Push and Pull: Role of Therapist Mentalizing in Navigating Therapeutic Distance.

ABSTRACT

In the relational playground of psychotherapy, negotiating therapeutic distance is crucial for the process as well as the outcome of treatment. The challenge of navigating this closeness and distance may be accentuated during emotionally charged interactions in therapy. Therapist and client may get locked in complementary, rigid positions, leading to either submission or resistance to the others' demands. The therapist's ability to respond appropriately to these pushes and pulls is supported by their ability to mentalize, which is their ability to attend to and understand their own states of mind while being aware of others' states of mind. Therapists are expected to maintain a mentalizing stance throughout and despite the relevance and impact of therapist mentalization, there is relatively less research, training, or practice-related guidance on how to maintain this balance. We use case illustrations to demonstrate therapeutic interactions that can trigger non-mentalizing for the therapist and reflect on ways of recognizing and addressing these patterns related to closeness and distance. We also share recommendations for reflective practice and supervision, training as well as research on therapist mentalization.