To avoid bullshitting in psychotherapy we must mentalize

by Jon G. Allen, PhD on January 20, 2011 · 15 comments

in mentalizing

If a distinguished Princeton philosopher can write a (small) treatise on it, I think we clinicians are entitled to use the word “bullshit” as a technical term rather than relegating it to the bin of vulgarities. Harry Frankfurt’s book, On Bullshit, is a gem. We can understand bullshitting best by contrasting it with lying. Lying requires a keen concern for the truth; to pull off a lie, you must be aware of the other person’s factual knowledge and tailor your lie accordingly. Bullshitting is marked by a lack of concern with truth—spinning a yarn for the sake of spinning a yarn, without concern about concealing or revealing anything real.

What does bullshitting have to do with psychotherapy?

Here’s what grabbed my attention. Frankfurt pointed out that politicians often are at risk for bullshitting, because they are asked a wide range of questions to which they could not possibly have all the answers. I immediately realized that the same is true for psychotherapists:

“How long will it take me to pull out of this depression?”

“Should I go through with the divorce?”

“Should I give up on reconciling with my mother?”

“Do these images that keep coming to mind mean that I was really sexually abused, even though I can’t remember it?”

Therapists who strive to answer such questions with any sense of certainty put themselves at risk for bullshitting.

But patients as well as therapists are liable to bullshit in psychotherapy—to their own detriment. For example, avoiding painful experiences and conflicts, patients may talk in elaborate detail about relatively minor or peripheral concerns. Or they may gloss over serious problems such as self-destructive behavior with flippant remarks. More rarely, patients may strive to entertain therapists with their exploits.

Making strides with mentalizing

Here we need to bring in the concept of mentalizing, that is, being aware of mental states such as thoughts, feelings, and desires in yourself and others—and interpreting behavior accordingly. If you were sitting with a friend at a coffee shop and she suddenly bolted out of her chair, you couldn’t help mentalizing because you’d immediately start trying to figure out what’s going on in her mind.

Mentalizing involves empathy, not only for others but also for oneself. And what makes mentalizing “real” is emotional authenticity, a feeling of conviction, anchored in reality. Our colleague, British psychoanalyst and attachment researcher Peter Fonagy, PhD, pioneered our understanding of mentalizing. He distinguishes the “mentalizing mode” of functioning from the “pretend mode,” where ideas are no longer grounded in reality—reality doesn’t matter. After reading Frankfurt’s little book, it occurred to me that “bullshitting” is plainer language for the pretend mode as it pertains to psychotherapy. For this reason, we put a section on bullshitting in our book, Mentalizing in Clinical Practice, which I am reiterating here for a more general audience.

Psychobabble

Here’s my worry about psychotherapy: we can engage in bullshitting without being aware of it. All of us, patients and therapists, can engage in “psychobabble,” that is, using jargon and well-worn clichés. We have psychology texts and self-help books filling shelf after shelf, and we can easily parrot concepts and lines from these. “I have a self-esteem problem.” “My inner child is feeling abandoned.” And we can use diagnostic terms in the same way: “What else would you expect me to do in that situation? Don’t you know I’m borderline?!”

Blatant psychobabble isn’t a major problem, because it’s easy to detect. A more significant problem is bullshitting and not knowing that you’re doing it. Detecting bullshitting, in oneself or another person, requires mentalizing: Is what we’re talking about sincere, real, significant, authentic? Most important, will this conversation make any difference? Bullshitting in psychotherapy in any form risks wasting time and money, where the patient and the therapist have the illusion of doing real work and yet nothing changes.

Frankfurt makes a final point about bullshitting that is worthy of a Zen master. We call mentalizing a not-knowing stance. That is, we can never know with any certainty what’s in another person’s mind. Moreover, we cannot know with certainty what’s in our own mind. Our conscious experience is a mere glimpse of the working of our mind—often enough, we speculate about the reasons for our actions. Thus I leave you to ponder Frankfurt’s paradox and its implication for detecting bullshitting: to quote him, “Sincerity itself is bullshit.”

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{ 15 comments… read them below or add one }

Dan February 6, 2014 at 9:49 pm

Psychotherapy is arguably the worst thing to ever happen to the world. We’ve had over one hundred years of it and the world is not the better for it. There are a multitude of reasons for this, but the simplest way to understand it is that the therapeutic relationship is entirely unnatural. It is one-way intimacy.

Most people who go to therapy have problems forming and/or maintaining intimate relationships. I don’t mean sexual relationships per se, though these are often an issue, rather I mean any sort of significant friendships. Relationships are a mutual give and take, and this is obviously not what occurs in a therapeutic relationship. The only way to experience mutual reciprocity in relationships is to go out and do it. Unfortunately, once exposed to therapy, it is that much harder for people to do this, because the contrived therapeutic environment takes away from a person’s ability to be natural.

The simple fact is that most people who go into therapy have problems with relationships and many people who are exposed to therapy often end up going into the field themselves because it becomes the only way they know how to relate to the world. It is, in essence, a self-affirming environment.

For more, please see: http://www.criticalmethods.org/hook.htm

And: http://trytherapyfree.wordpress.com/

Cristalexi December 16, 2013 at 4:46 am

In response to Sara’s comments about therapists restricting and controlling patients like children, I’ve got news for you: these people treat EVERYONE THEY SEE AS HAVING AUTHORITY OVER like that. I have contact with psychotherapists in a work capacity and it appears to me that they are incapable of conversing without giving an instruction. I’m a very competent person and am perfectly good at making decisions where my work is concerned but they HAVE to give me instructions, even though they are clueless in my area of expertise, so their instructions are always bullshit. When I call them out on it they get defensive, and indignant that I have questioned their authority; then dismiss me like a child. This mentalizing is what they are teaching the clients here and recently the mindfulness too but as far as I can see they don’t practice it themselves.

Vicki September 11, 2013 at 11:48 pm

Depacote and the other powerful psych drugs (librium, lithium derivitive, prozac), dubbed, “heavy hitters”, made my hair fall out, sick to my stomach and contributed to memory loss; lots of enticement to stay on them, eh?

My doc even admitted that she was at a loss and was only prescribing them cause couldnt find the correct insurance code to give me anything else. Needless to say, did not continue meds or visits with her.

Cognitive behavorial therapy seemed like best track for awhile but $30k comes quickly. Then you have used all your benefits and shown the door.

Would like to see here if anyone has suggestions or thoughts as to where to find help. I gave up cause have no money and now apprehensive about even approaching subject. Easier to just be thought strange and still have a roof over head.

any ideas?

Georgina Pilkington February 26, 2013 at 6:47 am

the idea of not-knowing is the right stance for good therapy to happen in my view. i never know what i don’t know yet.

Barbara, RN July 25, 2012 at 3:39 pm

If you are reading this, Sara, I am sorry for you to have had a bad experience as you described. You did get 2 supportive responses from Ravi and Dr. Shelly Hayes, MD about the importance of being able to say I don’t know. Actually, I do know why Q-tips probably aren’t allowed because I happened to have had a patient once who punctured his eardrum with one. But if I didn’t know why I would certainly tell you that I don’t know but it is against the rules and you are right: it’s not a sharp. You did say that there was a total unwillingness on the part of most of the staff to participate in a dialogue with patients. You could be very helpful if you explain what it was about the few staff who were willing to listen and respond to you in a helpful way. Like an example of an issue that was positive just as you gave examples of the negative. Thanks if you are reading this for giving an honest perspective of your experience.

shame on me shame on you November 15, 2011 at 3:36 pm

I ENJOY READING THE COMMENTS BY THESE WONDERFUL AND CARING PEOPLE ON THIS MESSAGE FORMAT !!! JAN, THANKS TO YOU FOR EXPLAINING STUFF. I HAVE BEEN TO 3 INPATIENT (MENTAL ILLNESS) HOSPITALS AND 2 OUTPATIENT. I WAS ALL MESSED UP ON PSYCODELIC DRUGS (18-22 YRS.). I DID STOP THAT HOLE-OF-DEPRESSION-CAUSING LIFESTYLE IN 1985, THANK GOODNESS. NOW, I AM ON DEPACOTE, LAMICTAL, RISPERDOL, AND CYMBALTA. I KNOW I AM MENTALLY/PHYSICALLY ADDICTED TO THESE AWFUL SUBSTANCES. MY PSYCHE TELLS ME: IF YOU DON’T TAKE CONTROL OF YOUR LIFE (EXTREMELY MENTAL DETACHMENT), YOU NEED THESE SUBSTANCES TO HELP YOUR MIND-STABILIZE-AND-GAIN EMPOWERMENT OVER THESE MENTAL CONDITIONS. NOW, I REALIZE MOST OF YOU PROBABLY DON’T TAKE PRESCRIPTIONS AND CAN YOU INFORM ME HOW YOU SURVIVE WITHOUT THEM !!!

shame on me shame on you November 15, 2011 at 3:18 pm

FOUND OUT, IN 2001, THAT I WAS BIPOLAR. IT WAS LATER DETERMINED THAT I ALSO HAVE SCHIZOAFFECTIVE DISORDER AND A PERSONALITY DISORDER. THIS WAS DETERMINED BY MY PSYCHE. I’D HAVE ALWAY BEEN A (LIT FIRECRACKER) AT THE ONLY TWO JOBS I’D HAD FOR 28 YRS. I WAS ARGUMENTATIVE WITH CO-WORERS UNDER ME. (I MEAN: UNDER MY THUMB). IN BOTH JOBS I WORKED AS AN EXECUTIVE AND ADMINISTRATIVE ASSISTANT TO ( 2 PRESIDENTS/VICE PRESIDENTS) , I WAS ALSO IN CHARGE OVER ALL SALESMEN/STAFF AND WAS IN CHARGE OF ALL ACTIVITIES COM. I WAS A PROFESSIONAL PHOTOGRAPHER. I WAS ALWAYS COMPLAINING AND A TATTLE (TALE). WHAT I WANT TO SAY IN THIS COMMENT IS THAT I SURVIVE NOW (I DON’T WORK ANYMORE BECAUSE I HAVE THESE DISABILITIES AND CAN’T STAND BEING AROUND PEOPLE. I AM ON DISABILITY/SOCIAL SECURITY. MY PSYCHE TELLS ME TO GO OUTSIDE INTO THE WORLD (GOIN A CLUB, GET SOME SUN AND FRESH AIR, GET MY DRIVER’S LICENCE, TRY AND MAKE SOME FRIENDS, LEARN HOW TO COPE WITH MY STRESS OF LIFE). I AM TRYING TO LEARN TO GET TO KNOW MY POSITIVE ATTRIBUTES AND A SENSE OF WELL-BEING.

OH WELL, THANKS FOR GIVING ME THE OPPORTUNITY TO COMMENT HERE. BYE, BYE, BYE !!

Jan November 10, 2011 at 1:53 pm

After reading the above, I have to add my thoughts. In the last 14 months, I spent 7 of those months in Menninger. It was a catastrophic year for me. I also had bilateral total hip replacements when I was not at Menninger.

I lost my job due to absence and I am currently in the phase of rebuilding my life.

No psychiatric hospital is about the space. It is about the people. If you choose as a patient to be ruthlessly honest about what is going on inside of you, then you can get the help you need. If, however, you only tell them half-truths and part of the story, you won’t get much out of it. That is bullshitting.

At Menninger, only one of my providers seemed to lack empathy. The rest, my personal psychologist, social worker, psychiatrist and my personal RN truly cared and worked hard with me to help me get through my extremely severe suicidal depression. Without Menninger and the people there, I am certain that I would not be here today.

In particular, Dr. Tom Ellis, Dr. Jon Allen, Dr. Kayatekin, Eric Cool, RN and Jennifer, LISW were crucial in my healing.

REgarding mentalizing, in my first class with Dr. Allen, I called the word mentalizing an abomination of the English language. I learned that this horrendous word is actually in the dictionary. DBT has it’s own version of the word. In DBT it is being mindful of what you and others say in order to be able to validate each other and communicate in a equitable way. Mentalizing takes it one step further. Mentalizing literally means getting our of your own body and watching the interaction from a detached gently curious point of view and using that view to help us be aware of what we are thinking and feeling and helps us to communicate with others.

Mentalizing and writing stories about others’ fictional lives in that context was very helpful.

Mentalizing turned my past experience of therapy which was psychobabble that got me nowhere into a healing experience. Most of all learning about CBT with my psychologist did literally save my life.

Kent Roberts October 11, 2011 at 7:18 pm

I’m thinking about Sara’s post on October 4, 2011 at 11:11 pm

I’m saddened by your post. It sounds like your experience at Menninger ended with you being worse off than when you began. I hope your life has improved since then!

“Mentalizing”/”Psychobabble”
It’s not the name we give to a concept that’s important. It’s understanding what it means and how to apply it that counts. It’s much more productive to explore the use and application of the concept than it is to rant about its name or its misapplication.

Why give the concept of “mentalizing” a name in the first place? We humans need a name or word for everything. It creates vocabulary. We come to understand things through education. Education is nothing more than expanding our vocabulary with concentrated attention to the meaning of certain words.

Want to become an engineer? Study things that allow you to understand words like hydrology, adiabatic process, bending moment, shear, physics, calculus, etc. With the right mix of expanded vocabulary you will succeed in becoming an engineer.

“Release from prison”
Your comparison of a patient to a criminal after release fails to recognize at least one important difference between each one’s lot in life after release. The Menninger patient has the benefit of a program that includes the patient’s personal support group such as family and friends. This group is included from the beginning of treatment until release. They’re educated and coached in how to help the patient adjust after release. They’re encouraged to grasp the concept of “mentalizing”. They’re also encouraged to practice it for themselves. After release, this support group, plus ongoing sessions of therapy, is there to help the patient navigate their way back into everyday life.

I’m not sure what they named the concepts that were used on me 18 years ago. BUT THAT “PSYCHOBABBLE” SAVED MY LIFE!

Cara October 8, 2011 at 2:32 pm

It seems to me that “mentalizing” could just as easily be called “being present and aware”, or otherwise named by other DBT concepts. Why such a big long spiel about mentalizing (and why an entire book about it??).

Yes, people do often fool themselves in the depth of a psychological illness. I would theorize that this is rather inherent in many illnesses, especially in those like schizophrenia, personality disorders, PTSD, and eating disorders. Nobody wants to face all the horrible demons they carry inside themselves. Which is why it’s the therapist’s job to be able to see through layers, or masks (which I would call it rather than ‘bullshit’, as calling them ‘bullshit’ is very pejorative and negative), or schemas, or whatever other non-derogatory name you’d like to put on it. And it’s the therapist’s job to try and make the patient aware of such schemas, by communicating in a way that actually gets through to each particular patient.

Sara October 4, 2011 at 11:11 pm

In this case, “sincerity” itself is bullshit.

I personally experienced three months of Menninger, from the other side of the locked door as the writer. In my experience, there was very little actual empathy for patients; there was a total unwillingness on the part of most of the staff to participate in a dialogue with patients. Empathy cannot exist if you are not even willing to listen.

You want to talk about not bullshitting as treaters, about not wanting to engage in psychobabble–but your post uses a common bit of Menninger psychobabble, “mentalizing.” Even if you link to another post that attempts to define it, it’s still your own invented psychobabble. It’s even a post that the writer himself also authored. This is an excellent example of the hamster-wheel logic pervasively used at Menninger: you run around and around and around, but you never get anywhere.

“Safety” is another example of the psychobabble Menninger employs. Patients are heavily restricted and told it’s “for everyone’s safety.” On the surface, this seems to make sense–but scratch beneath the surface of that thin Menninger veneer and it becomes nonsensical. If you take away from patients anything with which they could possibly harm themselves or others, how are they going to learn to regulate the emotional states that cause those harmful behaviors? It’s similar to the problem faced by many people upon release from prison: they’ve been controlled, not rehabilitated, so once they’re free again, in an environment where many potential weapons are available, they tend to repeat the harmful behaviors because external regulation has not taught them internal regulation.

But if a patient dares to question why they are not allowed to have, say, a Q-tip (and yes, these were actually taken away because they were classified as “sharps”), the only answer they’ll get is “We’ve had a problem with it in the past. It’s a safety concern.” This seems to make sense at first, but one must examine it beneath the surface level.

Part of Merriam-Webster’s definition of “safe” is “not likely to be harmed or lost.” What are patients losing when the people they look to for help treat them like children and criminals? What are patients losing when they’re locked in an insular, Orwellian world where they must constantly watch every word and motion because doing the “wrong” thing brings infantilizing punishment?

I lost a lot at Menninger. I lost being treated as a competent adult. I lost the decision to make any meaningful decisions about my daily life. I lost faith in the people I’d expected to help and support me in my efforts to put my life back together. Most importantly, I lost hope.

That, to me, is the very opposite of “safe.”

My diagnosis: Menninger’s “empathy” is bullshit, and their writing about combating their internal psychobabble is bullshit.

AGuerra January 23, 2011 at 10:10 am

The fairy tale “The Emperors New Clothes” come to mind. Sometimes we learn to bullshit because the emperor (whoever that might be–the family system, our early caretakers etc.) implicitly demand that we do. I am guessing that “bullshitting” might also be a style of relating that avoids mentalizing and keeps a family system (or other system, i.e. group) in place.

rick January 21, 2011 at 4:22 pm

A lifetime as a psychoanalyst has by degrees introduced me to the wisdom of indeterminacy and ambivalence. Life is complex, and forgetting that lets us care-givers in for terrible unconscious runs of bullshit. When we get to “knowing” it can be positively scary. Kudos to Frankfurt and Allen.

Ravi January 21, 2011 at 3:58 pm

I liked this post. I remember as a medical student practicing the very scary phrase “I don’t know”. Good practice for life. To be balanced with the creed, “Fake it til you make it”, which is what most people have to do at some point or another.

Shelley Hayes, MD January 21, 2011 at 12:51 pm

Hilda Bruch taught psychotherapy invoking the “use of ignorance”. She loved this quotation from Maimonides: “Teach thy tongue to say I do not know and thou shalt progress.”

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