ABSTRACT
This chapter explores the way maladaptive attachment histories in patients contribute to the behaviors they exhibit in the inpatient setting. Mentalization, the ability to understand the mental states of oneself and those of others, begins to develop via secure attachment relationships between the child and primary caregiver(s). Various forms of psychopathology and symptoms such as borderline personality, self-injurious behaviors and aggression toward others, and cognitive distortions that co-occur with problematic attachment patterns are secondary to abusive attachment histories. On the psychiatric unit, the violence exhibited by such patients is often the result of impaired mentalization abilities. Threats toward patients and staff, property destruction, and patient and staff assaults are often the result of perceived slights by the patient and inability to appropriately identify and manage their own mental states. These difficulties often hinder the patient’s ability to effectively participate in the recovery and treatment process, and to form healthy therapeutic relationships with treatment staff. Helping patients shift their self-perception, and respond to others via improved mentalization abilities, can be a goal of the therapeutic relationship with the unit psychologist. This chapter will examine how improving a violent patient’s mentalization abilities via the therapeutic relationship can be an effective intervention to improve patient symptoms, discharge readiness, and unit safety.
