GHP News Mental healthcare & Compassion excellence awards

Is Mentalization Colorblind? A Qualitative Study of Race in Mentalization Based Therapy 

Borderline Personality Disorder presents differently in Black, Indian, People of Color (BIPOC) patients than it does in White patients (Newhill, Eack, & Conner, 2009, McGilloway, Hall, Lee, & Bhui, 2010, De Genna & Feske, 2013, Gaztambide, 2019). The literature also indicates that BIPOC patients generally are more likely to have negative views of counseling usefulness and outcomes, and an increased challenge in creating a trusting therapeutic rapport if treated by a White therapist (Constantine, 2007). Patients with BPD are particularly challenging for clinicians, as their personality organizations create inherent mistrust in attachment figures, such as family members, romantic partners, and even therapists (Fonagy & Allison, 2014, Choi-Kain, Finch, Masland, Jenkins, & Unruh, 2017). At present, there is no qualitative study that explores how Race can impact the conceptualization and subsequent treatment of this population in Mentalization Based Therapy. This lack of exploration into how MBT therapists integrate the history of racial identity development, including racial/cultural trauma and mistrust into the development of epistemic trust and therapeutic outcomes (Constantine, 2007) leaves a significant gap in the literature. My research aims to 1.) Provide thick descriptions of the training Mentalization Based Therapists receive in the integration of Race into the treatment of BIPOC with BPD, 2.) Understand the clinical experiences of MBT Clinicians and their BIPOC patients, and 3.) Provide a critique of MBT’s lack of inclusion of Race in terms that are useful for the consideration of MBT Clinicians in the development of Epistemic Trust with BIPOC patients with BPD. 

Dissertation Chair: Carter James Carter, PhD

Second Reader: Elliot Jurist, PhD, PhD

Sex Positive Education - Who is it for and why is it important?

 The Sex Positive Educational approach seeks to engage young adults by meeting them where they are, providing a more inclusive and non-judgmental environment, and supporting buy-in of sexual education. This educational approach goes beyond sex as an act solely for reproduction or pleasure. Sex Positive Education includes learning about sexual anatomy, various forms of protection, healthy relationships, enthusiastic consent, the ability to say no, and understanding one’s own sexual identity. Through this approach, we work to de-stigmatize STIs, challenge social-sexual constructs, and dismantle toxic gender stereotypes and rape culture. Sex Positive Education also prioritizes inclusion which is of critical importance for marginalized communities. Sex Education is typically heteronormative and taught through a “straight” lens. Providing a safe and informative space through Sex POSITIVE Education, for those who identify as LGBTQIA+ leads to increased self-acceptance, understanding of healthy sexual relationships, and reduces intimate partner violence and exploitation. 

Psychoanalysis and Supervision

Progressive Psychoanalysis concerns itself with: 

1.) Trauma, and the influence of trauma on Attachment and development of Epistemic Trust in all relationships (including relationships with providers and institutions)

2.) Structural oppression: Racism, Sexism, Poverty, Marginalization, Colonialism, Violence (psychological, sexual, physical, verbal/visual)

3.) Hidden Bias for practitioners (Intersectionality, Position, and Countertransference) 

4.) Power and power structures within relationships (client/others, client/provider, provider/supervisor)

Psychoanalytically-Informed Supervision Includes:

1.) Recognition of Structural Enactments (Morey, 2019)

2.) Intersectionality & Position

3.) The Working Alliance (between patient/therapist and therapist/supervisor)

4.) The "Not-Knowing Stance"

5.) Transference and Countertransference (between patient/therapist and therapist/supervisor)

The quality of our relationships is a great barometer for the success and satisfaction we experience in our lives. For so many of our patients, healthy relationships are nearly impossible to achieve and maintain. This coincides with poor self-image, disrupted identity development, and self-sabotaging behaviors. Attachment to our parents is our first experience of relational connection. When this process is interrupted or hindered, our insecure attachments inform the relationships we make for the duration of our lives. Through our exploration of the effect insecure attachment has on the development of Borderline Personality Disorder (BPD) and other characterological dysfunction, we recognize the importance of repairing these early relationships to provide the scaffolding for self-healing and personal success.

To mend these relational fractures and support growth in individual therapy, we look to family therapy to act as the vehicle that facilitates healing. By utilizing a Mentalization-Based approach to work within the family system, we are able to assess overall family functioning and subsequently provide reparative relational experiences that support progress and growth in individual therapy. Mentalization-Based Therapy (MBT) is a psychodynamically-oriented modality designed to treat individuals with Borderline Personality disorder (BPD). The process of Mentalizing is an exercise in observing the mental states associated with behaviors and emotions, both in ourselves and in others. A comparative examination of a patient’s inner experience alongside the perspective of the therapist provides an arena wherein the patient may cultivate insight into unhealthy interpersonal interactions through assessment, coaching, and role-play. In family therapy, MBT provides the opportunity to examine patterns of communication and behavior to identify relational deficits and intervene in support of both the family system and the individual patient’s experience. Our patients learn, in vivo, how to operate as a healthier system. 

The healing power of secure attachment can be seen in our patients’ ability to build ego strength, weather adversity, and reduce self-sabotage. The ability to successfully Mentalize becomes evident in our patients’ ability to cultivate and maintain healthy, meaningful relationships with both self and other. As our patients gain personal stasis and relational stability, they are able to achieve their global treatment goals and function interpersonally in healthier ways.