Distinguished Clinicians Series with Peter Fonagy, PhD - Mentalizing and Substance Use Disorder (SUD)

  • 15 Mar 2019
  • 10:00 AM - 12:00 PM
  • The Menninger Clinic 12301 Main Street Houston, TX 77035
  • 16


Registration is closed

“Without mentalizing there can be no robust sense of self, no constructive social interaction, no mutuality in relationships, and no sense of personal security” (Bateman & Fonagy, 2016, p. 3). This absence strongly characterizes the core state of many patients with Substance Use Disorder (SUD), particularly when co-morbid with PD.

Substances are used to stabilize the collapse in self-states and as a form of relief from the intensity of isolation and distress that can accompany a collapse in mentalizing. There is a circular problem, in which mentalizing difficulties may lead to substance misuse, but substance misuse also impairs mentalizing – it can be particularly associated with pretend mode/pseudo-mentalizing. Strategies frequently used to ensure abstinence in treatments approaches to SUD, however, are often incompatible with mentalizing and may at times undermine that capacity increasing the chance of relapse.

MBT-SUD is a dual track program, combining MBT with addiction-specific strategies. It aims to directly tackle substance use through working towards abstinence and also by targeting emotional dysregulation and impulsivity and maintain mentalizing in SUD settings which function in modes not compatible with mentalization.  Core mentalizing difficulty for these patients is often an unstable sense of self, and an important therapeutic task is to increase and stabilize their ability to identify, know, and regulate their own self-states.

Reducing or stopping substance use means the individual will become more aware of negative emotions and be thrown into dysregulating emotions without functional soothing strategies. This makes treatment a potentially demanding process. In order to deal with these difficulties, MBT for SUD uses motivational interviewing, particularly initially, to strengthen therapeutic alliance and motivation. There is also a particular emphasis on interpersonal interactions where mentalizing breaks down and substance use is triggered. MBT-SUD is an extended long-term community treatment, enabling attention to issues of daily life, the stabilization of the social context and a combination of individual and group MBT.

At the conclusion of this live presentation, participants should be able to:

    • Distinguish the relationship between substance abuse and non-mentalizing – in particular the role of psychic equivalence and pretend mode.
    • Recognize  the role of the alien self as a response to a collapse in sense of self in the face of interpersonal stressors, and the role of substance use as a response to the overwhelming presence of the alien self.
    • Appreciate the limitations of a focus on mentalizing alone in the management of SUD and identify modifiable aspects the patient’s social context to support the management of SUD.
    • Integrate techniques of managing addictions with a potential to activate non-mentalizing strategies with a mentalizing focus.

    $50.00 Professional Rate

    $25.00 Student Rate

    Forms of payment accepted are Visa, MasterCard, Discover, and American Express. Registration will be finalized with receipt of payment. Payments must be made in advance. No checks or cash will be accepted at the door.

    Registration is limited to 80 attendees; so sign up today.

     Continuing Education Credits

    2.0 contact/credit/clock hours have been designated by The Menninger Clinic for the following disciplines:



    Social Workers

    Licensed Professional Counselors

    Addictions Professionals

    Special Dietary or ADA Needs 

    For ADA or lactation needs, please email directly to: 

    Michelle A. Taylor: 


    Powered by Wild Apricot Membership Software