Mentalization for Addiction
For those living with addiction, finding new paths with reflection and connection.
Posted November 23, 2025 | Reviewed by Jessica Schrader
Mentalization-based treatment helps people reflect upon and redirect urges and impulses. Researchers have found that mentalization may be an undervalued treatment for people in addiction recovery. Knowing one's mind, feelings, triggers, and motivations, however conflicted, improves outcomes in work, love, life, and re-creating a life. Better understanding of the inner states and traits of others is also useful.
Secure Attachment and Mentalization in Early Life
Secure attachment fosters mentalization, or a capacity to understand, process, and manage one's inner life. Insecure attachments early on can interfere with mentalization and seed addiction. Stressful home environments can lead to insecure attachments. Insecure attachments spur a child to reckon with overwhelming feelings and fears of being solo. If the trust is not there, going it alone may be the only option, though an unsettling one. Ideally, a caregiver shares in a child's concerns. The others—witnessing: "I get it"; weathering: "I'm with you"; and offering: "What if we look at it another way?"—are crucial elements for coping. These interventions, whether intuitive or explicit, model a path for stepping back, processing the situation, and finding one's way. The good news is that one can learn mentalization later in life and use it to help with recovery from addiction.
Emotional Processing, Emotional Blindness, and Mentalization
Without emotional processing in the context of a caring relationship, emotional blindness or alexithymia can occur. Substances, which distract, numb, or excite, can serve as self- medication for unnameable angst. Alexithymia involves a disconnection from one's own feelings and many people with addiction struggle from this. Not knowing can be a way to shield their self-pain, and in this way is a psychological defense. Mentalization might be seen as the opposite of emotional blindness, as it identifies inner feelings and thoughts and brings them into relief. One must be ready to see. Supports, as well as shifts in perspective, can position one to face things and move on.
Coping Skills Versus Substances
Substances assuage in the moment, but over time curb the development of coping skills and can make a fraught situation worse. Whatever one was trying to avoid by using a substance may still be there and even harder to manage in thr throes of addiction. Good relationships, safe spaces, insight, emotional regulation techniques, and reflective capacity are tools for both recovery and the well-lived life. Reflective capacity, the warp and weft of mentalization, if not a solution in and of itself, can become a protective tool or coping skill. Impulses channeled rather than released in the moment can help with regret, shame , and guilt .
The Why as Well as the What
Mentalization, because it involves grasping the why as well as the what, goes deeper than empathy. Knowing the why or the underlying intent helps, because it decreases resentment and improves relations. Mistreatment by another, triggered by their inner or outer stressors, may not be acceptable but is easier to manage when the why is known. One may be less inclined to escape into substances, if the "it's me" turns to "it's not me," or the part that one is responsible for is understood in a more benevolent, yet realistic way.
Technical Steps of Mentalization in a Group
In a group setting, if our feelings, beliefs, and fears are seen, understood, and respected, we can start to work through them and get better. Deeply held yet disturbing convictions can be altered by trustworthy others with helpful insights. In our recovery community, we practice mentalization-based therapy in group. One person shares a difficult moment and others help them work through what happened. No judgment, no critique, but rather different perspectives, exploration of inner motivations and vulnerabilities, and an overall empathic experience.
Steps for Processing a Difficulty in Mentalization Group
Through mentalization-based treatment, we develop skills that allow for agency rather than reactivity. Broadened perspectives, relational trust, and shared vulnerabilities in a group setting can be emotionally corrective. An entrenched story of injury, brokenness, rejection, failure, or shame, in which one is absolutely certain of one's own immovable defects, can be debilitating. When trusted others challenge truths that may not be true, and one can truly consider them, one can start to feel better.
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https://pmc.ncbi.nlm.nih.gov/articles/PMC4392970/
https://onlinelibrary.wiley.com/doi/10.1111/sjop.12821
https://www.tandfonline.com/doi/full/10.1080/00207284.2025.2497237?src=
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Carrie (Grace Caroline) Barron, M.D. , is Psychiatrist-in-Charge of the Silver Hill New York Intensive Outpatient Program and an Associate Professor of Medical Education at Dell Medical School at the University of Texas at Austin.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.