Mentalization—A Uniting Thread in the Treatment of Complex Posttraumatic Stress Disorder (CPTSD): Commentary on Phoebe Shepard’s Case Study of "Chloe"]
Keywords:mentalization; mentalizing; Mentalization Based Treatment (MBT); trauma; complex trauma; complex posttraumatic stress disorder (CPTSD); psychodynamic theory; attachment theory; case study; clinical case study
Phoebe Shepard’s (2022) hybrid case study of "Chloe' describes a young woman struggling with a constellation of difficulties rooted in the relational trauma of her childhood. Shepard’s treatment approach with Chloe is anchored in Courtois and Ford’s (2013) Sequenced, Relationship-Based Approach to treating complex trauma. Within the structure provided by Courtois and Ford’s model, Shepard integrated techniques from a wide array of treatment perspectives including Cognitive Behavioral Therapy (CBT), Sensorimotor Psychotherapy (SP), and Accelerated Experiential Dynamic Psychotherapy (AEDP). Despite pulling from such seemingly disparate sources, Shepard presents a cohesive treatment anchored in a focus on the healing potential of the therapeutic relationship. In the approximately two years that she worked with Chloe, this emphasis on safety and connectedness yielded deeply meaningful and clinically significant change. In this commentary I hope to simultaneously honor the deeply reflective and compassionate approach taken by Shepard and to present a simplified guiding conceptualization of Chloe’s presentation and treatment—one rooted in "mentalization." Mentalization, sometimes summarized as "thinking about thinking," is the process of thinking about one’s self from the outside in and thinking about others from the inside out—considering the thoughts, feelings, and needs underlying our own and others’ behavior. I propose that many of Chloe’s difficulties can be viewed through a lens of mentalization lapses, and much of the beautiful and transformative work Shepard accomplished with this client may have been driven by improvements in Chloe’s capacity to mentalize. By simplifying what is an undoubtedly complicated clinical presentation—rich with history, multilayered interpersonal dynamics, transient self-states, and overlapping symptom profiles—I hope to present the perspective that treating complex trauma need not be quite so complex.
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