Feature by Dr. Sara Schapiro and Nikita Fernandes
Interpersonal psychotherapy was created to address symptoms of depression. It was at first intended to be a time-limited approach. Today, it is applied throughout treatment. Understanding how life events, relationships, and social support interact with mood disorders and other mental conditions served as the foundation for interpersonal therapy.
Mentalizing is the ability to “think about thinking”. The ability to observe one's thoughts and to consider what someone else's thoughts or beliefs might be (also referred to as “inner mental states”). The most important aspect of mentalization is the ability to be open to considering that someone else's thoughts and feelings may be different than one’s own.
Bateman and Fonagy created Mentalization Based Therapy (MBT) initially for patients who were diagnosed with a borderline personality disorder. MBT aims to increase the client’s ability to mentalize. Such as, the client will begin to develop a curiosity about others' thoughts, feelings, and motivations.
How are these interventions used in therapy?
Interpersonal Psychotherapy Interventions Applied
Our problems are created in the space between people and therefore healing will happen in the space between person to person. The interpersonal therapeutic approach is focused on the “here-and-now” and the person’s everyday problems.
Everyday problems: Although we understand that our early childhood relationships impact how we function in our adult relationships, interpersonal therapists pay attention to our current relational dynamics. In therapy, you can expect to share with your therapist an overview of your childhood. This is so your therapist can understand you better and make educated guesses of what may be contributing to your problems. Simply said, this helps the therapist understand “why you do what you do”.
Here-and-now: The therapeutic relationship (the relationship between you and your therapist) is used by the therapist as a barometer to understand how you relate to others. For example, you often come late to sessions after a session that was particularly honest and authentic. While you tell your therapist your reasons for coming late (e.g., a work meeting, the trains, etc), your therapist begins to pay attention to and observe the pattern. Your therapist will then share with you their thoughts: “I noticed that after a particularly intense session you come late the following week, have you noticed that?” The therapist will then share their interpretation, “I am wondering if when someone feels too close to you, you tend to withdraw?” Your therapist and you will then continue into a discussion about closeness, withdrawal, intimacy, how you manage relationships, your fears, why you have the impulse to withdraw, and on and on….
Mentalization-Based Therapy Interventions Applied:
Mentalization-based therapy can be used to help clients cope with the overwhelming sense of emotions. For example, a therapist has been working with a client and helping them explore their interpersonal relationships. The client has been feeling insecure and lonely and learns that their friend is canceling their plans because the friend feels unwell. The client responds by feeling betrayed, lonely and angry. They internalize the situation, concluding that they are not important enough to their friend resulting in feelings of unworthiness and self-contempt. The client’s internal narrative of “no one likes me” is further reinforced; “even my own friend doesn’t want to spend time with me”. The client is now convinced that the friend canceled plans to secretly hang out with other friends who are more fun when in reality, the friend was unwell. Since mentalization-based therapy includes being mindful of how others see us, the therapist might ask the client to speak about how their best friend might see their friendship. The therapist works with the clients to help them realize that their thoughts are not a reality. This opens up a path for the client to consider that their internal dialogue is not accurate thus leading to a more balanced view of the situation. This results in the client's ability to tolerate the situation better and to be kinder to themselves.
Putting It All Together:
Interpersonal Psychotherapy and MBT are interventions that can be utilized simultaneously and at times they seem to be the same.
Interpersonal therapy explores how you have been influenced by past relationships. The therapist will help you gain an understanding of how beliefs of the past may be misplaced in current relationships. For example, during your childhood, whenever you were happy about something, your mother criticized you. You learned that being happy is not an acceptable emotion and you stopped sharing your happiness with others; happiness became a dangerous emotion for you to feel. Currently, your friends say you are a “debby downer” or you feel sad most of the time and you cannot understand why given many of the good things that have happened to you over the years. Interpersonal psychotherapy helps you recognize that the belief that others cannot tolerate your happiness is misplaced. Your mother was unable to tolerate your happiness (for her emotional reasons), but that does not mean that everyone else cannot tolerate it. In fact, the people who love you want to see you happy. Next, MBT is the skills and techniques that will be used to help you develop a curiosity and consideration that other people have different thoughts, beliefs, and tolerance than you think they do. Excuse the cliche here but, “not everyone is your mother.” In treatment, your therapist will ask you to explore how others might be thinking and feeling, including your therapist. For example, when you share with your therapist something that you are happy about, your therapist might ask you, “how do you think I feel when you shared that with me?” “Can you consider that I am genuinely happy for you?”. This experience between you and your therapist can be an authentic and powerful healing moment for you.
Nikita Fernandes is a mental health therapist in New York City. You can contact Nikita at firstname.lastname@example.org and read more blog posts at www.mwr.nyc. Dr. Sara Schapiro holds a New York State Mental Health Counseling License, and an AASECT Certified Sex Therapist. You can contact Sara at email@example.com and read more blog posts at www.mwr.nyc.