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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by alexandra_k on October 14, 2006, at 2:38:31
i found this:
http://www3.interscience.wiley.com/cgi-bin/jissue/112466906
(i'm really sorry but i couldn't find free access so unfortunately you need individual / institutional subscription to access)
Journal of Clinical Psychology, Special Issue: Putative Mechanisms of Action in the Psychotherapy Treatment of Borderline Personality Disorder.
They go through some different theoretical orientations to treatment including: mentalization based, interpersonal, schema, dialectical behaviour therapy, transference based, and cognitive.
Posted by Jost on October 14, 2006, at 11:17:37
In reply to bpd, posted by alexandra_k on October 14, 2006, at 2:38:31
Yeah, my institution doesn't get that Journal--I've come across interesting articles before, and they don't subscribe. Frustrating.
Is there some reason a major US library wouldn't subscribe? Do you think the article is really good? I can get things through interlibrary loan, but I don't like to ask unless it's really worthwhile, cause it's expensive for the University.
Hmmm. I can ask why they don't get it== but I'm just a faculty SigO, so they might wonder. Maybe I can get the Officerr in Question to ask.
Jost
Posted by alexandra_k on October 15, 2006, at 5:31:20
In reply to Re: bpd, posted by Jost on October 14, 2006, at 11:17:37
> Yeah, my institution doesn't get that Journal--I've come across interesting articles before, and they don't subscribe. Frustrating.
Bugger. Yeah, I don't have online access the psychoanalytic journals and can't be bothered putting in for interloans...
> Is there some reason a major US library wouldn't subscribe?
No earthly idea about that one...
I couldn't access the Australian and New Zealand Journal of Psychiatry for ages and I was really stumped with that...
I search for articles / journal access via Google. Usually there are multiple links via google to the journal by way of different databases. You want to try and find access by way of a database that your uni subscribes to. The link I posted gets full text of the journal by way of Wiley Interscience. If your institution doesn't subscribe to the Wiley Interscience database then you won't be able to access the journal by way of that link. What I've found though is that often there are a few different database providers that give you full text access for the same journal. I couldn't get to the ANZJP via one database because we didn't subscribe to that one, but I managed to find access via another database. Sometimes it just takes a bit of searching via Google.
(Or alternatively I guess you can figure the same info from the library catalogue... Sorry, my search techniques probably aren't the most efficient because I like to look for lecture notes and summaries and the like as well as academic articles...)
Here is the abstract. I can always email you the PDF if you want to Babblemail me your email address...
AbstractThere are very few less contentious issues than the role of attachment in psychotherapy. Concepts such as the therapeutic alliance speak directly to the importance of activating the attachment system, normally in relation to the therapist in individual therapy and in relation to other family members in family-based intervention, if therapeutic progress is to be made. In group therapy the attachment process may be activated by group membership. The past decade of neuroscientific research has helped us to understand some key processes that attachment entails at brain level. The article outlines this progress and links it to recent findings on the relationship between the neural systems underpinning attachment and other processes such as making of social judgments, theory of mind, and access to long-term memory. These findings allow intriguing speculations, which are currently undergoing empirical tests on the neural basis of individual differences in attachment as well as the nature of psychological disturbances associated with profound disturbances of the attachment system. In this article, we explore the crucial paradoxical brain state created by psychotherapy with powerful clinical implications for the maximization of therapeutic benefit from the talking cure. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 411-430, 2006.
The abstract isn't the best... But they cover a lot of neuroscientific ground and also...
I've never heard of BPD as a theory of mind disorder before...
Though I have studied theory of mind deficit in autistic spectrum disorders...
I had no idea it was thought to be relevant here...The special edition of the journal is about the underlying mechanisms that are hypothesised to be crucial to the success of different kinds of psychotherapy for BPD.
Different theories have slightly different names... Basically... They seemed to be fairly consistent in what they were saying, however.
Linehans 'observe, describe, participate' (mindfulness stuff)
Is very similar to their notion of teaching mentalization while the attachment system is active.I guess I was just blown away that theory of mind was relevant here...
And that mindfulness stuff is related...I know this is just some anecdotal evidence but...
Jeepers...
I was doing DBT mindfulness stuff during the semester I studied philosophy of mind. I remembered reading about what mental states are supposed to be (which *is* a puzzling problem). But some of the things that were said that were supposed to be *obvious* surprised me rather.Eventually... We settled on analytic functionalism as the best theory of mind out there (there are lots of varieties of functionalism, though, so really the problems just *begin* once one accepts functionalism...) But I remember reading what are considered to be 'common sense platitudes' like 'if someone says they want to get married and yet they do not despite excellent opportunity then we are left having to conclude that they never really did want to get married'. And I remembered finding... The relationship between stimuli and mental state, and mental state to other mental states, and mental states to behaviour... To be very profound indeed.
To label mental states on the basis of likely causes and likely effects. So when asked 'how do you feel' I'd observe what I was thinking about and what I *felt* like doing.
Before that... I tried to label my emotions on the basis of introspection. Trouble with that is that introspection isn't enough for me to distinguish in much more detail than 'ok / good' or 'bad'. For the rest... I needed to understand the role of context.
And then in DBT... They were trying to teach us the same thing... But the philosophy... Sh*t... It was amazing.
That is supposed to be... The ability to mentalize...
And current thinking is... That is what is crucial. To better mentalize when the attachment system is active.
Posted by alexandra_k on October 15, 2006, at 6:08:05
In reply to Re: bpd, posted by alexandra_k on October 15, 2006, at 5:31:20
Theory of Mind.
The notion is that sometime between ages 3 and 4 people normally acquire the concept of belief. Having the concept of belief is different from having beliefs, it is the ability to have meta-beliefs, or beliefs about beliefs.
In order to understand what it is to have a belief one needs to know that false beliefs are possible.
There is a task... That is supposed to show whether someone has the concept of belief or not. The task involves something along the lines of this (it is typically catered for children)... If you show someone a tube with 'smarties' (a brand of sweets) and you ask them 'what do you think is in the tube?' they will say 'sweets'. Then you open the tube and show them that it actually contains a pencil. Then you put the pencil back in the tube and close it and you ask them 'if I show the tube to your mother (or whoever) and ask them what is in the tube what do you think they will say?'
People who have the concept of belief (and understand that people can have false beliefs) appreciate that their mother (or whoever) will say 'sweets'. People who don't have the concept of belief will say 'a pencil'. Having a theory of mind is sometimes called having the ability to mind read. Not in a spooky way... It is more that it is such a phenomenal acomplishment that we have the ability to do this and it is... A kind of mind reading ability.
The ability to pass the false belief task normally develops between ages 3 and 4. We consider that when people can pass the false belief task they have acquired a 'theory of mind'. They understand about mental states. Of course that is a very basic task... What is interesting about the task, however, is that people with autistic spectrum disorders typically can't pass the task even though they have age appropriate causal understanding. People with downs syndrome typically have age appropriate performance on the task but significant difficulty with tasks that involve causal understanding. That shows that the ability to pass the false belief task isn't merely to do with general intelligence.
There is a higher order belief task too (which tests the ability to attribute say x believes that y believes that... appropriately) But anyways...
There is controversy as to whether having a theory of mind involves literally having a theory (understanding of propositions) or whether having a theory of mind is having an ability (such as the ability to put oneself into anothers shoes via simulation / empathy).
Theory of mind isn't just to do with beliefs, however. It is to do with other mental states like desires and emotions too. It is about being able to attribute them appropriately to others and being able to attribute them appropriately to oneself. It has been found that those two abilities tend to be correlated. People who have trouble attributing appropriate mental states to others (in order to understand and explain the behaviour of others) also tend to have trouble attributing appropriate mental states to themselves (in order to understand and explain their own behaviour).
There are many different philosophical theories of the nature of mental states... One that has gained a lot of currency is analytic functionalism. According to analytic functionalism the meaning of a mental state term is fixed by the role the term plays in the 'folk conception' of mind. Which is to say the meaning of a mental state term is fixed by the role that mental state terms play in our efforts to understand and explain behaviour.
So...
Anger is whatever inner state of a person that...
Tends to be caused by:
-perception of injustice etc etc.
Tends to cause:
-increased heart rate
-clenched jaw etc etc.
Tends to cause action urges such as:
-desire to hurt etc etc.So... If you are asked how you feel instead of focusing on the inner phenomenology / feeling... One can observe what one is thinking about. If one is thinking 'how unfair is that!' and one has an urge to punch someone, for example, then 'anger' is the term that has been assigned to that state in the English language. Thus emotions... Aren't solely defined on the basis of how they feel.
:-O
Amazing...
But sometimes... The ability to observe goes out the window...
I learned... That you don't need to *feel* anything in order to have an emotion... You just need to be able to *observe* those other things...
But sometimes... The ability to observe goes out the window...
(Usually because observing prompts feelings of guilt or something or because one is in such heightened physiological arousal that one can't think. So mentalization therapy / mindfulness is supposed to teach you to be able to mentalize appropriately (in order to attribute likely / appropriate mental states to oneself and others) in the face of heightened physiological arousal).
:-)
Posted by alexandra_k on October 15, 2006, at 6:35:37
In reply to Re: mentalization and BPD, posted by alexandra_k on October 15, 2006, at 6:08:05
and...
thus the ability to mentalize (which, i guess, is a more sophisticated ability than the false belief task lol) is supposed to naturally emerge in the normal course of development.
but of course, sometimes it doesn't.
partly... it is probably about modelling. our parents teach us to mentalize by telling us what they are doing and why and why they did whatever they did. and they help us explain what we are doing and why and so on. but sometimes parents don't do a particularly good job of that... my mother wasn't good at mentalizing. i did things because i was evil etc. so i learned to explain my own behaviour by appealing to my inner state of evil and so forth. and sometimes certain things aren't discussed... certain traumas and stuff like that... and so we don't know how to / can't mentalize them either. like the motivations of abusers and the like... like our motivations when we do things that we are repeatedly told are 'bad' and things like that.
and if you can't mentalize... then you can't explain and you can't express... and so i guess projective identification is a way of getting people to understand because you can't mentalize / explain it. you don't know how to convey what is going on...
i remember studying 'language and communication' (a course in philosophy of language). we learned about how one of the main functions of language in sophisticated societies such as ours is to INFORM. not to CONVINCE but to INFORM. jeepers... that surprised me too... i thought language was about... trying to convince people that you didn't need to be punished and things like that...
:-(
so... mentalization apparantly.
instead of projective identification
:-(
which is considered 'manipulative' i guess...
:-(
(sorry, probably more than you needed or wanted to know lol)
This is the end of the thread.
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