miércoles, 3 de mayo de 2017

LA PSICOTERAPIA HOY



Con motivo de mi participación en el III Congreso Nacional de Gestalt, 2017. "Compartiendo inquietudes", elaboré un guión sobre una serie de preguntas básicas que se plantearon de cara al Panel Plenario. El coloquio en la práctica no siguió ningún guión estricto y es muy probable que el vídeo sea publicado.


1  Dado que la demanda en terapia es frecuentemente motivada por las fricciones que la persona siente con su entorno y en definitiva con esta sociedad, ¿Cómo es éticamente trabajar para que una persona se ajuste a una sociedad profundamente enferma? ¿Cuál es el trabajo que sería intrínsecamente saludable?

Posiblemente el objetivo no es tanto que la persona se adapte o se ajuste a una sociedad profundamente enferma sino que busque el mejor camino para mantenerse relativamente sana y moderadamente feliz a pesar de la sociedad que le rodea. Por otra parte, tampoco puede considerarse que la sociedad esté profundamente enferma, pues entonces lo mejor sería que nos bajáramos del barco. Siempre habrá personas y grupos relativamente sanos en nuestra. Una de los principales objetivos que se buscan en toda terapia es la aceptación de uno mismo, lo que normalmente pasa por la aceptación del propio cuerpo. Quizá el rechazo del cuerpo, es uno de los aspectos más negativos de nuestra cultura, que se muestra en diferentes formas de autoagresión: anorexia, vigorexia, negación de la sexualidad o exacerbación de la misma, evitación de la amistad y del contacto. Somos nuestro cuerpo, si es que aquí se puede aplicar el concepto de “propiedad”. Pero este cuerpo, esta persona, no está nunca aislado, aunque momentáneamente pueda estar sola, desde el primer contacto piel con piel con la madre. Se supone que en la medida en que nos permitimos el disfrute y la autorrealización también estamos en la mejor disposición para permitírselo. 

2    ¿Qué inquietudes y retos se nos plantean en la aplicación de la salud mental, emocional, etc... en este mundo con cambios continuos y galopantes?

Creo no equivocarme si afirmo que los aquí presentes somos defensores del “slow food” frente al “fast food”.  Debemos preconizar el disfrute reposado del momento y de los momentos sucesivos, de la amistad y el afecto. El afecto por uno mismo y por los demás ha sido rechazado en los últimos siglos por creencias religiosas erróneas que consideraban todo disfrute de sí mismo y de los otros como egoísmo pecaminoso. Pero cuando el afecto por el otro no va acompañado por el afecto propio se convierte en una máscara de abnegación que esconde sentimientos negativos. Estamos impregnados de esta religión negativa, pero en los últimos tiempos, quizá como reacción contra la religiosidad, se pretende negar los límites de la existencia humana, el dolor, la vejez y la muerte. Estas son circunstancias que deberemos enfrentar en cada momento tratando de obtener el mayor beneficio moral de la experiencia y reduciendo los daños posibles, pero sin dar la espalda a una realidad que se nos impone. Se podría decir que estamos en un mundo que huye de sus conflictos.

     B ¿Podemos estar trabajando con supuestos básicos en psicoterapia que en realidad son cuestionables o son específicos de esta sociedad, y no de otras sociedades o períodos históricos?
Si seguimos los principios de una filosofía valorativa hacia la persona, que defienda la empatía y el apego, los errores técnicos nunca provocarán problemas graves. El psicoanálisis relacional postula que la primera necesidad es la necesidad de contacto y compañía, la relación con otras personas y grupos. Es una necesidad que se cumple en sí misma sin que haya otros objetivos. La teoría pulsional freudiana, en cambio, postulaba que buscamos a los otros para satisfacer nuestras necesidades, sexuales o de destrucción. Aun así, pienso que la mayoría de los colegas de orientación psicoanalítica han buscado sinceramente beneficiar a las personas con las que han trabajado, por lo menos con la misma intensidad que ellas querían beneficiarse del proceso, y que su teoría en gran parte errónea no ha impedido que sirvieran de gran ayuda a estas personas. Esto no quiere decir que debamos adoptar una postura ingenua, pues muchas veces somos nosotros mismos – como pacientes pero también como terapeutas -  los que nos oponemos al cambio, por otro tipo de necesidades adquiridas. Normalmente hemos aprendido a sufrir de una forma particular y concreta, no por el disfrute del sufrimiento en sí, sino para evitar un sufrimiento mayor: el temor a la pérdida del afecto, el derrumbe, la vergüenza, la culpa.

     C  ¿Qué aspectos de nuestra labor quedan en entredicho o han de dar giros?  ¿Cuáles han de ser reforzados, si los hubiera, a pesar de las demandas cambiantes?

En la lucha contra el cartesianismo y la concepción occidental de la “mente aislada”, entroncada con el rechazo del cuerpo, el mayor riesgo que debemos evitar como terapeutas es la creencia en que la terapia es algo que el terapeuta ejerce sobre el paciente o cliente. Desde el psicoanálisis relacional insistimos en que la terapia es una tarea de dos personas (o más), en la que uno ejerce el rol de terapeuta pero inmerso también en una relación enriquecedora y que le proporciona una posibilidad de cambio personal. Sin que se llegue a una igualdad total de roles, pues uno se ofrece profesionalmente como terapeuta y otro como paciente, se trata de una situación gobernada por la mutualidad. El terapeuta que quiere demostrar su gran intuición, inteligencia y capacidad de análisis ante el paciente corre el riesgo de realizar intervenciones quizá brillantes pero inútiles. Lo que el paciente necesita no es un erudito o un santo sino una relación genuina.

3.  ¿Qué podría hacer los profesionales de la salud por un mundo del SXXI… que no hace?

Los profesionales de la salud deberían atender a los enfermos y no a las enfermedades, pues cada persona enferma según su propia naturaleza y características. Los profesionales de la salud mental, por su parte, deberían pensar que, salvo excepciones, las personas a las que atienden no son enfermos sino individuos que tienen dificultades en su forma de estar en el mundo y de relacionarse con los demás. La psicoterapia debe ser pensada como una nueva oportunidad para aprender formas más satisfactorias de estar con el otro, y nosotros también.


    ¿En qué les parece que se parecen Uds. en su hacer -(no tanto quizás en cómo lo cuentan) - a pesar de pertenecer a enfoques supuestamente diferentes (psicoanálisis, gestalt);

Todas las formas de psicoterapia que busquen escuchar al otro con paciencia y empatía y ofrecerle un vínculo positivo se parecen, aunque utilicen “técnicas” diferentes y se sustenten en teorías particulares.

lunes, 24 de abril de 2017

ESPECIALISTA Y MASTER EN PSICOTERAPIA PSICOANALÍTICA RELACIONAL





INSCRIPCIÓN ABIERTA: ESPECIALISTA/MÁSTER EN PSICOTERAPIA RELACIONAL

 


Marzo 2017
ABIERTA LA INSCRIPCIÓN PARA EL CURSO 2017-18  
ESPECIALISTA EN PSICOTERAPIA PSICOANALÍTICA RELACIONAL
(60 créditos)
Y MÁSTER EN PSICOTERAPIA RELACIONAL (100 créditos)

Directores: Profs. Alejandro Ávila Espada y Carlos Rodríguez Sutil


Opciones de formación presencial y
semi-presencial con cursos on-line
Con un selecto cuerpo de profesores miembros de entidades nacionales e internacionales de prestigio e integrado por cursos que se someten todos ellos regularmente a acreditación de la Comisión de Formación Continuada de las Profesiones Sanitarias de la Comunidad de Madrid.
Ambas formaciones tienen en común los seminarios obligatorios:
§  Modalidad Semanal presencial: 3 niveles, de 14 créditos cada uno (3 cursos académicos, de octubre a junio) de los seminarios Clínica Relacional (martes lectivos de octubre a junio, de 19.00h a 22.00h) y Renovadores de la Psicoterapia Psicoanalítica (miércoles lectivos de octubre a junio, de 20.30h-22.00h).
§  Modalidad Intensiva presencial: 3 niveles, de 15 créditos cada uno (3 cursos académicos, de octubre a junio) del seminario Psicoterapia Psicoanalítica Relacional. 11 sábados por cada curso académico (de 10.00h a 19.30h; 15 créditos nivel) completado con cursos a distancia.

Cursos adicionales obligatorios para quiénes además del Título de Especialista en Psicoterapia Psicoanalítica Relacional desean obtener el Título de Máster en Psicoterapia Relacional:


1) Introducción al Modelo Dinámico-Relacional (6 créditos).
2) Bases del Modelo Sistémico y Epistemología de la Clínica (6 créditos).
3) Teoría y Técnicas de Grupo para Servicios Sociales y de Salud (6 créditos; curso on-line mixto: online + sesión intensiva presencial).
4) Casuística Ética del Psicoterapeuta Profesional (2 créditos).
5) Metodología de Investigación para el Psicoterapeuta Profesional (6 créditos).
6) Trabajo Fin de Máster (se otorgarán hasta 12 créditos; es valorado por una comisión y eventualmente publicado).

El catálogo completo de cursos on-line se encuentra disponible en el siguiente enlace.

Toda la información completa sobre el Máster/Especialista está disponible aquí

Para un Plan personalizado de estudios adaptado a sus necesidades, contacte con: gformacion@psicoterapiarelacional.com

DISPONEMOS TAMBIÉN DE FORMACIÓN 100% ONLINE:
EXPERTO EN PSICOTERAPIA INTERSUBJETIVA FOCAL (30 créditos, formación 100% online), con cursos fundamentales (de 6 créditos cada uno: IMDR, PIF-I y PIF2) y cursos optativos, 6 créditos cada uno. 2 a elegir entre: TPPR, IPBM, ITPP. 
EXPERTO EN PSICOTERAPIA DE GRUPO (30 créditos, formación 100% online), con cursos fundamentales (de 6 créditos cada uno: IMDR, TGSS y PGTC) y cursos optativos (de 6 créditos cada uno. 2 a elegir entre los ofertados y otros programas).
Y UN AMPLIO CATÁLOGO DE CURSOS ONLINE que puede consultar aquí

martes, 24 de enero de 2017

NUEVA EDICIÓN DE CURSOS ON-LINE

Estimados/as colegas,

El 15 d​febrero de 201​7 dará comienzo la nueva temporada de Cursos On-Line, acreditados por la Comisión de Formación Continuada de Profesiones Sanitarias de la Comunidad de Madrid, con validez en todo el Estado, y de amplio prestigio internacional. Suponen una oferta actualizada de formación especializada, impartida y tutorizada por profesorado de amplia experiencia. 


Os detallamos el listado de cursos ofertados, para los que ya está abierto el periodo de inscripción. 

Como novedad, ​os informamos de un 
curso nuevo 
sobre "Revisión de Conceptos y Autores Psicoanalíticos Fundamentales (RCAF): Introducción a la lectura de S. Freud. M. Klein y W. Bion", cuya primera edición comienza el próximo 15 de febrero. Este curso, cuyo profesorado está compuesto por 
Alejandro Ávila Espada, Carlos Rodríguez Sutil y Eva Alonso Fernández
​,​
 
facilita documentación y esquemas de apoyo para introducirse en la lectura de tres autores clave del pensamiento psicoanalítico: S.Freud, M. Klein y W. Bion; todos ellos desde el punto de vista de las convergencias y divergencias con el pensamiento relacional.

Además, destacamos 
​​
dos
 cursos de reciente creación que son parte de la formación básica y especializada en Psicoterapia Psicoanalítica Relacional, y que tienen una extensión más amplia:

  • Renovadores de la PsicoterapiaPsicoanalítica (RPP1): Introducción a la obra de S. Ferenczi, W. R. Fairbain y H. S. Sullivan. 9 créditos equivalentes a ECTS. Este curso, desarrollado en nuestra nueva plataforma Moodle, introduce a los médicos/as, psicólogos/as y profesionales de la Salud Mental en la obra de autores de gran relevancia desde la perspectiva dinámico-relacional, a sus aportaciones teóricas y para la técnica psicoanalítica. El primer nivel (RPP1) está dedicado a la revisión de la vida, obra y aportaciones de Sándor Ferenczi, Ronald Fairbairn y Harry S. SullivanCurso pendiente de acreditación
  • Renovadores de la PsicoterapiaPsicoanalítica-3 (RPP3): FRANÇOISE DOLTÓ. INTRODUCCIÓN A SU PENSAMIENTO6 créditosEste curso, tiene el propósito de adentrarnos en el pensamiento clínico psicoanalítico de Françoise Doltó.  Se profundizará en el conocimiento de su lugar en la clínica contemporánea, así como en el psicoanálisis francés. La abundante casuística que revisa nos sitúa ante la práctica con el psicoanálisis de niños y adolescentes. Está integrado por nueve módulos que serán desarrollados y evaluados en un periodo total de 6 meses. Curso pendiente de acreditación
 Nuestros Cursos Teórico-Técnicos aplicados a la clínica:

Nuestros Cursos de Grupos:
  • Curso TGSS: Teoría y Técnicas de Grupo para Servicios Sociales y de Salud. 6 créditos equivalentes a ECTS (100 horas on-line, más 34 horas de trabajo práctico del alumno y hasta 16 presenciales recomendadas en experiencia grupal intensiva). Forma parte del curso para EXPERTO EN PSICOTERAPIA DE GRUPO, también del Máster, y puede cursarse separadamente.
  • Curso PGTC: La Psicoterapia de Grupo comotratamiento combinado: Modelos y técnicas actuales.
    ​ ​
    6 créditos equivalentes a ECTS (100 horas on-line de lecturas y trabajos tutelados para complementar y fundamentar la práctica grupal actual en el ámbito comunitario). Forma parte del curso para EXPERTO EN PSICOTERAPIA DE GRUPO, también del Máster, y puede cursarse separadamente.

Cursos Metodológicos y Éticos para la Clínica:

Podéis consultar de la información detallada (programa de los cursos, precios, procedimiento de inscripciones,...) desde la siguiente página web: 

Estos cursos forman parte de nuestro sistema modular del Máster en Psicoterapia Relacional (Especialista en Psicoterapia Psicoanalítica Relacional / Especialista en Psicoterapia Sistémica), de diferentes Diplomas de Experto, aunque todos ellos también pueden ser cursados de forma independiente y cuentan con acreditaciones de formación continua para Psicólogos Clínicos y Médicos.

Podéis hacer llegar esta información a cualquier persona que creáis pueda estar interesada. Existen condiciones especiales para los inscritos en los Estudios de Máster y Especialista en Psicoterapia Psicoanalítica Relacional, y los miembros del Instituto de Psicoterapia Relacional.

Para cualquier consulta que pueda surgiros, estamos a vuestra disposición.

Un cordial saludo,
AGORA RELACIONAL
Sandra Toribio Caballero
Coordinación de Gestión de Formación
gformacion@psicoterapiarelacional.com
Alberto Aguilera, 10 – Escalera Izquierda – 1º
28015-MADRID
Teléfono (+34) 915919006 – Fax 91-4457333

www.psicoterapiarelacional.es

martes, 3 de enero de 2017

Mentalizing: Artifice and Culture



Copyright © 2016
Avello Publishing Journal
ISSN: 2049 - 498X

Issue 1 Volume 6:
A Synthesis of ‘Analytic’ and ‘Continental’ Philosophy.



Carlos Rodríguez Sutil, University of Complutense, Madrid, Spain.


Relational psychoanalysis and other postmodern psychoanalytical orientations manifest their opposition to Descartes’ ontological dualism and its postulation of an internal more or less isolated mind. This ontology became long time ago the official language -the ‘official doctrine’ (Gilbert Ryle). Psychoanalysis understood as a technique assumes that an isolated mind, the analyst, is doing something to another isolated mind, the patient, or, at worst, the reverse.
Freud sometimes managed the conception of an unconscious subject relatively isolated from his environment, a solipsistic ego under the control of primary narcissism.  Fonagy doesn’t maintain, fortunately, such classical concepts as ‘primary narcissism’ or the drive/instinct theory, but gets trapped if not on the Cartesian thought at least in some form of the ‘official doctrine’ language, and his theorization conveyed and image excessively introspective of the action-reaction dynamic that is established between the infant and its social environment. The mind is not born with the individual but develops in the context of human interaction and the mind is not only internal but also external, mainly external, that is, the pragmatic context of interpersonal relationships. The internal space is something that is created (Vygotsky, Wittgenstein).


Before practice had demonstrates that the letters of the alphabet could bind winged words in row after row of script, no one would have conceived of a storage room or wax tablet within the mind.

Ivan Illich (1993, pp. 38-39)

Throw away the book. (Leon Hoffman cited by Paul Fonagy, 1999 b)


Chuang Tzu and Hui Tzu were strolling along the dam of the Hao River when Chuang Tzu said, "See how the minnows come out and dart around where they please! That's what fish really enjoy!"

Hui Tzu said, "You're not a fish - how do you know what fish enjoy?"

Chuang Tzu said, "You're not I, so how do you know I don't know what fish enjoy?"

Hui Tzu said, "I'm not you, so I certainly don't know what you know. On the other hand, you're certainly not a fish so that still proves you don't know what fish enjoy!"

Chuang Tzu said, "Let's go back to your original question, please. You asked me how I know what fish enjoy so you already knew I knew it when you asked the question. I know it by standing here beside the Hao."

— Zhuangzi, 17, tr. Watson 1968:188-9

 
This Taoist tale clearly shows the huge difficulties and contradictions we face when we tray to theorize about what really happens inside people’s minds. It is a field full of quicksand. Let’s take another perspective on this enigma. We are going to see a fragment of and old film directed by the great master Alfred Hitchcock “Dial M for Murder”. Now we read a brief description of the plot.
Tony Wendice is married to wealthy jetsetter Margot. She had an affair with an American crime-fiction writer Mark Halliday. Tony discovers the affair and decides to murder her, both for revenge and to ensure that her money will continue to finance his comfortable lifestyle. Tony meets an acquaintance from the University, Swann who has become a small-time criminal. Tony had stolen Margot’s handbag, which contained a love letter from Mark, and anonymously blackmailed her. After tricking Swann into leaving his fingerprints on the letter, Tony offers to pay him to kill Margot; if Swann refuses, Tony will turn him in to the police as Margot's blackmailer.
The plan is: the following evening Tony will take Mark to a party, leaving Margot at home and hiding her latchkey outside the front door of their flat. Swann is to sneak in when Margot is asleep and hide behind the curtains. At eleven o'clock, Tony will telephone the flat from the party and Swann must kill Margot when she answers the phone, open the garden doors, suggesting a burglary gone wrong, and exit through the front door, hiding the key again. When Margot comes to the phone, Swann tries to strangle her, but she manages to grab a pair of scissors and kill him. She picks up the telephone receiver and pleads for help. When Tony returns to the flat, he calls the police and, before the police arrive, Tony moves what he thinks is Margot's latchkey from Swann's pocket into her handbag, plants a Mark's letter on Swann. Chief Inspector Hubbard arrests Margot after concluding that she killed Swann for blackmailing her. Margot is found guilty and sentenced to death. On the day before Margot's scheduled execution, Hubbard asks Tony about large sums of cash he has been spending, tricks him into revealing that his latchkey is in his raincoat, and discreetly swaps his own raincoat with Tony's, and as soon as Tony leaves, he uses Tony's key to re-enter the flat, followed by Mark. Hubbard had already discovered that the key in Margot's handbag was Swann's latchkey, and deduced that Swann had put the key back in its hiding place after unlocking the door. Tony retrieves Margot’s handbag from the police station after discovering that he has no key. The key from Margot's bag does not work, so he finally uses the hidden key to open the door, proving his guilt. One of the last scenes shows how Tony ‘internally’ reasoning about the keys and Hubbard offering the audience the voice-off of what is happening into his head.
Since the time of Plato (Theaetetus) to think is to speak to oneself but it was not until Descartes that prevailed the conception of thought as an internal activity in a closed internal space, the mind (or the brain). One of the most dangerous ideas for a philosopher, said Wittgenstein (1945-48, § 605, § 606), is that we think in our heads, in a closed space, hidden. What we see in Hitchcock’s film is real, and in some way internal, although the signals are all exterior, and show the result of a long developmental process in a sophisticated intelligent adult, although morally deficient. That “internal” room is not something given from the scratch. 
Relationalists, intersubjetivists, and other neo-psychoanalysts, as well as Fonagy (2008), in short, all of us, we manifest our opposition to Descartes ontological dualism and its postulation of an internal more or less isolated mind. This ontology became long time ago the official language -the ‘official doctrine’ as Gilbert Ryle (1945) called it- and today has become a labor of Hercules to get rid of it. According to this doctrine all human beings, except little children and idiots, are living two parallel stories: that of the body and that of the mind. The soul, or mind, is the most immediately knowable existence for each person. The other's mind is not known directly, although it can be inferred: somehow is phosphorescent. The place of this inner life, the thought, is the head or, more specifically, the brain. One of the erroneous results of this framework is to consider that all behavior of the person has an internal cause, hidden, in principle unknown.  But the future also, as Ryle says, is unknown to us, and that does not mean it is hidden anywhere. The other mistake is to transpose the physical causality to mental events (Wittgenstein, 1945-49). Official doctrine, therefore, takes as something given, primitive, the existence of internal mechanisms.
I think that the arguments used by Fonagy sometimes fall, inadvertently, in current errors due to this Cartesian perspective. For instance, Fonagy states his anti-Cartesian position as follows:
 Our approach explicitly rejects the classical Cartesian assumption that mental states are apprehended by introspection; on the contrary, mental states are discovered through contingent mirroring interactions with the caregiver. (2008, p. 10; our emphasize)

Instead I would say, probably, that ‘mental states’ are not discovered but created by social interaction. The expression ‘mental state’ is a cultural-dependent term currently used in Western societies. There is a more basic principle in Cartesianism than that of the acquisition of contents by introspections, and it is the ontological separation of the two substances, mind en matter, spirit and extension, internal and external.
The position that we embrace regarding Cartesianism determines to a certain extent our position in the clinical setting. Psychoanalysis understood as a technique assumes that an isolated mind, the analyst, is doing something to another isolated mind, the patient, or, at worst, the reverse. The result can’t be a healthier human being; the human being is left aside, and the best outcome is a better polished object. Technical recommendations became fixed rules that persist today in our ‘collective psychoanalytic superego’ (Orange, Atwood, Stolorow, 1997). We experienced in our relationship with another - coherently with the technical position- that things happen sequentially, in the form of action and reaction, as in a one-way bridge, giving place to a linear causality. In brief, one is agent and the other patient, in some cases alternatively, in a kind of complementary relationship where the other's subjectivity is not recognized as such. This action-reaction myth is the one that dominates the classical psychoanalysis as well as most studies on current cognitive psychology, indebted to the ‘computer metaphor’. Such point of view was not shared by pioneers in developmental psychology, inspired by some form of constructivism, either ‘biological constructivism’ (Piaget and followers), or ‘social constructivism’ (Vygotsky, Bruner).
One of the main differences between relational and classical psychoanalysis lie in the increasing proximity or symmetry between therapist and patient, forming both a therapeutical couple. Therapy is no more something therapist do upon the patient, but rather a common task of mutuality and reciprocal experience, in a co-constructed field. Fonagy is well informed about relational psychoanalysis principles and theories (Cf. Fonagy, 1998). Let us quote Fonagy himself alluding to relational psychoanalysis:
It would be churlish to devote too much space to criticizing “work in progress.” These ideas are in the process of creation and an excessively critical stance can only serve to stifle such a critical process. I would prefer to point to some areas that I would like the authors to explore for the sake of completeness. (1998, p. 351)

I appreciate deeply Fonagy’s theories as really useful instruments in the clinical work with personality disordered patients. Mentalization theory is useful as long as it agrees with the Western conception, shared by therapist and patient, of what is the mind and how goes on. However, for the very same reason, such a theory, or more precisely certain hard version of it that could be revealed by a careful reading of Fonagy’s texts, may deserve some criticism. My intention is, so long as I know, to point to some areas of his thought for the sake of, not completeness but of a better conceptual framework on Fonagy’s theoretical stance, and thus avoid some undesirable potential consequences for clinical work.  Well understood, those are consequences that can occur only in some cases, because fortunately most clinicians do not follow blindly the theoretical principles they learned, and are able to ‘throw away the book’ (Leon Hoffman cited by Paul Fonagy, 1999 a). Kohut (1984) said that empathy was not something he himself had invented but something already in use by other psychoanalysts of other orientations (Freudians, Kleinians, etc.).


EPISTEMOLOGICAL CRITIQUE OF MENTALIZATION THEORY

One of the capabilities that define the human being is to take into account both his own mental states and that of the others in understanding and predicting the behavior. In developmental psychology this is what has been called ‘a theory of mind’ (Cf. Wellman and Liu, 2004). This concept serves to collect all intuitive ideas each one has about mental functioning and the nature of the experience, memory, beliefs, attributions, intentions, emotions and desires of their own and those belonging to other.
However, when abuses occur by parents, the son’s theory of mind weakens (Fonagy, 1991, 2001; Fonagy y Target, 1996). Fonagy explains convincingly that for the child is no longer a sure thing to think about desires, because this involves observing the parent wishes to hurt him. So high representation of mental events is inhibited, which provides certain benefits for the individual, allowing him, so to speak, to make a detour against an intolerable mental pain. The child seeks comfort in a merger down with the object, with a 'parent rescuer' in fantasy. Therefore it is logical to conclude that the analyst thinking and talking about thinking of the patient, can help to repair global or focal defects in the patient's mentalizing ability.
Fonagy suggest that mentalization is a theory that provides an integrative framework that could integrate brain and mind and can serve as a ‘common language’ for a range of therapeutic modalities (Fonagy and Allison, 2014, p.373). The mentalizing of patients may be a common factor across psychotherapies ‘not because patients need to learn about the contents of their minds or those of others, but because mentalizing may be a generic way on increasing epistemic trust, trust the reality of what the therapist says] and therefore achieving change in mental function’. (Fonagy and Allison, 2014, p.477)
Taking all this into account it seems appropriate to seek a precise definition of ‘mentalization’:
We define mentalization as a form of mostly preconscious imaginative mental activity, namely, interpreting human behavior in terms of intentional mental states (e.g., needs, desires, feelings, beliefs, goals, purposes, and reasons). Mentalizing is imaginative because we have to imagine what other people might be thinking or feeling; an important indicator of high quality of mentalization is the awareness that we do not and cannot know absolutely what is in someone else’s mind. We suggest that a similar kind of imaginative lap is required to understand one’s one mental experience, particularly in relation to emotionally charged issues. In order to conceive of others as having a mind, the individual needs a symbolic representational system for mental states and also must be able to selectively activate states of mind in line with particular intentions, which requires attentional control. (Fonagy, 2008, p. 4, emphasis added).

I beg Fonagy’s pardon if I compare his stance – complex and comprehensive - in some respects to that of Andrew Meltzoff. In the mid-70's, Meltzoff discovered that infants between 12 and 21 days of age can imitate both facial and manual gestures (Meltzoff and Moore, 1977). This behavior implies that human neonates can equate their own unseen behaviors with gestures they see others perform. More important for what concerns us here, Meltzoff (2007) proposed the ‘like me’ hypothesis about the infant development: ‘Here is something that is like me’. The infant experiences a regular association between his or her own acts and the underlying mental states. Subsequently, the infant projects internal experiences onto others performing similar acts, and begins to acquire an understanding of ‘other minds’: their mental states, emotions, desires, and so on. Imitating is an innate ability and the comprehension of the other’s mental states is a derivative. In the same vein Fonagy suggests:

… the ability to give meaning to psychological experiences evolves as a result of our discovery of the mind behind other’s actions, which develops optimally in a relatively safe and secure social context (2008, p. 29, emphasis added).

 I would say not that it “develops” but that it is “learned” through caregiver’s instructions.
Meltzoff’s (and Fonagy) hypothesis is indebted for the per analogiam argument raised by the English philosopher John Stuart Mill, in the nineteenth century, to solve the ‘other minds’ problem and the risks of solipsism and isolated mind stemming from Cartesianism. According to this the statement that other persons also have a consciousness is a conclusion we derive from their actions and visible manifestations, with the aim of making their behavior understandable. What is equivalent to say that to attribute consciousness to others is an inference and not an irrefutable experience.
I would suggest that the infant doesn’t compare an internal state to a visual stimulation, but merely that we are ‘programmed’ (is our nature) in a way that allows us to display spontaneously an emotional response, for instance, in front of a smile of the caregiver, and so we share his or her ‘mental state’. The ‘mental state’ is not originally an individual property but it is owned by at least two people (CF. Knoblauch, 2000, p. 158); the unconscious mind is also owned by two or more people (Lyons-Ruth, 1999, Gerson, 2004). When we think steadily that they are indeed private entities, it follows that they are expression of some inner feelings. Nevertheless, even acknowledging the fact that emotions require cognitive processing and physiological responses, something that I do not care to recognize, they are social phenomena that often occur by a perceptual contagion, without any cognitive mediation.
Fonagy postulates that symbolic representation of mental states may be seen as a prerequisite for a sense of identity (Fonagy and Target, 1996; Target and Fonagy, 1996; Fonagy and Allison, 2014). Thus, patients with severe personality disorders inhibit their reflective function, and have little access to an accurate picture of their own representational world. But I suspect that what these patients have is not a hidden or inhibited representational world, but rather they suffer from a lack, that is, they show deficits in their representational world. They have not acquired the necessary skills to represent and therefore don’t have a ‘complete’ representational world.
It is usual to construct our psychological (cognitive) theories on the basis of mental representations. However we don’t know yet how representation represents. I feel uncomfortable with the language of cognitive psychology that pervades relational psychoanalysis, and even not relational. Perhaps a mentalistic outlook should be suitable for all patients, regardless of their disorder. Also borderline disordered patients benefit from a mentalizing attitude on the part of the therapist. I guess these patients are in greater need of an empathic acceptance and recognition, and only secondarily to mentalization. Fonagy's answer probably is that mentalizing is not at all incompatible with acceptance and recognition, but maybe it should be better to think in terms of relational patterns – from a descriptive and external point of view - and rhythmicity (a scarcely mentalist concept) in the relationship therapist-patient.
In other part Fonagy (Fonagy, 1999 a; Fonagy, Steele, Steele, Leigh, Kennedy, Mattoon, and Target, 1995) confirms the idea that relationships – the perception of an analyst having empathy or healing intentions, and not only interpretations- lead to changes in representational structures. ‘Then, there is no qualitative difference between the means by which therapeutic change is achieved via interpretation and via a new relationship’ (Fonagy, 1999 a). To perceive the therapist as somebody who listens empathetically or has healing intentions bring changes through the same mechanism of change as interpretations.
But these two ‘technical’ stances are not equivalent, because if our praxis is mainly based on interpretation it means in a concealed way that we have the truth about the patient’s problems, and consequently adopt the classical position analyst-patient. Recently Margy Sperry (2013) based her criticism of Fonagy's ideas on a similar ground. When Fonagy sees the patient blocked in a prementalizing stage of development, Sperry says:

Such an assumption establishes the analyst as an authoritative and objective interpreter of the meanings and sources of the patient's mentalizing process, and minimizes the ways that analyst may contribute to the very phenomena that she is explaining. (id., p. 686).

But Fonagy surely will answer that:
However, interpretation is not enforced in some dictatorial way but offered as the start of trying to make sense of what otherwise may be an apparently meaningless event or feeling. It becomes a way in which a therapist can demonstrate that they are thinking in their own mind about the patient’s mind and inevitably it can be given with varying degrees of competence and sensitivity.  (Bateman and Fonagy, 2004, p. 131)

However, it is very likely that in a relational analysis we use in a lesser extent the interpretation than it is usual in classic analysis, and even less in patients with a borderline functioning.
Fonagy (2008, pp. 4-9) says that the baby’s experience of himself as having a mind or self is not a genetic given, but evolves from infancy through childhood and depends upon the interaction with attuned caregivers. But at the same time he states that mentalization is the ‘evolutionary pinnacle’ of human intellectual achievement, after the selection processes of two million years of human evolution –a proposition that surely Hegel would had endorsed-. It implies a huge risk of misinterpretation to identify cultural change with Darwinian evolution. When we refer to the history of humanity prudence advises us to think merely on a strictly non-evaluative sense, rather than assume the existence of a positive development, avoiding any idea of improvement and the culturocentrism. It seems that inspired in social Darwinism, Fonagy suggests that our exceptional intelligence evolved not to deal with the hostile forces of nature but rather to deal with competition from other people. This fact is not grounded on genetics; the ‘social brain’ must reach higher and higher level of sophistication ‘to stay on top’. I suspect, however, that this competitiveness is only consistent with Western values.
Mentalizing entails making sense of the actions of oneself and other’s on the basis of intentional mental states (IIF) (Fonagy, 2008), that is, treating the object whose behavior you want to predict as a rational or intentional agent with beliefs and desires. This function provides developmental advantages. During the second year, children understand that they and others are intentional agents whose actions are caused by prior states of mind (desires, intentions) and that their actions can bring about changes in minds as well as bodies (id p. 26). In connection with that you can object that on many occasions desire and intention don’t precede action but accompany it or, maybe we should say, every act is an expression of desire or is an intentional action. Maybe Fonagy conveyed here and image excessively introspective of the action-reaction dynamic that is established between the infant and its social environment. Surely it is a much more complex phenomenon: Whose is the desire? When exactly appears the desire? I have a desire or the desire has caught me? Fonagy’s explanations sound excessively representational or cognitive. I prefer to talk not of representations but of patterns of action, mainly procedural.
Let us put another example. Fonagy added: 

In sum, the ability to give meaning to psychological experiences evolves as a result of our discovery of the mind behind other’s actions, which develops optimally in a relatively safe and secure social context. (2008, p. 29, emphasis added).

This fragment sound quit paradoxical. If I have to seek for a meaning ‘behind’ other’s actions it is because the social context is not safe and secure at all. What makes me distrust the good intentions of others is their behavior in the long run, nothing internal. There might be some signs in the here and now that make me distrust their ‘intention’. Also ‘intention’ is a generalized term I have learned to qualify long sequences of behavior. There are a lot of things we ignore but the truth should not be hidden behind. There is nothing behind, or ‘nothing is hidden’ (Malcolm, 1986). 
The acquisition of mentalization – Fonagy suggests (id., pp. 8-9) - enable the child to distinguish inner from outer reality and internal mental and emotional processes from interpersonal events. Regarding that we have to object that internal events are also interpersonal by definition: Thinking is to speak to oneself (Platon), and it is impossible for us to feel an emotion that is not located on the interpersonal level. It is a matter of fact what Fonagy argues: Self-awareness enables us to modify the way we present ourselves to others and to mislead them, ‘opens the door to more malicious teasing’ (id., p. 29). Children under four years usually belief that what they know, everybody knows. Experiments related to the false belief task seem to have probative value, although some researchers manifested disagreement (Cf. Bloom and German, 2000). Anyway, lying exists, but is an ability we have to learn (Wittgenstein: Lying is a language-game that needs to be learned like any other one, 1945-49, § 249). And it is only possible to doubt when there is certainty. We can assert that lying is only possible when there is truth. That does not mean that all our social relations are based on deception. For most of our actions you only have to bear in mind their ‘apparent’ meaning because main part of our social life is based on confidence. 
The French philosopher and historian of ideas Michel Foucault (1988) introduced the term ‘self-technologies’ which it is possibly applicable to the theory of mentalization. There are four major types of ‘technologies’:
(I) technologies of production;
(2) technologies of sign systems;
(3) technologies of power, which determine the conduct of individuals and submit them to certain ends or domination, an objectivizing of the subject; and
(4) technologies of the self.

Each implies certain modes of training and modification of individuals, depend on the historical moment, and not only involve the acquisition of certain skills but also the acquisition of certain attitudes. Technologies of the self permit individuals to effect a certain number of operations on their own bodies and souls, thoughts, conduct, and way of being, so as to transform themselves in order to attain a certain state of happiness, purity, wisdom, perfection, or immortality.
The modern consciousness is devoted to two essential problems which were not present in the mind of old cultures: Obeying the law and self-knowledge (Foucault, 2001, p. 305). The two mandates of Greek antiquity were ‘Take care of yourself’ and ‘Know thyself’ and the second covered and obscured the first. Says Bruno Snell (2007, pp. 289-90) that the bad conscience is a state of mind first reported by Euripides, as well as shame, embarrassment to others. The Homeric heroes had no bad conscience, not to say guilt. Instead, they had the Furies or Eumenides, goddesses of vengeance pursuing those who had committed crimes of blood, especially parricide. In any case, it was an external factor to the individual's mind. I would not dare to say that the culture of ancient Greece was inferior to ours.
On the one hand, borderline patients sometimes are very sensitive to the other mental states, well understood in order to control and manipulate (Cf. Fonagy, 1999 b).  Mentalizing is an ego or self-technology developmentally acquired that admits positive and negative purposes. Fonagy warns us to identify more mentalizing with the best disposition to serve prosocial ends (2008, p. 29). I would put it in Piagetian terms: overcoming the stage of concrete operations to reach the stage of formal operations does not mean it has been reached an autonomous morality. It looks necessary to complete mentalization theory with a theory of moral development. I recommend the tripartite scheme of the stages of moral development established by Lawrence Kohlberg (1964; Kohlberg, Levine, and Hewer, 1984): pre-conventional, conventional and post-conventional morality. Post-conventional morality is rather an achievement reached by some individuals, regardless of their dominant personality, although it is barred for ‘hard skin’ narcissist and antisocial subjects. In the individual decision-making process three different expressions arise that represent three groups or types of subjects: ‘I want it’, ‘the group approves it’, and ‘it is the correct’. The second one, corresponding to the conventional morality, is characteristic of borderline personalities, where the ‘internal’ incorporation of the rules has not yet been achieved; while pre-conventional morality (I want it) is typical of psychopaths and ‘hard skin’ narcissists. Conventional morality involves the fear of losing the appreciation of the significant other.


CONCLUSIONS

Freud sometimes managed the conception of an unconscious subject relatively isolated from his environment, a solipsistic ego under the control of primary narcissism.  Fonagy doesn’t maintain, fortunately, such classical concepts as ‘primary narcissism’ or the drive/instinct theory, but gets trapped if not on the Cartesian thought at least in some form of the "official doctrine" language. For instance when we read: ‘[Small] Children  do not know fully that they are separate, that their internal world is something private and individual, of which they will eventually take ownership or at least claim privileged access.’ (Fonagy, 2008, id. p. 31)
The mind is not born with the individual but develops in the context of human interaction and the mind is not only internal but also external, mainly external, that is, the pragmatic context of interpersonal relationships. The internal space is something that is created, as we can see, for example, in the description supplied by Vygotsky (1977) of how the egocentric speech is built, as an intermediate phase or ‘transition’ between the external language (social) and inner speech, when the child is talking to himself, for example, explaining the actions of his game, for anyone but himself, but aloud.
Morris Eagle (2011, p. 170), not long ago, said that in the current psychoanalytic literature representations are unconscious not only because they are defensive processes but because they have been acquired nonverbally in the early stages of life. He is referring to the procedural unconscious (Cf. Lyons-Ruth, 1999). However, when he added, correctly, that these representations are similar to the habits and motoric skills incorporated into the body, why continue to maintain that they are ‘representations’? Human beings, like any organism, behaves usually following a sequence of acts, that sequence can be represented by a scheme or script, the script is a reconstruction we make ourselves and don’t have to be ‘represented’ in any way within the body or the brain.
As Knoblauch (2000, p. 158) states, affects are not in the person but are continually built as an emotional field that slides between people who are influencing each other. What the person performs in practice are operational schemes, learned in context, and not internal images.
What goes on within also has meaning only in the stream of life. (Auch was im Innern vorghet hat nur im Fluss des Lebens Bedeutung) (Wittgenstein, 1951, II, p.30).

Errors arise from our tendency to give a value per se to these internal images, when in fact the internal image has stability only if contrasted with the use (Wittgenstein 1945-48, § 258, § 293, II, p.196/451). Whoever becomes blind, after some time, loses the ability to represent the world in visual images. For Wittgenstein the essential postulate are not representational systems, but interpersonal communication.        
There is no difficulty for me to recognize that the theory of mentalization provides an integrative framework that could constitute the ‘common language’ Fonagy and Allison (2014, p. 375) suggest. They propose mentalization; other experts highlight other concepts: attachment, empathy, recognition, etc. Anyway Fonagy and Allison are right when state that a key factor is:
… the patient’s experience of another person having the patients mind in mind, and that therapy (…) works by reviving the patient’s capacity to interpret behaviour as motivated by mental states, both in themselves and in others. (emphasis added)

Whenever we understand that ‘having the patients mind in mind’ is equivalent to empathy and recognition, and that the patient’s capacity to ‘interpret behavior as motivated by mental states’ could be substituted by ‘agency’. Then my conclusion is that our differences could be in a great proportion merely question of language, a confusion of tongues. But nonetheless I fear that some of the expressions found in Fonagy’s texts may encourage in some novice therapist to assume an authoritarian or dogmatic attitude.
Someday we will have to spend no small time to resolve the issue of the representation, and its central role in contemporary psychology, not only in its cognitive versions.



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