Fam. Treatment of eating disorders with mentalization

EL eating disorders they represent one of the most complex pathologies in the field of mental disorders. Several researchers have highlighted the difficulties of self-regulation in this type of disorder, which is manifested in patients as a deficit in the identification and description of their emotions; impaired ability to mentalize the emotional experiences of others; attention problems and deficit of the executive function.

Announcements By building a bridge between psychodynamics, cognitive-behavioral, and systemic and narrative traditions, mentalization-based guidance helps the clinician develop an intervention protocol to address the multiple factors underlying eating disorderoffering a person-centered treatment based on the therapeutic relationship, to be able to establish contact with even the seemingly most unattainable and difficult patient.

The book presented can be defined as a manual, as it illustrates a model of treatment of eating disorders, based on a theoretical and historical introduction. However, it does not include detailed descriptions of session-by-session techniques and strategies, because the primary goal of this treatment is to create a stable and secure therapeutic relationship; Therefore, they will go into detail, specifically, “the art of meeting“, Because “only a patient who feels safe finds the courage to change“(Page 29).

The authors begin by defining eating disorders as “severe forms of impaired ability to mentalize one’s own and others’ emotional experiences“(Page 8). What is meant by mentalization? It is a form of emotional knowledge and consists of the normal ability to attribute intentions and meanings to human behavior and to reflect on one’s own mind and that of others. acting impulsively, driven by strong emotions, we can use the mind to assess the situation and act more adaptively and constructively. building meaningful relationships.

According to the authors of this treatise, the psychopathological core of eating disorders consists of a “poor sense of self“(Page 19); these are patients who are unaware of their own inner experiences and cannot trust their thoughts, feelings and bodily sensations, thus experiencing enormous inner anguish. In this type of patient there is There are several aspects of mental functioning that have abnormalities, including difficulty expressing and recognizing emotions, mental deficits, and distorted thinking, which can have negative consequences for problem-solving ability, interpersonal management, and interpersonal relationships. in involvement in therapy.Using the language of mentalization it can be said, then, that these disorders are the result of deficits in self-regulation and affective regulation.

The volume describes the treatment based on mentalization applied to eating disorders (Mentalization Based Therapy for Eating Disorders; MBT-ED), which emphasizes the therapeutic encounter, creating the conditions for the patient to feel safe enough; in this model, therapy is therefore a bond of affection, and its aim is to help the patient feel less lonely and to accompany him in the co-construction of new narratives about himself and others. From what has been written, it is clear that the mentalization model undoubtedly has its roots in the psychodynamic tradition, but it also focuses on cognitive and emotional processes, thus establishing a bridge between the psychoanalytic and the cognitive tradition.

Establishing a successful therapeutic alliance is a great challenge to work with these patients, many of whom are discontinuing therapy or have a very unstable motivation for treatment. Despite the attention of many treatments for ai eating disorders has focused on this topic, studies continue to show a high dropout rate; Mentalization-based treatment, then, focuses on creating a healthy therapeutic alliance and therefore pays close attention to the skills that the therapist must develop. But what are the skills and competencies of the MBT therapist? They consist, first of all, in the ability to adopt an inquiring attitude and a position of “not knowing”, which communicates to the patient a sincere and genuine interest, then in the ability to communicate with the patient in a direct way. , authentic and transparent and finally in the ability to accompany the patient in mentalization, helping him to explore their mental states. No less important are the ability to establish a relationship based on support and empathy and to adopt a positive and encouraging attitude, stimulating change in the patient. The abilities to clarify, explore, and refute internal emotional states are also critical to supporting the patient in the process of recognizing, accepting, and changing experiences and thoughts related to them.

The second part of the volume describes the structure of the MBT-ED treatment, which is constructed with the explicit intention of stimulating mentalization on the one hand and, on the other, of reducing dietary symptoms (therapy “double track“, P. 134). Long-term treatment should be considered, involving a combination of psychoeducational group work, individual therapy, group therapy, active use of written case formulations, crisis plans, and periodic budgets.

Announcements Psychoeducational group work is the initial work of “preparation for treatment.” The goal at this stage is to prepare patients and increase their motivation. These sessions will explore the issues inherent in the concept of mentalization and eating disorder. Group therapy, which for many patients is considered the most complex part of treatment, is an essential environment in which to practice mentalization. Therapists have the role of actively promoting interactions, controlling activations and non-functional modalities, always encouraging patients to “consider the mind of the other“(Page 202). Undoubtedly, individual therapy plays an important role, a space within which the patient can contribute to the issues that arise in the groups, discuss and rework them. The formulation of the case is a story that helps to give coherence to the history of the disorder, linking the present with the future, while the action / crisis plan is a document that suggests how to manage strong physical and emotional activations. clarify the objectives of the treatment and the care route, elaborating in collaboration with the patient.

Working with families is also crucial, as patients are likely to have learned unmentalized pathways within the family unit, and therefore represent the ideal context for empowering them. Mentalization-based family therapy (MBT-F) uses practices derived from different systemic traditions and more purely psychodynamic practices. The aim of the treatment is to transform vicious circles into constructive circles for family interactions, encouraging parental mentalization, also working hard on the couple (it is therefore a combination therapy).

As has been said several times, work in the field of eating disorders it puts pressure on the therapist’s ability to metallize, which can come into contact with intense emotions (fear, anger, frustration, helplessness), which is why constant supervision is essential. The quality of the treatment is linked not only to the therapist’s ability to apply MBT to the sessions, but also to the effectiveness of the teamwork between the different team members involved. The essential function of supervision is to encourage therapists and the team to reflect on patients, clinical practice, and teamwork.

Having outlined the contents of the manual, I would like to conclude this article with some considerations. According to the model of intervention described in this book, it is certainly important to pay symptomatic attention to the mechanisms that maintain the eating disorderbut it is equally important for the person to learn to “to get to know each other better, experience and enhance their skills“(Page 275) The social sphere is, in fact, terribly compromised in most people who suffer from these problems, so we can witness serious situations of isolation and loneliness. These situations can continue until All after the remission of the disorder, it is therefore essential to intervene in this aspect of interpersonal skills and abilities.The authors of the volume argue that mentalization is the core of any psychological intervention, in the book in which they focused eating disorders, highlighting how the treatment of these life-threatening conditions has been hampered by a number of factors, such as fear of criticism of health systems or concerns for patient safety. These influences have led professionals to narrow their perspective, focusing exclusively on the somatic sphere and focusing interventions on body and weight. Instead, the authors aim to train professionals in a dual approach, which takes into account not only the physical consequences of eating disorders, but also the psychological processes and emotional states that accompany them. The authors argue that “the model of mentalization can fully respond to this need, because it is essentially non-Cartesian and recognizes the integration between mind and body.“(Page 257).

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  • Robinson, P., Skårderud, F. and Sommerfeldt, B. (2022). Hunger – treat eating disorders with mentalization. Editorial Astrolabio.
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