Keeping Culture in Mind: Mentalizing from a Cross-Cultural Perspective

Mentalizing is the psychological capacity to reflect and understand behavior in terms of internal mental states, such as thoughts, feelings, and intentions (Fonagy, Gergely, Jurist, & Target, 2002). A rapidly growing body of empirical evidence supports the notion that deficient mentalizing is a psychological mechanism underlying various psychopathologies (Katznelson, 2014); likewise, the promotion of mentalizing is seen as a common factor of treatment across different therapeutic approaches (Fonagy & Allison, 2014; Bateman et al., 2018). Nevertheless, mentalizing has yet to be examined from a cross-cultural perspective. In our recently published article in Clinical Psychology: Science and Practice, we aimed to raise awareness for this disparity, and to offer an initial understanding of mentalizing from a cross-cultural perspective.

To this end, we first outline a conceptual framework for the understanding of mentalizing from a cross-cultural perspective in the context of the universalism–relativism debate. Then, we systematically review cross-cultural studies of five concepts that overlap with mentalizing: Theory of Mind, empathy, perspective-taking, alexithymia, and mindfulness. Since mentalizing is seen as a broad, multidimensional construct (e.g., self and other mentalizing, addressing the metacognitive thinking processes that enable thinking about one’s own mental states, alongside one’s ability to perceive the mental states of others; Choi-Kain & Gunderson, 2008), we synthesize the results while addressing the unique overlap each of these concepts has with mentalizing. By doing so, we were able to address mentalizing profiles – namely, the set of strengths and weaknesses regarding each dimension of mentalizing – across different cultures.

The results, which are based on healthy, sub-clinical, and clinical samples investigated across more than 45cultures, led us to draw several conclusions. First, it seems that mentalizing profiles may vary between cultures (e.g., self > other mentalizing in individualistic cultures, self < other mentalizing in collectivistic cultures). Second, there seem to be several mediating factors for the relationship between culture and mentalizing, including linguistic factors, value preferences, and parenting characteristics. Finally, the data suggests a universality of the link between mentalizing and mental health; however, the supporting evidence is preliminary and methodologically limited, thus pointing to a strong need for further research on the relationship between mentalizing and mental health across cultures.

We conclude our article by addressing several points of interest on a theoretical, empirical, and clinical level. From a theoretical standpoint, an intermediate approach that transcends the two sides of the universalism–relativism debate appears to provide a useful conceptual framework for understanding mentalization cross-culturally. Contrary to a relativist view of mentalizing, this intermediate perspective sees the importance of mentalizing as universal, yet in contrast to a purely universalistic view, it suggests that different dimensions of mentalizing may be more prominent in different cultures. From an empirical standpoint, we address several methodological considerations for further research. Most importantly, we emphasize the need for studies on mentalizing in clinical samples across different cultures, using a multi-method approach, and by paying specific attention to a rigorous cultural adaptation of measures. Concerning the latter, we offer several practical recommendations.

Lastly, from a clinical standpoint, we offer some preliminary clinical implications. We encourage clinicians to consider clients’ cultural background when addressing the mentalizing capacity of their clients. As mentalizing profile should be understood with reference to clients’ cultural background (e.g., lower self-mentalizing in collectivistic cultures), it should not be automatically equated with pathology. Furthermore, from our own clinical experience in working with clients from traditional and collectivistic societies, we have learned that an invitation to focus on thoughts and feelings – particularly, regarding attachment figures – can sometimes be experienced by clients as far from their world, irrelevant, or even offensive. In other words, culturally insensitive mentalistic talk can make it difficult to establish epistemic trust (Fonagy & Allison, 2014), as it can be seen as a violation of filial respect. We therefore suggest that we need to adopt a general stance of awareness about cultural aspects of mentalizing in practice. Similar to the hallmarks of good mentalizing – a non-egocentric stance, that acknowledges that people’s minds are basically opaque, yet characterized by interest and curiosity towards others’ thoughts and feelings (Fonagy, Target, Steele, & Steele, 1998) – we offer to adopt a non-ethnocentric approach, that is aware of its limited perspective, yet curious about clients’ unique cultural meanings concerning mentalizing.

 Discussion Questions

  • In what ways can we adopt a general stance of awarenessabout cultural aspects of mentalizing in our practice?
  • How can we expand our understanding of mentalizing – in particular, its relationship with psychopathology – beyond WEIRD samples (i.e., Western, Educated, Industrialized, Rich, and Democratic; Henrich, Heine, and Norenzayan, 2010) in our research?

Author Bio

Erez Aival-Naveh is a PhD candidate in clinical psychology at the University of Haifa, and a clinical psychology intern at the Ha’amakim Community Mental-Health Center, Israel. His PhD focuses on the interplay between culture, mentalizing, and psychopathology.

Lily Rothschild-Yakar received her PhD in psychology from the University of Haifa and is currently a Clinical Professor there. She is a senior clinical psychologist. Her expertise covers several overlapping domains: personality assessment, psychopathology, and mentalizing. Her recent studies focused on understanding the dynamics of eating disorders, somatic symptom disorders, and ADHD from the developmental aspect of mentalizing and social cognition.

Jenny Kurman received her PhD in psychology from the University of Haifa and is currently a professor there. Her main research interests concern the intersection between self and culture (i.e., self-enhancement, self-regulation, and control strategies from cultural aspects). Some of her studies deal with various aspects of minorities in Israel, among them identity issues, stereotype threat, and well-being.

 

Reference article

Aival-Naveh, E., Rothschild‐Yakar, L., & Kurman, J. (2019). Keeping culture in mind: A systematic review and initial conceptualization of mentalizing from a cross‐cultural perspective. Clinical Psychology: Science and Practice, e12300. https ://doi. org/10.1111/cpsp.12300. 

References

Bateman, A., Campbell, C., Luyten, P., & Fonagy, P. (2018). A mentalization-based approach to common factors in the treatment of borderline personality disorder. Current opinion in psychology21, 44-49. https://doi.org/10.1016/j.copsyc.2017.09.005.

Choi-Kain, L. W., & Gunderson, J. G. (2008). Mentalization: Ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry165(9), 1127-1135. https ://doi.org/10.1176/appi.ajp.2008.07081360.

Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy51(3), 372. https ://doi.org/10.1037/a0036505.

Fonagy, P. Gergely, G., Jurist, E., & Target, M.  (2002). Affect regulation, mentalization and the development of the self. New York: Routledge.

Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-functioning manual, version 5.0, for application to adult attachment interviews. London: University College London.

Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world?. Behavioral and brain sciences33(2-3), 61-83. https://doi.org/10.1017/S0140525X0999152X.

Katznelson, H. (2014). Reflective functioning: A review. Clinical Psychology Review34(2), 107-117.‏ https ://doi.org/10.1016/j. cpr.2013.12.003.

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