You may think that you're good at guessing what others are thinking, but how adept are you at reading what they’re feeling? And why should that matter?
You may not always know what people are feeling, but if you can make a good guess, you improve your chances of being able to interact with them in a healthy manner. You may also gain a better understanding of yourself in the process. A new study authored led by Marc-Andreas Edel (2016) tests the idea that people with borderline personality disorder (BPD) can benefit from a form of therapy in which they gain the ability to “mentalize,” or learn how to form “a realistic picture of what another person is thinking, feeling, or intending…to guess what is passing through the mind of others and to understand that other views the world from a different perspective than one’s own” (p. 2). Long thought of as a challenge to traditional psychotherapeutic interventions, a great deal of progress has been made in the treatment of people with BPD via dialectical behavioral therapy (DBT); Edel and his team believed that adding mentalization-based therapy (MBT) could even enhance the treatment process further.
MBT, developed by University College London’s Peter Fonagy and Anthony Bateman, provides an important missing link to changing the behavior of people with BPD, as well as their ability to appreciate what other people are thinking and feeling. In an email to me, U.K. mental health advocate Fenella Lemonsky (treated by Anthony Bateman) stated:
“MBT worked for me as the intensity was titrated. It was good to work through painful emotional ups and downs and tackle poor coping mechanisms at the same time. DBT does this separately. I was able over time to move away from destructive coping to better times where I could smile and laugh.”
Previous work suggested that MBT should work, but it wasn’t until Edel et al. conducted a pilot study comparing DBT alone with DBT and MBT together that this idea was empirically tested. In the pilot study, 73 women residing in a psychiatric facility, all with BPD, were in treatment primarily for other co-occurring disorders, including major depressive and eating disorders. The MBT manipulation involved training the patients how better to recognize the emotions of others, as well as emotions in oneself. They were also trained in reading “intentions, desires and limitations” in others as well as oneself. By assessing mentalization skills before and after treatment, along with BPD symptoms, the authors were able to demonstrate benefits of MBT combined with DBT vs. DBT alone in intensity of self-harm behaviors. People in the combined treatment group also showed a decline in fearful attachment, or the belief that one will be abandoned by significant others.
MBT seems to have value, then, in helping people known to have specific difficulties in gaining insight into the emotional lives of others. This raises the question of whether it’s possible to put a number on how well anyone is able to mentalize. If your number is too low, it would make sense that your own mental health might benefit from applying some principles of MBT to your own understanding of other people. After all, if you erroneously conclude that someone is trying to take advantage of you, wouldn't it be beneficial if you refined your ability to tell whether you're coming to the wrong conclusion?
The test of mentalizing that the Edel et al. developed involved having the participants complete a cartoon test (developed by Brüne et al., 2016) in which two or more characters interact in a complex emotional scenario involving emotions such as jealousy, envy, and “schadenfreude” (taking pleasure in other people’s pain). First, participants had to judge the correct order of events for each cartoon scenario. Next, they had to choose an appropriate cartoon from a set of choices that would represent the emotional state of the characters. The example cited in the paper by Brüne and associates uses as the “prosocial” condition, where one person comforts another. In the “antisocial” condition, a character is excluded. In the “avoidant” condition, a character leaves an emotional issue unresolved, and in the “disorganized” condition, the character shows behavior that doesn’t really make any sense.
To imagine this task, consider separating the squares in a comic strip and then having to put them back together in order, with no captions to guide you. Then, imagine what final square you would construct (or choose) depending on the emotions or interpersonal relationships you’re being asked to represent.
In reality, you’re constantly practicing this skill, even if you don't realize it. Consider what might happen when you’re at your health provider’s waiting room. You see a group of people coming in together and, out of sheer boredom, try to figure out what their relationship is and how they’re feeling. Are they siblings, friends, romantic partners, or roommates who don’t know each other that well? Which one, or ones, of them are seeking treatment? Is it a serious or relatively minor illness that brings them in? If your wait is long enough, and you feel brave enough, you might try to find out what’s really going on with them. Then you can see how close you came to guessing their actual emotional state and relationships among each other.
If you’re not that brave or aren’t into speculating about the relationships of strangers, think about what happens when you’re watching a movie or TV show in which the situations aren’t particularly clear. This happens at the beginning of almost any piece of drama, especially mysteries. The scene is set and it’s up to you to form hypotheses about how the people involved feel about themselves, each other, and the situation. Eventually, you can test these hypotheses against the actual unfolding of the action.
Playing these emotional charade games can provide more than just idle amusement. As the Edel study on people with BPD shows, it can help you refine the interpersonal and intrapersonal skills that can benefit your mental health. Being able to sense, accurately, the feelings of others can help you—in Lemonsky’s words—allow “destructive coping” to turn into the ability “to smile and laugh.”
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Copyright Susan Krauss Whitbourne 2016
Brüne, M., Walden, S., Edel, M., & Dimaggio, G. (2016). Mentalization of complex emotions in borderline personality disorder: The impact of parenting and exposure to trauma on the performance in a novel cartoon-based task. Comprehensive Psychiatry, 6429-37. doi:10.1016/j.comppsych.2015.08.003
Edel, M., Raaff, V., Dimaggio, G., Buchheim, A., & Brüne, M. (2016). Exploring the effectiveness of combined mentalization‐based group therapy and dialectical behaviour therapy for inpatients with borderline personality disorder – a pilot study. British Journal Of Clinical Psychology, doi:10.1111/bjc.12123
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