Extract from Tavistock Relationships' Book; Engaging Couples: New Approaches to Working Therapeutically with Families, by Andrew Balfour, Christopher Clulow and Kate Thompson
Description of the overall treatment and discussing the concept of contaiment
Mentalization-based treatment (MBT) is a form of psychodynamic psychotherapy which has been developed and manualised by Peter Fonagy and Anthony Bateman (Bateman & Fonagy 2012, 2016 ). It was originally designed for individuals with borderline personality disorder (BPD). In the course of the past decade the use of the MBT approach has widened and is now used in a variety of settings, as well as within different modalities, including short-term interventions. It is being applied to a range of diagnostic categories such as depression, eating disorders, addiction and trauma (Fonagy & Bateman 2012).
The adult intimate couple relationship can be conceptualised as an emotional container for the two partners, and it is often when the relationship has failed to function as a psychological container that a couple will look for help. One couple, attending a first consultation, describe how the state of their relationship feels like “being in a house where the roof had fallen in”. In itself, this description indicates a couple capable of a degree of mentalizing and symbolic thinking as they can conceptualize the emotional state of feeling trapped under dangerous circumstances. Nevertheless, the image speaks to the terror of being ensnared in an intimate relationship where the containing function is missing. The example with Carrie and Nick illustrates how for some couples an argument about fizzy drinks can be experienced as if 'the roof falls in' in the way it stirs up unmanageable feelings around the couple's different ways of parenting. When the internal space to manage and contain is absent it leaves “people with no choice but to use the external space they live in...” (Ruszczynski 2012, p.141). Whatever the presenting problem, individuals within a couple relationship are often seeking help to address overwhelming anxiety, or unbearable psychic pain. It is not only that the couple have difficulties, but that their central problem is being unable to find a way to talk about them (Morgan 2017, in press).
The aim of MBT-CT intervention is to enable couples increasingly to be able to regulate the affect between them, as well as within themselves, so that the relationship can be experienced as a potentially containing and benign resource rather than as a state which threatens the stability of their minds. In the overlap between MBT-CT and a psychoanalytic understanding of containment, it is evident that when someone is feeling contained this in itself fosters mentalizing. Conversely, when it is missing, the couple's joint affect dysregulation disrupts any potential containing function that the relationship might offer. If emotional states are contained the couple is able to think differently, and if they can think differently the couple may also be more contained. Although old wounds and traumatic experiences cannot be undone, the adult couple relationship holds within it the possibility of a different experience, and this speaks to the potentially benign cycle that may develop in a couple relationship, and the centrality of containment in understanding the couple relationship.
A person’s facility to provide containment relies in part on the capacity for curiosity about other’s mental states, to ‘read’ one’s own and others’ psychic processes. A mind which is characterized by a limited capacity for containment will also manifest a deficit in curiosity, as well as being unable to provide containment for levels of anxiety aroused by the attachment and proximity in an intimate relationship. This can lead to the development of a more fundamentalist state of mind where perceived solutions are often omnipotent and where differences between the partners challenges certainty and hence are perceived as a threat. In psychoanalytic theory this state of mind is understood as being characterized by unconscious paranoid-schizoid anxieties (Klein 1946). When a couple is able to challenge and dislodge some of their fixed ideas of who the other partner 'ought' to be, and instead can be curious about the other, this provides the basis for a relationship which potentially offers emotional containment.
To find out about how we deliver our work with couples and individuals in this way, contact Honor.Rhodes@TavistockRelationships.org