories involving thoughts and feelings. Think of a time when you had to justify your actions to someone, such as asking your boss for time off. Think about how you explain your emotional reactions to someone else’s behavior. Think about how squabbling children behave when a parent confronts them. Each one comes up with a different story. Then the parent needs to mentalize to sort it out and intervene appropriately.

You begin learning to mentalize early in life by creating stories to account for your actions. And you do this in your own mind. For better or for worse, you continually tell yourself stories about yourself, and these stories influence who you are. Self-critical stories, for example, can undermine your self-confidence. “Nothing I do ever turns out right, no matter how hard I try. I’m useless. If anything goes wrong, I’m always the one to be blamed. The story of my life…”

Ideally, mentalizing, like story telling more generally, is creative: mentalizing, you come up with fresh perspectives, seeing yourself and others from more than one point of view. Thus you’re mentalizing when you wonder, “I’m really irked at him. What else might I be feeling? I guess he hurt my feelings.” Similarly, you’re mentalizing when, after you think, “What an idiot I am,” you reconsider and think, “I made an understandable mistake; I was trying to do too much at once.” Jeremy Holmes insightfully construed psychotherapy as a “story-making” and “story-breaking” process. Mentalizing, you move out of old ruts in the way you see yourself and others.

Conditions for Mentalizing
Children learn language best in a language-rich environment, by hearing speech, being spoken to, and being listened and responded to when they are learning to speak. Similarly, children learn to mentalize best when their family members are sensitive to their states of mind, especially their emotions. Children learn to mentalize by being mentalized, that is, when others have their mind in mind. Mentalizing will not flourish in emotionally neglectful relationships. Rather, mentalizing develops best in trusting and safe relationships—what we call secure attachment relationships. Moreover, once children begin to acquire language, talking openly with them about their own and others’ needs, feelings, fears, and reasons for actions gives mentalizing a great boost. As with all other skills, mentalizing is learned through practice, and learning continues throughout the lifetime.

Developing the ability to mentalize is one thing; using it consistently is another. Some conditions are more conducive to mentalizing than others. Your level of emotional arousal is a major factor in being able to mentalize at any given moment. Mentalizing goes best when your level of emotional arousal is neither too high nor too low. You need to feel relatively safe to mentalize. If you’re feeling threatened—angry or frightened—you’ll be more concerned with self-protection than with taking the time and effort to mentalize. In states of high emotional arousal, the instinctive fight-or-flight response takes over, and mentalizing falls by the wayside. You can feel so panicky or infuriated that you can’t think straight, much less consider what someone else is thinking or feeling.

You’re generally likely to have most difficulty mentalizing in emotionally close attachment relationships when conflicts arise and feelings run high. Catch-22: mentalizing is most difficult when you most need to do it. That’s why much of our mentalizing takes place after the fact; fortunately, we can translate hindsight into foresight. And you may need professional help in the form of individual or couples therapy so that you can learn to mentalize when you’re experiencing conflict or feeling threatened in your attachment relationships. Mentalizing enables you to be aware of your feelings as well as those of your partner. To engage in constructive problem solving, each person needs to keep their own mind as well as the other’s mind in mind. And the best way to engage another person in mentalizing is to be doing it yourself.

Either too much or too little emotional arousal can interfere with mentalizing. If you’re too depressed or lethargic, you won’t be inclined to mentalize. Mentalizing takes effort, and you must be motivated to do it. If you’re indifferent to others’ needs or feelings, you won’t be inclined to mentalize.

Skillful Mentalizing
The two hallmarks of skillful mentalizing are accuracy and richness. Mentalizing accurately means seeing others for who they really are as well as seeing yourself for who you really are.  Mentalizing requires imagination, for example, being able to project your own experience into others, putting yourself in their shoes, and imagining how you might feel if you were in their situation. But projecting from your own experience can be a slippery slope; your imagination can lead to distorted mentalizing. For example, feeling ashamed and inadequate or being excessively self-critical, you might wrongly imagine that others look down on you or judge you harshly. In so doing, you would be mentalizing, but you would be mentalizing inaccurately.

We are often asked, “Can you mentalize too much?” Frequently, this question reveals ineffective or inaccurate mentalizing such as obsessing or worrying about what someone else is thinking or ruminating about your past failures and deficiencies. Skillful mentalizing, on the contrary, is flexible and exploratory; you’re not stuck in a rut. Of course, as with all else, health lies in balance; there’s more to life than mentalizing.

As problems with worrying and ruminating illustrate, mentalizing accurately means grounding your imagination in reality; you might do this by asking others what they think and feel instead of relying solely on your assumptions or projections. If you think someone is put out with you or critical of what you’ve done but you’re not sure, you can ask. If you’re unsure of your interpretation of a situation, you can check out how others saw it. Often, different people interpret the same situation in different ways. This brings us to the essence of mentalizing: recognizing that there are many mental perspectives on the same outer reality. That’s mental reality.

Richness in mentalizing refers to the process of mental elaboration—making the effort to use your imagination and think beyond the surface. A father is failing to mentalize when he dismisses his son’s tears as showing that “he’s just a spoiled brat” rather than considering the basis of his son’s disappointment or frustration. Similarly, thinking that a co-worker is “just a jerk” is a non-mentalizing view. You might think of yourself in the same non-mentalizing way: “I’m just lazy” or “I’m just impulsive.” The word, “just,” is a tip-off to non-mentalizing; it closes off thoughtful exploration of the potential multitude of reasons for behavior.

In her book, The Sovereignty of Good, novelist and philosopher Iris Murdoch provided a now-celebrated example of a mother-in-law’s shift in perspective regarding her daughter-in-law, a shift in viewpoint that illustrates a transformation from inaccurate to accurate mentalizing. Initially, the mother-in-law found her daughter-in-law to be crude, unrefined, and juvenile; she thought her son had married beneath him. Outwardly, she treated her daughter-in-law with impeccable kindness but, inwardly, she felt scorn. Yet the mother-in-law was uncomfortable with her attitude and wondered if she were being snobbish. She put her mind to seeing her daughter-in-law accurately, justly, and lovingly. She was determined to see her daughter-in-law for who she really was. Through a concerted effort of attention and imagination, she came to see her daughter-in-law not as vulgar but rather as refreshingly simple, spontaneous, and delightfully youthful—a dramatic shift of perspective.

Because mentalizing is inherently open-ended, allowing for multiple perspectives, you know you’ve stopped mentalizing whenever you have a sense of certainty. You’ve stopped mentalizing when you declare, “I know you really don’t want me here!” You’ve shifted into mentalizing when you say, “I’m thinking you really don’t want me here—is that so?”

The Benefits of Mentalizing
The most obvious benefit of mentalizing is engaging in fulfilling relationships with others, particularly those with whom you are emotionally attached. Mentalizing—each person having the other’s mind in mind—lies at the heart of intimacy. Mentalizing skillfully also enables you to influence others effectively, taking their point of view into account while respecting their individuality. When you fail to mentalize, you tend to impose your point of view and your will on others, trying to force them to comply with your wishes, needs, or beliefs. Conflict, antagonism, and resentment are bound to ensue. And mentalizing not only allows you to influence others but also opens you up to being influenced by others. You could not learn from others if you were unable to have their mind in your mind.

Ironically, while mentalizing develops best in secure attachment relationships in childhood, one advantage of secure attachments is that you typically don’t have to put too much conscious effort into mentalizing as long as things are going smoothly. You will need to put effort into mentalizing, however, when you are in competitive relationships as well as when you are not sure of another person’s trustworthiness. If you are naively trusting—not making the effort to discern the other person’s true intentions or motives—you can put yourself in danger. Thus, in a new relationship, cautious appraisal as well as being attuned to your gut reactions is essential.

Mentalizing not only is essential to good relationships with others but also to your relationship with yourself. Just as you need to influence others, you need to be able to influence yourself, for example, when you want to change your feelings, attitudes, thought patterns, or behavior. To influence yourself, you must know yourself and be attuned to yourself, keeping your own mind in mind.  If you’re struggling with an addiction, you need to anticipate situations that will tempt you and steer clear of them.

Mentalizing your emotions is most important and most difficult. You can be immersed in an emotional state without mentalizing. You can be emotionally agitated and appear tense and edgy to others without being aware of your feelings. Or you may be dimly aware of feeling “out of sorts” but not be clear about just what you are feeling or why. Mentalizing emotion requires feeling and thinking about feeling at the same time, clarifying your feelings and their basis. Your feelings are your gut-level guide to your needs and to how your relationships are going. You feel annoyed when someone invades your space, and your annoyance prompts you to stand up for yourself. When you’re aware of your feelings through mentalizing, you’re in the best position to get your needs met effectively. You can express your feelings to others accordingly and thus solve the problems that your feelings are signaling: “I don’t like it when you just barge in without knocking.” Even when it’s not a good idea to express your feelings outwardly to others, you can at least express them inwardly to yourself. Ideally, you can take an understanding and compassionate attitude toward your feelings, just as you would wish others to do. You might not want to tell your boss how angry you are about his being unreasonable, but you might say to yourself, “I can’t believe how aggravating this is—no wonder I was anxious about asking him for time off!” And you might express your feelings later to a trusted friend as well.

Mentalizing your emotions also enables you to refrain from impulsive and self-defeating behavior—storming out of your boss’s office. Mentalizing is like pushing a pause button, giving yourself time to think about your needs and feelings and the best way to manage them rather than employing desperate measures to quell them. For example, mentalizing enables you to recognize, tolerate, regulate, and express your feelings of frustration rather than having to drink to the point of intoxication to get rid of them.

A Mentalizing Attitude
To repeat, mentalizing is like language: short of rare genetic abnormalities or extreme deprivation, we all learn to talk and we all learn to mentalize. Yet all of us can all learn to speak and write more articulately, and all of us can learn to mentalize more effectively and consistently. The main problem with mentalizing is not lacking the basic ability but rather failing to cultivate it and put it to use. When you’re having trouble in close relationships or difficulty managing your own emotional states, you’ll need to pay more attention to mentalizing and put more effort into it. You may need professional help. We’ve said that the best way to influence another person to mentalize is to do it yourself. This is what we therapists aspire to do: by mentalizing, we help our patients to mentalize. In fact, we believe that the success of all forms of therapy rests on mentalizing on the part of patients and their therapists.

As therapists, we wrote this article to inspire what we call a mentalizing attitude, that is, an attitude of openness, inquisitiveness, and curiosity about what’s going on in others’ minds and in your own. This attitude requires tolerance for ambiguity—comfort with not knowing.  Mentalizing involves exploring possibilities with an open-minded attitude, a sense that there’s always more to the story. This article is a mere introduction.

[1] Appendix to Chapter 8, “Psychoeducation,” in Allen, J.G., Fonagy, P., and Bateman, A. (forthcoming). Mentalizing in Clinical Practice. Washington , DC : American Psychiatric Publishing.