Tag Archives: development

Peter Fonagy on Metallization

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Peter Fonagy and his colleagues have introduced and elaborated the concept of metallization. Metallization includes the developmental capacity to reflect on one’s inner life and to imagine the inner life of another person. It is central to important other capacities such as the capacity of empathy and self control. The relationship between empathy and metallization is easy to understand in that you have to be able to imagine what another person is thinking and feeling in order to empathize with him. Self control, on the other hand, takes more explanation. As the child develops the capacity to reflect on what is going on inside of himself, he begins to be able to make sense of the motivations for his actions and also for the consequences of his actions on others. He sees a playmate cry when he pushes him or when he grabs a toy away from her. With the help of an adult caregiver, he realizes that his action caused distress to the other child. Then he starts to make a connection between his inner desire to have the toy or his anger at the other child and his action of pushing or grabbing. He also realizes that if he wants to play with the other child, he will have to control his impulse to push or to grab. All of this cognitive and emotional activity is scaffolded by the caregiving relationship and grows into a competency for self reflection and also for self control. Fonagy and his group call this competency metallization.

All individuals, including adults, lose their capacity for mentalizing when they are highly stressed. The individual’s ability to mentalize therefore depends both on the robustness and flexibility of their developmental competency and also on the stress in their lives.

Metallization distinguishes humans from other apes. Animals are very poor at recognizing whether an act of a conspecific is due to serendipity or is rooted in intention, wish, belief, or desire. The capacity to recognize these intention, wishes, desires, and beliefs of the other person is sometimes called “metallization”. It has been argued to account for the major difference between humans and other apes.” (Fonagy, 2014). (Peter says that dogs can mentalize humans but not other dogs. That could explain a lot!)

We all depend on one another to know ourselves. A working definition of mentalization is that of a form of imaginative mental activity, perceiving and interpreting human behavior. Mentalizing is the capacity to see ourselves from the outside and to see others from the inside. It has to do with seeing oneself as an agent, as an intentional being and also seeing others as intentional beings. The capacity to mentalize allows us to create a narrative continuity over time. Mentalization is an integrative framework.

The Development of Mentalization: The newborn has a social brain. She detects and prefers social agents, gazing longer at faces with open eyes and to direct versus averted gaze, showing greater activation of the anterior temporal cortex to voices versus non-voices, and differential activation of the orbitofrontal cortex and insula to happy versus sad voices. The newborn is prepared for mimicry by the mirror neuron systems in the prefrontal and parietal regions, and oxytocin and vasopressin mediate mutuality in the infant-caregiver relationship. In fact, administering oxytocin in the nose makes adults better at reading the expression of others’ intentions.

The Reward Circuits Are More Active in Secure Mothers: The oxytocin levels of mothers whose AAI’s (Adult Attachment Inventory) were read as secure before the birth of their child, went up when they interacted with their children. By contrast, in the case of mothers with “insecure” AAI’s, the oxytocin levels went down. Later on, the pituitary, the part of the brain that generates oxytocin, released more oxytocin in secure mothers. Also, the mesocorticolimbic areas were more active for secure mothers when looking at their babies smiling. All this suggests that the reward circuits are more active in secure moms. Fonagy suggests that this is because when the baby is crying, secure moms have an elevation of activity in the Ventral Striatum, whereas insecure moms do not. Rather, insecure moms have activation in insula (negative memories). Looking at their baby when he is sad makes her sad. You could argue that the absence of oxytocin in insecure moms gives them difficulty mirroring their awareness that it is the baby’s sadness and not theirs. That would make it harder for the baby to manage his sad affect.

Provisional Model for the Developmental Roots of Mentalization : The “secure” mother generates increased oxytocin when interacting with her baby, in association with a more mentalizing (marked-contingent) maternal response to the baby’s distress. The baby perceives the mother’s empathy, while at the same time appreciating that she herself is OK and available to comfort him. This improves the baby’s regulatory state. The evolving capacity of the baby to perceive his mother as having a different mental state from his own is consistent with the development of mentalization and the infant’s resilience. On the other hand, if the mother herself is insecure and generates a reduced level of oxytocin, she makes a “non-mentalizing response” to her infant, reacting not only with her own distress but with an escalating distress response that communicates helplessness. This is not comforting to the infant and may increase his sense of helplessness and fear. He is at risk of not developing the capacity to discriminate between what is in his mind and what is in his partner’s mind, which makes him more vulnerable.

Fonagy referred to a paper in which the maternal oxytocin response predicts mother-infant gaze: in the case of the antenatally secure mother with high oxytocin, the mother looks longer at her infant, especially in the recovery phase of the still face experiment, and there is more imitation of the infant’s intention (Kim, Fonay & Strathearn in press). This is interpreted as the mother’s capacity to tolerate the infant’s distress and is therefore emotionally available to the infant.

Numerous studies reveal the development of an important group of social capacities related to reciprocity, the sharing of mental states, self-awareness, and identification. Joint attention is usually achieved at 9-12 mos. This capacity involves the medial prefrontal cortex and posterior temporal sulcus and is incredibly important. In order for humans to have culture, a shared sense of where they are, they have to develop the idea that when they are looking at the same thing as others in their culture, they are thinking the same thing.

Studies suggest early emergence of the capacities for empathy and mentalizing. In the Baby and Smurf test, the baby’s capacity to put himself in the place of the smurf who has lost its ball is tested. The baby’s sensitivity to the smurf’s situation (the baby saw where the ball went but the smurf did not) is measured in terms of looking time. The baby at 7 months is capable of considering what the smurf believes about the status of the ball (AM Kovacs et al, Science 2011; 330:1830-1834). At 9 months, babies have a sense of fairness, as they demonstrate in an experiment in which of two giraffes one giraffe gets two toys and the other gets only one. Interestingly, it is relative deprivation, not absolute deprivation that predicts outcome. How well we are doing in relation to others around us has a profound influence on outcome.

The Romanian orphanage (orphanages in which the children were essentially deprived of a responsive caregiving relationship) studies show that the age beyond which the influences of deprivation cannot be repaired is between 6-18 mos. Children who were placed in these orphanages at birth and stayed for longer than 6-18 months demonstrated atypical development: signs of autism – reduced imitation, lessened response to name, lower social interest and social smiling, atypical eye contact. On the other hand, deprivation before 6 months (in cases in which the child was placed in a family at 6 months) has surprisingly little consequences.

Child’s Play


.Today I am writing about children’s creative play. I was inspired to do so by a unique construction hanging down the stairwell that leads to my office. It was placed there a couple of weeks ago, but I have left it there because I am so fond of it. It is – as a young observer called it – “a wad of tissue on a string”. It is actually facial tissue tied with colored yarn, but he is mostly right. This construction was created by another child, and for her I think it had the meaning of exploring my spaces, taking me over aggressively but also lovingly, as she dangled it over the top of the banister and let it sink slowly down three floors to rest on the carpet of the cellar level. In the small area at the bottom of the stairs, she then imagined having an “office” of her own, claiming the wooden ledge as her “desk”. Then to clearly establish her hegemony, she carefully wrote a sign: “Please do not take this down. Thank you.” Asking me how to spell my name, she finished off her notice with the name, “Alex Harrison”.

The magic of this construction is not in its ingredients – tissue, colored yarn, maybe a little tape – but in the imagination that turned these humble household objects into a powerful narrative. These objects cannot compare with the complicated electronics that my little patients are usually so fond of. Even the other toys in my office – dolls, blocks, vehicles, etc. – do not have quite the potential of these objects. Other children agree. All of them have noticed the tangle of colored yarn and wondered what was at the bottom, marveled at the mysterious meaning of the object and its relationship to me.

The boy who referred to it as “a wad of tissue” is very adept at games on computers and i-phones, even at his young age. In spite of this, he spent a whole session with me raising up the “wad” on its yarn pulley, untangling the tangles and considering the effect of the tangles on its smooth sailing, lowering it again, discussing with me the trajectories of each lowering and wondering what was influencing it to move further to one side or the other. Considering the difficulties this child has disentangling himself from his mother and negotiating transitions and the “ups and downs” of life, I thought he and I were doing just what we needed to be doing to make him stronger.

As he and I huddled together in our explorations, I was aware of feeling happy and engaged in my work. The feeling is a kind of playfulness, a letting go of the constraints of reality and entering – with a companion – into a magical world of rainbows (colored yarn), wads of tissue (gift wrapped presents), castles in the air (three level staircase), and forbidding dungeons (the cellar at the bottom of the stairs). Of course, the real “work” lies in facing the monsters in the dungeon together (the child’s fears and problem behavior), but in order to conquer those monsters you have to find them, and you find them by creating this magic world with a trusty traveling companion.

The world of rainbows and dungeons is obviously not exclusive to child psychotherapy. That is the magic of it – it is the possession of every child. But it has to be exercised, practiced, and that means putting away the computer, the i-phone, and the television, for long enough to enter this other space stay awhile.

The little boys in the photograph of this posting are finding this play space in the dirt of the playground. The children at the preschool found it in the pirate play and in the hunt for bears. The girl in my practice found it in her creation of the “office” at the foot of my stairs and the magic wad on pulleys that led to it. When the child is developing the capacity to create this world of pretend he/she is simultaneously building an internal capacity for flexibility, for impulse control, for empathy. That is what the pediatricians and scientists tell us from their observations and experiments (Baron-Cohen, Fonagy, Slade, Winnicott, to name a few). It is also what I know from my experience.

Sometimes it is hard to explain that to parents who understandably want a “solution” to a problem behavior – a method for shaping behavior, a behavioral strategy. Of course, I understand this. But behavioral strategies that address a discrete behavior do not always generalize; they cannot grow the brain in the elemental and natural way that pretend play can do. Now, I am in favor of anything that works, so I do support good behavioral therapies. Yet, I am always aiming in my work with children for opportunities to scaffold the growth of the important developmental capacity for imaginative play, and I am always delighted when I can awaken the child in myself to join my young patients in creating a “pretend” solution of their own.


Baron-Cohen S (1994). Mindblindness: An essay on autism and theories of mind. Cambridge, MA: MIT Press.

Fonagy P, Gergely G, Jurist EL, Target M (2002). Affect Regulation, Mentalization, and the Development of Self. New York: Other Press.

Slade A (1994). Making meaning and making believe: Their role in the clinical process, in Children at Play, Edited by Slade A, Wolff DP, New York: Oxford University Press, pp. 81-107.

Winnicott DW (1971). Playing and Reality, London: Routledge.


Photograph by Ginger Gregory