Ensink, K., Maheux, J., Normandin, L., Sabourin, S., … & Parent, K. (2013). The impact of mentalization training on the reflective function of novice therapists: A randomized controlled trial, Psychotherapy Research, 23, 526-538, DOI: 10.1080/10503307.2013.800950
Recently, researchers and clinicians have been discussing the importance of therapists’ capacity to mentalize. That is, the capacity of therapists to be aware of mental states within themselves and clients, to identify and reflect upon emotional experiences of clients, and to understand the impact of client emotions and life experiences on the therapist’s capacity to be present, empathic, and effective. Most training programs in psychology and psychiatry focus almost exclusively on techniques – the rational application of psychological theory to diagnose and treat. These programs rarely, if ever, focus on training student therapists to mentalize. And yet, much of effective therapy also involves active listening, empathic understanding, developing a therapeutic bond, and consciously and deliberately imagining clients’ mental states. Without such skills, therapists may be susceptible to engage in anti-therapeutic acts (acting out, disengaging, verbalizing anger and frustration, feeling ineffective, burning out) born out of un-reflected personal reactions to clients and their experiences. In their study, Ensink and colleagues tested a training program designed to improve the capacity to mentalize in student therapists compared to therapists who only received traditional training in identifying psychopathology and applying therapeutic techniques. Mentalizing training involved 30 hours of experiential workshops that provided feedback to students on identifying their own reactions that might interfere with understanding the client, reflecting on their reactions, and considering how this reflection might help to understand the patient better. Capacity to mentalize was assessed by rating responses and reactions of student therapists in both conditions (mentalizing training vs traditional didactic training) to videos of clients in therapy. All novice therapists (in both training conditions) started at relatively low levels of reflectivity (an index of mentalizing), suggesting that students did not start the training program with these skills. Trainees in the mentalizing training group showed significant improvement in their capacity to mentalize, whereas students in the traditional didactic training showed a significant decline in their reflective capacity to mentalize.
Psychotherapists do not start their training with high capacities to mentalize and so they may require training to hone this skill. Also, therapists who receive no such training do not spontaneously acquire these skills. Clients often have experiences that are perceived as foreign to trainee therapists, and so therapists may feel ill equipped to empathize, understand, and respond emotionally to such challenging client experiences. Therapists can be trained to identify their internal experiences (negative or positive emotional reactions that may be related to the client’s and/or therapist’s unresolved issues) that may interfere with establishing a productive therapeutic relationship. Increasing the capacity to mentalize may reduce therapists work-related stress as it affords therapists a greater measure of control and mastery over challenging encounters with some clients.