Mentalization is seeing yourself and others as people with minds, and it grows from repeatedly having someone attend to your inner experience and give it back in words you can accept. If you cannot understand what is going on inside yourself, you cannot understand what is going on inside someone else. Compromised mentalization is a marker of severe personality impairment.
What it is
Ask how often in someone's life another person has carefully attended to their inner experience and communicated it back in a way they could accept. That is where the capacity comes from.
“how often in your life has someone carefully listened to and paid attention to your internal experiences and then communicated their findings back to you in a way that you can accept”
38:07The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 If you cannot understand what is going on inside yourself, there is no way you will understand what may be going on inside someone else.
“if you can't understand what's going on inside yourself, there is no way that you're going to be able to understand what's going on potentially inside of somebody else”
40:27The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 A developmental milestone is seeing that two other people can have something between them that is not about you: a triumph over the egocentrism of the early years.
“they have reached a developmental level of being able to see that there's something between these two that's not about them. So it's a triumph over the egocentrism of the younger years”
1:46:34Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode Without reaching that stage, people tend to feel only one side of a relationship at a time, which creates a lot of trouble.
“if you don't get to the Oedipal phase, you tend to feel only one side of that kind of thing at a time, which can create a lot of trouble for you”
1:49:32Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024Guest episode
In assessment
In severe personality impairment, the capacity for positive, enduring connection is significantly impaired, with on-and-off relationships: dropping people for years, then intense involvement again.
“the capacity for positive and enduring connections is significantly impaired. This is when you see the on and off again kind of quality to the relationships, right? Dropping some people even for years and then intensely being involved with them”
59:53Assessment of Personality: Practical Assessment in a Short TimeframeMay 2025
It also comes up on
- Borderline personality disorderThe APA now says there is good evidence for transference-focused psychotherapy, mentalization-based therapy and good psychiatric management. More important than the specific model is that the patient is in a talk therapy they commit to.
- AutismTheory of mind problems are common, but their source and how they show up differ from the mentalization problems of personality disorders.
- PsychotherapyModerate to severe borderline conditions should ideally be in weekly psychotherapy, though community resources are limited. Beyond DBT, there is good evidence for transference-focused psychotherapy, mentalization-based therapy and good psychiatric management.
From these episodes
- The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025 · 2 points
- Assessment of Personality: Practical Assessment in a Short TimeframeMay 2025 · 1 point
- Nancy McWilliams on Psychoanalytic Diagnoses, Part 2: Depressive Personality, Histrionic Personality, OCPDNov 2024 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.