Affect Regulation, Mentalization and the Development of the Self

Peter Fonagy, Gyorgy Gergely, Elliot L. Jurist, Peter Fonagy, Gyorgy Gergely, Elliot L. Jurist

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429910647
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book focuses on the crucial importance of developmental work to psychotherapy and psychopathology. It offers an account of psychotherapy to integrate scientific knowledge of psychological development and represents psychological states in the minds of infants, children, adolescents, and adults.

Part I
Theoretical Perspectives

In Part I, we offer an introduction to some of the main theoretical concepts used in this hook. The first chapter can be thought of as an overture. We offer definitions of self reflective function and mentalization and, in particular, make the argument that the capacity to mentalize is a key determinant of a psychological sense of self. Yet, mentalization is not simply a cognitive concept, and thus we turn in the second chapter to focus in detail on different perspectives on affects and affect regulation. We clarify the meaning of affect regulation and emphasize the distinction between a basic form of affect regulation where the object is needed to modulate an affect or affects and a more complex form, altered by the development of mentalization, where the aim is to be able to regulate the self. Finally, in the third chapter, we stake out a defense of an environmental position concerning early development, which does not contest the evidence for a genetic-biological position but does challenge some of the inferences that are made from it—especially as they are mistranslated into the clinical realm. We also propose here a crucial reformulation of attachment theory: according to our view, a major goal of attachment is to produce a representational system for self states through mentalization.

1
Attachment and Reflective Function: Their Role in Self-Organization

This chapter introduces the idea of a relationship between attachment processes and the development of the capacity to envision mental states in self and others—the capacity that is referred to in this book as mentalization or reflective function. Throughout this book, we develop the argument that the capacity to mentalize is a key determinant of self-organization and affect regulation, and we maintain that this capacity is acquired in the context of the child's early social relationships. Here we give an overview of the evidence for an association between the quality of attachment relationship and reflective function in the parent and the child. We offer some hypotheses about the development of reflection in the context of the infant-caregiver relationship. We then interpret these data and speculations in the context of current models of theory-of-mind development.

Reflective Function or Mentalization: A Historical Context

Concepts and ideas around the notion of affect and self abound and have an extraordinarily rich history in philosophy and psychology. Even without a comprehensive historical perspective, it seems apparent that the concept of the self and allied ideas have, more recently, been experiencing a considerable revival of interest from social scientists and developmentalists (e.g., Bracken 1996; Cicchetti and Toth 1994). Psychological interest in the self is usually traced to W. James's (1890, 1892) distinction of two aspects of the self: the "I" (self as subject) and the "Me" (self as object). The "I" is the active agent responsible for constructing the self-concept of "Me." To paraphrase in the terms of current cognitive neuroscience, the "Me" is the mental representation, while the "I" embodies the self as agent, the mental processes or functions that underpin representations of the self (Mandler 1985). The "I" organizes and interprets experience, ensures the experience of continuity through time, creates a sense of freedom or initiative, and generates the experiences leading to the distinctness of oneself as a person (see chapter 5). Modern developmental psychology has brought us closer to a full understanding of the mental processes that combine to organize the representation of selfhood.

Developmentalists over the past ten years have drawn our attention to the near-universal and remarkable capacity of young children to interpret their own and others' behavior by attributing mental states (see chapters 3 and 4). Reflective function, referred to in developmental psychology as "theory of mind," is the developmental acquisition that permits children to respond not only to another person's behavior, but to the children's conception of others' beliefs, feelings, attitudes, desires, hopes, knowledge, imagination, pretense, deceit, intentions, plans, and so on. Reflective function, or mentalization, enables children to "read" other people's minds (Baron-Cohen 1995; Baron-Cohen, Tager-Flusberg, and Cohen 1993; Morton and Frith 1995). By doing this, children make people's behavior meaningful and predictable. Their early experiences with other people enable them to build up and organize multiple sets of self-other representations. As they learn to understand other people's behavior better, they become able flexibly to activate the representation(s) from these multiple sets that are best suited to respond to particular interpersonal transactions. The term "reflective function" (RF) refers to the operationalization of the psychological processes underlying the capacity to mentalize—a concept that has been described In both the psychoanalytic (Fonagy 1989; Fonagy, Edgcumbe, Moran, Kennedy, and Target 1993) and cognitive (e.g., Morton and Frith 1995) psychology literatures. Reflective functioning or mentalization is the active expression of this psychological capacity intimately related to the representation of the self (Forrni and Target 1995, 1996; Target and Fonagy 1996). RF involves both a self-reflective and an interpersonal component that ideally provides the individual with a well-developed capacity to distinguish inner from outer reality, pretend from "real" modes of functioning, and intrapersonal mental and emotional processes from interpersonal communications.

The interdependence of understanding applied to others and to the self was highlighted by the second pioneer of psychological self theory, Cooley (1912): 'The thing that moves us to pride and shame is not the mechanical reflection of ourselves, but an imputed sentiment, the imagined effect of this reflection upon another's mind" (p, 153). Developmentally, this may be thought to imply that a mental operation is required in early childhood to derive the self-state from the apperception of the mental state of the other. Exploring the meaning of others' actions is then a precursor of children's ability to label and find meaningful their own psychological experiences. This ability arguably underlies the capacities for affect regulation, impulse control, self-monitoring, and the experience of self-agency—the building blocks of the organization of the self. This book attempts to trace the stages of acquisition of reflective function or mentalization, its roots in attachment, the relationship with the development of self-organization, and the particular role of emotional experience. This is highlighted in the final chapter, on mentalized affectivity.

The notion of reflective function is rooted in Dennett's (1978, 1987, 1988) proposal that three stances are available in the prediction of behavior: the physical stance, the design stance, and the intentional stance. He takes predicting the behavior of a chess-playing computer as his example. At its simplest this can be based on knowledge of the physical properties of the machine (the physical stance). The design stance would be based on knowledge of the design of the computer, including the programming that had gone into its development. The third approach consists of predicting what might be the computer's most rational move. Here we attribute to the computer certain beliefs and desires—in other words, regulation by intentional states. Dennett's thesis is that explanation in terms of such states of meaning provides good grounds for predicting human behavior— the only grounds accessible to all of us—this knowledge is embodied in the theory of mind of folk psychology (Churchland 1986; Fodor 1987; Mele 1992).¹

"Theory of mind" is an interconnected set of beliefs and desires, attributed to explain a person's behavior. The theory-of-mind concept has great explanatory value. Philosophers of mind (Hopkins 1992; Wollheim 1995) have extended Dennett's approach to examine unconscious processes. They illustrated that one of Freud's substantive contributions was to extend folk psychology to unconscious mental states, a theory of unconscious mind, thus making those aspects of behavior meaningful that—using the ordinary constructs of intentionality—make little sense (e.g., dreams, neurotic symptoms, humor). These behaviors may be understood if we add unconscious beliefs, thoughts, feelings, and desires to our everyday model of the mind.

For research purposes, we have operationalized mentalization as reflective function (Fonagy et al. 1998): we have developed a tool by means of which the ability to give plausible interpretation of one's own and others' behavior in terms of underlying mental states can be measured. This implies awareness that experiences give rise to certain beliefs and emotions, that particular beliefs and desires tend to result in certain kinds of behavior, that there are transactional relationships between beliefs and emotions, and that particular developmental phases or relationships are associated with certain feelings and beliefs. We do not expect an individual to articulate this theoretically, but to demonstrate it in the way they interpret events within attachment relationships when asked to do so. Individuals differ in the extent to which they are able to go beyond observable phenomena to give an account of their own or others' actions in terms of beliefs, desires, plans, and so on. This cognitive capacity is an important determinant of individual differences in self-organization as it is intimately involved with many defining features of selfhood such as self-consciousness, autonomy, freedom, and responsibility (Bolton and Hill 1996; Cassam 1994). Intentional stance, in the broad sense considered here (i.e., including apparently irrational unconscious acts), creates the continuity of self-experience that is the underpinning of a coherent self-structure.

It is important not to conflate reflective function with introspection. Bolton and Hill (1996) note that the weakness of introspection is to define mental states in terms of consciousness or self-report rather than, as here, in terms of their capacity to make sense of, and thus regulate, behavior. Introspection or self-reflection is quite different from reflective function as the latter is an automatic procedure, unconsciously invoked in interpreting human action. We see introspection as an overlearned skill, which may be systematically misleading in a way that is much more difficult to detect and correct than mistakes in conscious attributions would be. The shape and coherence lent to self-organization by reflective function is entirely outside awareness, in contrast to introspection, which has a clear impact on experience of oneself. Knowledge of minds in general, rather than self-knowledge, is the defining feature; introspection is the application of the theory of mind to one's own mental states.

The Psychoanalytic Concept of Reflective Function

Various notions have been introduced in the psychoanalytic literature to denote mental processes that overlap with the construct of mentalization, underpinned by RF. Space does not permit an exhaustive review, but some of these should be mentioned, as they may assist the reader in making links between the current constructs and those proposed by other writers. Mentalization has been described in the psychoanalytic literature under various headings (see the excellent review by Lecours and Bouchard 1997). All such notions derive from Freud's initial concept of "Bindung" or linking. In his distinction between primary and secondary processes, Freud (1911b) stressed both that "Bindung" was a qualitative change from a physical (immediate) to a psychic associative quality of linking and that the psychic working out or representing of internal state of affairs (conceived of in energic terms) failed in various ways (Freud 1914c). Some might argue that Melanie Klein's notion of the depressive position (Klein 1945) is at least analogous to the notion of the acquisition of RF, which necessarily entails the recognition of hurt and suffering in the other as well as that of one's own role in the process. Wilfred Bion (1962a, 1962b), in describing the "alpha-function," delineated the transformation of internal events experienced as concrete ("beta-elements") into tolerable thinkable experiences. Similarly to the current conception, Bion also saw the mother-child relationship as at the root of the symbolic capacity. Winnicott (1962) also recognized the importance of the caregiver's psychological understanding of the infant for the emergence of the true self. Winnicott was also foremost among psychoanalytic theorists of self-development (e.g., Fairbairn 1952; Kohut 1977) in recognizing that the psychological self develops through the perception of oneself in another person's mind as thinking and feeling. Parents who cannot reflect with understanding on their children's inner experiences and respond accordingly deprive their children of a core psychological structure, which they need to build a viable sense of self.

Independently, French psychoanalysts developed a notion of mentalization that was largely formulated from the economic point of view. Pierre Marty discussed mentalization as a protective buffer in the preconscious system that prevents progressive disorganization (Marty 1968). He considers mentalization as connecting drive excitations and mental representations and thereby creating both "fluidity" and "constancy" (Marty 1990, 1991). Mentalization ensures freedom in the use of associations as well as permanence and stability. At the same time Pierre Luquet (1981, 1988) discussed the development of different forms of thinking and the reorganization of inner experience alongside this development. In his chapter on a theory of language (Luquet 1987), he distinguished primary mentalization {which we would consider the absence of RF) from secondary symbolic mentalization. While this form of mentalization was still seen as closely connected to sensory data and primary unconscious fantasies, it was nevertheless also seen as representative of these processes and observable in dreams, art, and play. His third level was verbal thought, which he considered most distant from bodily processes. Similar ideas were proposed by André Green (1975), Hanna Segal (1957), and Joyce McDougall (1978), and, more recently, by Auerbach (1993; Auerbach and Blatt 1996), Busch (1995), and Frosch (1995).

Theories Concerning the Development of Mentalization

Baron-Cohen and Swettenham appropriately ask: "how on earth can young children master such abstract concepts as belief (and false belief) with such ease, and roughly at the same time the world over" (1996, p. 158)? Their answer is that of modularity theorists, along the lines of Chomsky's solution to the problem of the acquisition of a knowledge of syntax. They postulate an innate (learning) mechanism with a specific location in the brain (see also Baron-Cohen 1995; Leslie 1994; G. Segal 1996). Other current psychological theories stress the cognitive precursors of theory of mind. Some favor the folk-psychology, theory-theory, approach, which assumes that the child evolves a scientific-theory-like network of interdependent propositions about the mind on the basis of experience (e.g., Botterill 1996; Gopnik 1996). Others assume that theory of mind is acquired via simulation of the mental state of the other, either through making inferences from what we ourselves would do in the imagined circumstances (e.g., Goldman 1993; P. L. Harris 1992) or an even more radical assumption of imagined transformation into the other which does not involve introspection or inference (Gordon 1992, 1995). These, and other theories, are considered in greater detail in chapter 5.

Both simulation and theory-theory models may at first glance appear to emphasize social-learning aspects of the development of mind-reading, but on closer scrutiny their focus is at the level of mechanism rather than content. They question how and when the child acquires knowledge of other minds in an abstract sense and do not ask what the child feels about the mental states he encounters in others. Yet, in this context at least, the question of knowledge and that of emotional investment are evidently closely related. The child may know what the other feels but care little or not at all about this; alternatively, this information may, for some youngsters, be an issue of survival. The emotional significance of mental states determines the evolution of the capacity or structure available for processing, but this is not usually addressed. Current models of theory-of-mind development tend to portray the child as an isolated processor of information, who constructs a theory of mind using biological mechanisms that have an expectable failure rate where the child's endowment is less than optimal.

From the viewpoint of developmental psychopathology and its psychosocial treatment, this is a barren picture, which ignores the central role of the child's emotional relationship with the parents in fostering the capacity to understand interactions in psychological terms. The development of children's understanding of mental states is embedded within the social world of the family, with its network of complex and often intensely emotionally charged relationships, which are, after all, much of what early reflection needs to comprehend. Therefore it should not surprise us that the nature of family interactions, the quality of parental control {Dunn, Brown, Slomkowski, Telsa, and Young-blade 1991), parental talk about emotions (Denham, Zoller, and Couchoud 1994), and the depth of parental discussion involving affect (Dunn, Brown, and Beardsall 1991) are all strongly associated with the acquisition of the intentional stance in observational studies. The involvement of the family in the child's acquisition of a theory of mind is further highlighted by the robust finding that the presence of older siblings in the family appears to improve the child's performance on a range of false-belief tasks (Jenkins and Astington 1996; Perner, Ruffman, and Leekam 1994; Ruffman, Perner, Naito, Parkin, and Clements 1998).

Modular accounts of theory-of-mind development have difficulty with such data. Neither the theory-theory nor the simulation account adequately covers the social origins of this critical aspect of self-organization. In the theory-theory account, mental concepts are thought to develop within a network of interdependent concepts on the basis of data from the social world, but the social world does not generally "give" concepts to the child; rather, it provides him with data for concept-building. In the simulation model, mental-state concepts are thought to arise from introspection, but this begs the question of how children come to think of their own mental states as feelings, beliefs, wishes, and so on. This chapter and the book as a whole explore the role of parent-child relationships in the transformation of prereflective experience of mental states into reflective understanding of them. Both social models of mind-reading may have their place here; the predominance of one or other route to understanding the mind may be a function of individual differences between children, but, in our view, a satisfactory model must be rooted in the child's relationships with attachme...