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Handbook of Mentalizing in Mental Health Practice

edited by Anthony W. Bateman, , M.A., F.R.C.Psych. and Peter Fonagy , Ph.D., F.B.A. Washington, DC, American Psychiatric Publishing, 2011, 617 pp., $69.00 (paper).

Reviewed by Lois W. Choi-Kain, M.D.
Am J Psychiatry 2012;169:336-336. doi:10.1176/appi.ajp.2011.11101525
View Author and Article Information

Belmont, Mass.

The author reports no financial relationships with commercial interests.

Book review accepted for publication October 2011.

Accepted October , 2011.

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In the last decade, there has been a decline in the usage of psychotherapeutic treatments by patients as well as in the training and practice of psychiatrists. As psychopharmacological interventions have come to dominate the field of mental health, the variety of psychotherapeutic approaches have proliferated and become increasingly disorder-specific. Consequently, the field of psychotherapy has become a veritable Tower of Babel, leading mental health practitioners to navigate a complex assortment of psychotherapeutic modalities, each with its own theoretical foundations and set of terms, techniques, and applications.

It is in this context that the Handbook of Mentalizing in Mental Health Practice provides mental health practitioners with a refreshingly broad, basic approach to psychotherapy, founded on up-to-date developmental psychology and neuroscientific research, applicable to a diverse number of disorders and clinical settings. While mentalization-based treatment was first introduced and empirically validated as a treatment for adults with borderline personality disorder, the use of mentalizing psychotherapies has extended to a wider range of patient groups (i.e., mother-infant dyads, families, children) and diagnoses (i.e., antisocial personality, eating, substance use, and mood disorders). Bateman, Fonagy, and their closest collaborators (many of whom are authors of chapters in this text) have identified mentalizing—defined as a distinctly human activity of reflecting on mental states in ourselves and in others, existing behind and apart from observable behaviors—as a common foundational mechanism driving all psychotherapies. From this point of view—that mentalizing is a generic, nonspecific basis of psychotherapy in general—Bateman and Fonagy have advanced an approach to treatment that is simple, user friendly, and collaborative instead of competitive with existing schools of psychotherapeutic thought.

This new textbook of mentalizing therapies provides a coherent, scientifically sophisticated, and clinically practical guide to navigating the broad conceptual, empirical, and clinical territory the editors claim that mentalizing covers. The book is divided into two main sections. In the first section, the authors outline the scientific and conceptual bases of mentalization-based treatment and the basic clinical approach involved in mentalizing therapies, as well as a number of modifications of techniques for different psychotherapeutic settings (e.g., group therapy, family therapy, child therapy, brief treatment, partial hospital, outpatient). The second section is devoted to describing specific applications of mentalizing therapies for treatment of different psychiatric presentations, such as borderline and antisocial personality disorder, eating disorders, trauma-related disorders, depression, and drug addiction. Each chapter explicates these different aspects and applications of mentalizing, with presentation of supporting scientific data as well as practical clinical techniques. The separate chapters in the book are coherent on their own but, altogether, are integrated and not repetitive. The book is designed in a way that allows mental health practitioners to start by reading a few chapters and enrich their perspectives on the approach as they read further.

This book is an important advance from the previous books by Bateman and Fonagy, as they have assiduously reviewed and integrated new research, and even criticisms, into their approach to revise earlier descriptions of the theory and technique of mentalizing treatments. Impressively, their conceptual model, informed by a growing empirical literature, is more nuanced and complex than that of previous manuals, and yet their technical description of the treatment is more simple and clear. Without a doubt, this is their most clear and comprehensive book to date on mentalizing. It is written for a wide audience, ranging from mental health clinicians in general practice to researchers seeking a comprehensive, integrated translation of attachment, developmental, social cognitive, and neuroscientific research relevant to clinical practice. The Handbook of Mentalizing in Mental Health Practice is an excellent guide to a modern psychotherapeutic approach bridging the gaps in the psychotherapeutic world, both among different treatment approaches and between psychiatric science and practice.

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