Mentalizing Family Violence Part 2: Techniques and Interventions

• DOI: http://doi.org/10.1111/famp.12276
• Date: 01 March 2017
• Author: Eia Asen,Peter Fonagy
• Published date: 01 March 2017

Mentalizing Family Violence Part 2: Techniques and

Interventions

EIA ASEN*

PETER FONAGY*

This is the second of two companion papers that provide an overview of mentali-

zation-based concepts and techniques when working with the seeming “mindlessness” of

intra-family violence. The focus of this paper is on general mentalization-oriented

approaches and specific interventions that aim to (1) disrupt the non-mentalizing cycles

that can generate intra-family violence and (2) encourage the emergence of patterns of

family interactions that provide the foundation for non-violent alternatives. Various

playful exercises and activities are described, including the taking of “mental state

snapshots” and “selfies” in sessions and staging inverted role-plays, as well as using

theatrical masks and creating body–mind maps and scans. These can make “chronic”

relationship issues come alive in session and permit “here and now” experiences that

generate a safe context for mentalizing to take place. At the core of the work is the con-

tinuous focus on integrating experience and reflection. Without acute awarene ss of the

thoughts and feelings occurring in the sessions, mere reflection is not likely to enable

change. By increasing mentalizing in the family system, family members’ trusting atti-

tudes grow, both within and outside the family.

Keywords: Mentalizing; Mentalization-Based Approach; Violence; Family

Fam Proc 56:22–44, 2017

The seeming “mindlessness” of family violence has many roots, but high levels of arou-

sal and the disruption of mentalizing capacities in the context of attachment relation-

ships may represent a major common pathway (Asen & Fonagy, 2012a,b). In our

companion paper in this issue (Asen & Fonagy, 2017), we have suggested that in order to

reduce aggressive behavior and intra-family violence, it is necessary to systematically

increase concern with mental states among family members. We laid out the argument

that violent families are often characterized by a pattern of attachment difficulties, sud-

den high levels of arousal, and poor affect control, which can lead to a collapse in

*Anna Freud National Centre for Children and Families, London, UK.

†

Research Department of Clinical, Educational and Health Psychology, University College London (UCL), Lon-

don, UK.

Correspondence concerning this article should be addressed to Peter Fonagy, Research Department of

Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place,

London WC1E 7HB, UK. E-mail: p.fonagy@ucl.ac.uk.

Peter Fonagy is in receipt of funding from the U.K. National Institute for Health Research Senior Inves-

tigator Award (NIHR) NF-SI-0514-10157. Peter Fonagy was in part supported by the NIHR Collaboration

for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS

Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the

Department of Health. The authors wish to acknowledge Dr. Chloe Campbell for her creative and wise

contributions to previous drafts of the manuscript, and the anonymous referees of the paper, for their help-

ful comments.

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Family Process, Vol. 56, No. 1, 2017 ©2017 Family Process Institute

doi: 10.1111/famp.12276

mentalizing capacity: We posited that physically violent acts are in most cases only possi-

ble in situations where mentalizing has broken down or become highly unbalanced and

distorted.

Mentalizing is a verb referring to the process of perceiving and interpreting human

behavior in terms of intentional mental states such as feelings, needs, reasons, or

purposes. The capacity to mentalize has both state and trait aspects which can vary

depending on the level of emotional arousal and interpersonal context. The chronic and

repeated breaking down of mentalizing in a family context, we have argued, blocks the

channels of social learning and epistemic trust, which may be a factor in the intergenera-

tional transmission of patterns of violence (Asen & Fonagy, 2017). A major objective of

mentalization-oriented family work is to enhance and maintain mentalizing during the

emotionally highly charged family discourse that often triggers and sustains intra-family

violence. The ultimate objective of therapeutic intervention is to help family members to

mentalize the precipitants of violent encounters, and the emerging dynamics and interac-

tions that produce violent reaction. The focus of work is on the contexts that generate the

specific feelings, needs, desires, beliefs, and thoughts that may contribute to the collapse

of mentalizing. The goal is to disrupt the feedback cycle of non-mentalizing that generates

aggressive and destructive interactions between family members. Just as the cycle of non-

mentalizing creates a high-risk background for physical acts to replace mental state dis-

course, so the building of mentalizing in the family system can become part of a virtuous

cycle where the mentalizing of some individuals in the family (even the youngest ones)

can spur the general family discourse to a more robust level so that the systemic risk of a

collapse in mentalizing becomes reduced.

The families for which this model was developed present with severe forms of emo-

tional, sexual, or physical abuse and often in the context of high levels of conflict between

caregiving adults—namely domestic violence and intimate partner violence. Inevitably,

child protection agencies are involved when children are at risk of abuse, or are known to

have suffered maltreatment. Rarely are these cases ones where maltreatment is discov-

ered in the course of therapy. Normally, violence in the family is the reason for referral.

The clinical issue of intimate partner violence is already well covered in the systemic fam-

ily therapy literature (e.g. Vetere & Cooper, 2001), notably by Virginia Goldner (1998,

2004). Our focus is overlapping; it frequently involves domestic violence, but is particu-

larly concerned with the impact of family violence on children.

The techniques we consider below are in no sense “new” or even “novel.” They are a col-

lection of methods and practices that many therapists use along with other traditio n- and

theory-driven actions (e.g. Chasin, Roth, & Bograd, 1989; Lund, Zimmerman, & Haddock,

2002; Tomm, Hoyt, & Madigan, 1988; White, 1988). The mentalizing strategies we

describe cannot be regarded as a new “modality” of intervention. Although new framings

of problematic situations can prompt fresh techniques, these, in our view, are comfortably

accommodated within existing systemic theories and practices, provided there is sufficient

flexibility on the part of the “gatekeepers” of relevant professional associations.

Here, we simply enumerate a number of general approaches and specific interventions

which have in common a high likelihood of effectively disrupting the non-mentalizing cycles

that can generate intra-family violence, and encouraging patterns of familyinteractions that

provide the bases for non-violent alternatives. While the techniques may not be new

(although we believe some of them may bear some marks of originality), the “collection”

stands out by focusing specifically on the most fundamental of human capacities: mentaliz-

ing. We anticipate the common reaction of the reader to be “Well, I do these things already!”

to which we might retort: “That is wonderful, just do more of it!” Discovering mentalizing in

Fam. Proc., Vol. 56, March, 2017

ASEN & FONAGY

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