Tag Archives: empathy

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.

Friendship: Antidote to Bullying


In this posting, I will discuss the most substantial long-term solution to bullying. The best way to combat bullying is to support the capacity for friendship and children’s development of empathy. Empathy is a function of “theory of mind”, that is, the ability of the child to imagine the thoughts and feelings of another person and to realize that other people have minds of their own.

For example, the 5-yo boy (let’s call him “Sam”) described above was having trouble imagining the mind of his classmate (“Ben”). I discovered that earlier that day in playground time Sam had been involved in a running game with Ben and some other boys. Ben, who is a fast runner, was leading the pack. Sam has some motor insecurity that has held him back, and he has not developed the strength and skill to keep up with the other boys in running games. I am guessing that he was feeling like a “loser”, and his way of making sense of those “loser” feelings was to perceive Ben as being the cause of his “loser-ness” by claiming to be older than Sam was. Ben actually hadn’t said anything of the sort, but Sam’s feelings were so strong and unmanageable that he completely lost his 5-yo capacity for self-reflection (“mentalization”). He did not link his very sad and angry feelings to having been left in the dust in the running game of minutes before. He really perceived Ben as trying to best him by claiming to be older and thereby causing him to feel bad.

Empathy is a complex competency that begins in the early infant-caregiver relationship when the baby first comes to recognize and resonate with the emotions of the caregiver. Parents and teachers can continue to support the development of empathy by valuing empathic responses, by making “being a good friend” a family (and school) value. If this “family value” is established, parents and teachers can always fall back on it as a support when they are confronting bullying behavior. “In this school, we do not believe in treating others that way.” The reason this kind of explanation is such a showstopper is that you can’t argue with beliefs. Empathy can even be extended to the bully.

I would not call Sam a bully – nor do I think the term is appropriate for such a young child – but his behavior was definitely intimidating to Ben. If called into this situation with Sam puffing out his chest threateningly to Ben and calling him a baby and Ben quaking in his boots, his parent or his teacher might try to scaffold the recovery of Sam’s self-reflection, and therefore his empathy. They might try to help him imagine how Ben felt, and they might even elicit Ben’s help in doing that (“Tell Sam how you felt when he said that to you and stood so close to you”).

However, there is a potential pitfall. If Sam is too stressed, the adult’s words – kind and helpful though they might be – will not sink in. Sam cannot take in information when he is dysregulated. The kind words – if they are addressing the source of his distress – might even escalate his dysregulation, The adult must first help Sam (and Ben) calm down, feel safe, and then – maybe twenty minutes later – try again. There are many good children’s books that have friendship as a theme. Some classics are George and Martha, Mrs. Piggle Wiggle, and Freddy the Pig.

Brooks, Walter R, Freddy the Detective, Overlook Juvenile Press, 2010.

Marshall, James, George and Martha (especially, the story of “Split Pea Soup”), HMH Books for Young Readers, 1974.

MacDonald, Betsy, Mrs. Piggle Wiggle, Harper Collins, 2007.


Peter Fonagy Presentation II


The Way Humans Learn About Their Culture

The way this kind of learning occurs helps us understand how the knowledge communicated between parent and child becomes “what is known” and “how it is done” in a large group of people, and then what about this gets passed down over generations. This does not occur through intentional, cognitive learning, but instead happens through the use of “ostensive communication cues”. These cues include such behaviors as eye contact, turn taking patterns, and specific tones of voice such as the falsetto voices mothers use to talk to their babies referred to as “motherese”. Fonagy explains that what establishes these ostensive cues most reliably is the same thing that generates secure attachment – sensitive, attuned behavior towards the baby, giving the baby the sense that the adult is trustworthy and therefore that the information is reliable. Fonagy stresses that all human life is built on social knowledge, and that if you deprive the child of “epistemic trust”, you deprive him of the possibility of benefiting from what he needs to succeed in the society into which he was born. Relationships are absolutely crucial to the transmission of cultural knowledge. 

The Implications of Mentalization for Helping People Grow (in psychotherapy or other ways)

When you are with someone who is not mentalizing, it is impossible to have a rational discussion with him. That is because he has a rigid position that is heavily influenced by his own internal beliefs and he cannot bring an open mind to the conversation. For example, if he perceives himself as a victim, he will see everything that happens to him as victimization by a cruel world, and if you try to explore with him how he might have contributed to the outcome by some of his actions, he will not agree and will probably feel victimized by you. This is fairly characteristic of many adolescents, and actually occurs in all of us if we are stressed to an extreme enough degree. One of the ways I see “normal” people let go of their mentalizing is when that person is a parent who is desperately worried about his child. In that case, the internal perception of helplessness in an uncaring world (if people really cared, they would do something!) is so overwhelming that the parent cannot imagine a situation in which there is nothing to be done but wait. Another situation is in high conflict divorces in which each parent perceives him or herself as the victim of the other, and cannot empathize with the other at all. 

Fonagy stressed the need to insist on a mentalizing process in therapeutic or other helping engagements. This means that if the person you are working with insists on taking a “non-mentalizing”, or irrational and highly personalized point of view, you must focus on bringing the conversation into a mentalizing one instead of just “hearing out” a lengthy non-mentalizing explanation from the other person. That is because the “hearing out” is deceptive in that it involves the person reestablishing his rigid point of view instead of presenting an opinon that is open to alternative perspectives. Fonagy points out that when your interactive partner is not mentalizing, you stop mentalizing!

Most of the patients Fonagy has studied from the point of mentalization have a diagnosis of Borderline Personality Disorder, but he makes the point that we are all vulnerable to lose our capacity to mentalize under extreme stress. This personality disorder (BPD), he thinks, is a developmental problem, in other words, the failure to develop a competency (mentalization) that it is possible to still develop. Twin studies suggest that it is heritable and it is also associated with early maternal separation and abuse (Belsky, Caspi, Arnseneault, Bleidorn, Fonagy et al, 2012, Dev. and Psychopathology).  This suggests that children with a family history of mental illness (any kind) and early parental separation, neglect, or abuse, should be the primary focus of attention of mental health clinicians.

Fonagy reiterates the genetics and early environmental influences activating the attachment system and disrupting mentalization, giving way to a disorganized sense of self and three problematic activities:

1. Psychic equivalence – in which a person thinks that just because they are thinking something, it is automatically true. Flashbacks are an extreme example, and intolerance of alternative perspectives is a more ordinary one.

2. Pretend mode – the mental world is decoupled from external reality. For example, a woman can be completely convinced that a man in her office is infatuated with her even though he has never given her evidence of this.

3. Teleological mode – physical action is seen as the only way to modify someone else’s mental state. An example is when a person insists on concrete evidence of your caring for them – including extra sessions or telephone calls or physical touching.

Fonagy recommends certain techniques for helping your interactive partner (patient, client, etc) to mentalize:

1. Take a stance of active questioning and “not knowing”. That means that you do not presume to know what is going on until the other person explains it to you. While “not knowing”, you gently insist on alternative perspectives. (“Of course, I don’t know, but when I think about it, it occurs to me that X might be happening instead of Y.”) 

2. Monitor your own mistakes. That means acknowledging your inability to really know what is in the other’s mind and apologize for your mistakes.

3. Empathy.

4. Curiosity about the other’s experience.

5. Staying in the present instead of moving to the past.

6. Lower arousal by bringing it back to you: “What have I said that bothered you?”

7. Quickly step back if the person seems to be losing control.

8. Highlight the experience of “feeling felt”.

9. Identify a break in mentalizing and “rewind” to the moment before.

10. The main idea is to “create a space” in which the rhythms of mentalizing can occur, a safe place where you collaborate in creating a more flexible and adaptive meaning about what is bothering the person.

Fonagy has a new book out about how to understand mentalizing and how to practice it: 

Anthony W. Bateman and Peter Fonagy, Handbook of Mentalizing in Mental Health Practice, American Psychiatric Association, 2012.

Read this blog in Spanish.