Mentalizing and ADHD

24/09/2019

Mentalizing and ADHD

As a psychological process, mentalizing describes first an everyday competence "to understand the actions of others and their own in terms of thoughts, feelings, desires and yearnings" (Schultz-Venrath and Felsberger 2016). This competence is acquired in the course of intellectual development and depends on the quality of the interaction with the social environment and caregivers.

Adults can also access previous mentalizing experiences in particularly stressful situations. In the equivalent mode, the inner, psychic experience is equated with the external reality, and unpleasant feelings, nightmares, negative beliefs are deemed to be real facts. In the as-if mode, the reality check (as in childish play behavior or in virtual reality) is suspended and the inner world is experienced as the only real one. In teleological mode, people seek to control the environment through their own, impulsive actions and thus to dissolve the inner tension.

The ability to mentalize is related to resilience. A strong mentalizing competence allows a better adaptation to adverse social circumstances and interpersonal stress. This competence requires "epistemic trust", that is to say, a willingness to be open to others that are deemed to be "safe" (Fonagy, Luyten, Allison, Campbell 2017).

Mentalizing as a psycho-therapeutic technique calls for an active yet neutral therapist, committed, curious and interested, friendly and ready - in special therapeutic situations - for self-disclosure. In this context, a specific technique can be described as "stop-and-rewind": the otherwise unstoppable thought and emotional flow of the patient is politely interrupted, the report "rewound", and then retraced together at a slower pace.

Persons with ADHD problems often show an impairment to their mentalizing ability. In dealing with themselves and others, they tend to refrain from intellectualizing and may exhibit less confidence in insights gained through mentalization (Perroud et al 2017).

In my experience, individuals with ADHD problems often report dysfunctional interactions with primary caregivers (parents, siblings). The latter react inadequately, partly out of ignorance, partly out of their own ADHD concern, to the special needs of the child. This interaction influences the inner relationship landscape of the child into adulthood.

A mentalizing-based therapy (MBT) can help to connect earlier relationship experiences (in there-and-then) with current (in there-and-now) ones, subjecting the latter during the therapeutic situation (in the here-and-now) to reconstruction to give them a new meaning. However, mentalizing also means recognizing and temporarily accepting the limitations of the latter compared to impulsive negotiation (in here-and-then).