Journal of Contemporary Psychotherapy

, Volume 44, Issue 3, pp 173–182 | Cite as

“I Will Fear no Evil, for I Am with Me”: Mentalization-Oriented Intervention with PTSD Patients. A Case Study

  • Sharon Palgi
  • Yuval Palgi
  • Menachem Ben-Ezra
  • Amit Shrira
Original Paper


Post traumatic stress disorder (PTSD) patients are described as suffering from a collapse of mentalization—the inability to understand and interpret their own behavior and that of others as emanating from intentional mental states. The present paper proposes an integrative focused intervention, called “traumatic mentalization change”, to improve and strengthen the mentalization abilities of PTSD patients. With the assistance of the therapist, patients learn how to embed their present self-states within their retrieved memories of the traumatic event and thus to change their traumatic narrative. These present selfstate images enrich the patients’ narratives with the emotional needs that were missing during the traumatic event by addressing mistaken attributions regarding these memories. In this way, the traumatic narrative changes, and the devastating selffeelings experienced during the original traumatic event are reduced. We demonstrate this intervention with a case study of a veteran PTSD patient who suffered from PTSD for 10 years after being involved in a terrorist attack. The neuro-clinical and clinical implications are discussed.


PTSD Mentalization Empathy Psychotherapy Projective self 


  1. Allen, J. G., Lemma, A., & Fonagy, P. (2012). Trauma. In A. W. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 419–444). Washington, DC: American Psychiatric Publishing.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, DSM-IV-tr. Washington, DC: American Psychiatric Association.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington, DC: American Psychiatric Association.Google Scholar
  4. Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck depression inventory-II manual. San Antonio: The Psychological Corporation.Google Scholar
  5. Bremner, J. D. (2007). Neuroimaging in posttraumatic stress disorder and other stress-related disorders. Neuroimaging Clinics of North America, 17, 523–544. doi: 10.1016/j.nic.2007.07.003.PubMedCentralPubMedCrossRefGoogle Scholar
  6. Brewin, C. R. (2005). Systematic review of screening instruments for adults at risk of PTSD. Journal of Traumatic Stress, 18, 53–62. doi: 10.1002/jts.20007.PubMedCrossRefGoogle Scholar
  7. Brewin, C. R. (2007). Autobiographical memory for trauma: Update on four controversies. Memory, 15, 227–248. doi: 10.1080/09658210701256423.PubMedCrossRefGoogle Scholar
  8. Bromberg, P. M. (2003). One need not be a house to be haunted: On enactment, dissociation, and the dread of “not-me”—A case study. Psychoanalytic Dialogues, 13, 689–709. doi: 10.1080/10481881309348764.CrossRefGoogle Scholar
  9. Buckner, R. L., & Carroll, D. C. (2007). Self-projection and the brain. Trends in Cognitive Sciences, 11, 49–57. doi: 10.1016/j.tics.2006.11.004.PubMedCrossRefGoogle Scholar
  10. Charuvastre, A., & Cloitre, M. (2008). Social bonds and posttraumatic stress disorder. Annual Review of Psychology, 59, 301–328. doi: 10.1146/annurev.psych.58.110405.085650.CrossRefGoogle Scholar
  11. Conway, M. A., & Pleydell-Pearce, C. W. (2000). The construction of autobiographical memories in the self-memory system. Psychological Review, 107, 261–288. doi: 10.1037//0033-295X.107.2.261.PubMedCrossRefGoogle Scholar
  12. Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44, 13–126. doi: 10.1037/0022-3514.44.1.113.CrossRefGoogle Scholar
  13. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 319–345. doi: 10.1016/S0005-7967.CrossRefGoogle Scholar
  14. Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451. doi: 10.1037/1040-3590.9.4.445.CrossRefGoogle Scholar
  15. Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. New york: Oxford University Press.Google Scholar
  16. Foa, E. B., Stein, D. J., & McFarleane, A. C. (2006). Symptomatology and psychopathology of mental health problems after disaster. Journal of Clinical Psychiatry, 67, 15–25.PubMedCrossRefGoogle Scholar
  17. Fonagy, P., Bateman, A. W., & Luyten, (2012). Introduction and overview. In A. W. Bateman & P. Fonagy (Eds.), Handbook of metallizing in mental health practice (pp. 419–444). Washington, DC: American Psychiatric Publishing.Google Scholar
  18. Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York/London: Other Books.Google Scholar
  19. Fonagy, P., & Target, M. (2006). The mentalization-focused approach to self pathology. Journal of Personality Disorders, 20, 544–576. doi: 10.1521/pedi.2006.20.6.544.PubMedCrossRefGoogle Scholar
  20. Fonagy, P., & Target, M. (2008). Attachment, trauma, and psychoanalysis: Where psychoanalysis meets neuroscience. In E. L. Jurist, A. Slade, & S. Bergner (Eds.), Mind to mind: Infant research, neuroscience, and psychoanalysis (pp. 15–49). New York: Other Press.Google Scholar
  21. Grey, N., Young, K., & Holmes, E. (2002). Cognitive restructuring within reliving: A treatment for peritraumatic emotional “hotspots” in posttraumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30, 37–56. doi: 10.1017/S1352465802001054.CrossRefGoogle Scholar
  22. Harari, H., Shamay-Tsoory, S. G., Ravid, M., & Levkovitz, Y. (2010). Double dissociation between cognitive and affective empathy in borderline personality disorder. Psychiatry Research, 175, 277–279. doi: 10.1016/j.psychres.2009.03.002.PubMedCrossRefGoogle Scholar
  23. Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.Google Scholar
  24. Liberzon, I., Britton, J. C., & Phan, K. L. (2003). Neural correlates of traumatic recall in posttraumatic stress disorder. Stress, 6, 151–156. doi: 10.1080/1025389031000136242.PubMedCrossRefGoogle Scholar
  25. Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of consulting and clinical psychology, 72(4), 579–587. doi: 10.1037/0022-006X.72.4.579.Google Scholar
  26. Omer, H., & Alon, N. (1994). The continuity principle: A unified approach to disaster and trauma. American Journal of Community Psychology, 22, 273–287. doi: 10.1007/BF02506866.PubMedCrossRefGoogle Scholar
  27. Palgi, Y., & Ben-Ezra, M. (2010a) “Back To The Future”: Narrative treatment for post-traumatic, acute stress disorder in the case of paramedic Mr. G. Pragmatic Case Studies in Psychotherapy, 6, 1–26.
  28. Palgi, Y., & Ben-Ezra, M. (2010b). Prepared and still surprised. Pragmatic Case Studies in Psychotherapy, 6, 4348.
  29. Perry, D., Hendler, T., & Shamay-Tsoory, S. G. (2011). Projecting memories: The role of the hippocampus in emotional mentalizing. NeuroImage, 54, 1669–1676. doi: 10.1016/j.neuroimage.2010.08.057.PubMedCrossRefGoogle Scholar
  30. Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30, 63–641.CrossRefGoogle Scholar
  31. Resick, P. A. (2001). Cognitive processing therapy: Generic version. St. Louis: University of Missouri-St. Louis.Google Scholar
  32. Schottenbauer, M. A., Glass, C. R., Glass, C. R., Arnkoff, D. B., & Gray, S. H. (2008). Contributions of psychodynamic approaches to treatment of PTSD and trauma: A review of the empirical treatment and psychopathology literature. Psychiatry, 71, 13–34. doi: 10.1521/psyc.2008.71.1.13.PubMedGoogle Scholar
  33. Seidler, G. H., & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine, 36, 1515–1522.
  34. Shamay-Tsoory, S. G. (2011). The neural bases for empathy. The Neuroscientis, 17, 18–24. doi: 10.1177/1073858410379268.CrossRefGoogle Scholar
  35. Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. New York: Guilford.Google Scholar
  36. Tulving, E. (2005). Episodic memory and autonoesis: Uniquely human? In H. S. Terrace & J. Metcalfe (Eds.), The missing link in cognition: Origins of self-reflective consciousness (pp. 3–56). Oxford: Oxford University Press.Google Scholar
  37. Williams, J. M. G., Barnhofer, T., Crane, C., Herman, D., Race, F., Watkin, S. E., et al. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133, 122–148. doi: 10.1037/0033-2909.133.1.122.PubMedCentralPubMedCrossRefGoogle Scholar
  38. Wisco, B. E., Sloan, D. M., & Marx, B. P. (2013). Cognitive emotion regulation and written exposure therapy for posttraumatic stress disorder. Clinical Psychological Science, 4(1), 435–442. doi: 10.1177/2167702613486630.
  39. Zoladz, P. R., & Diamond, D. M. (2013). Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature. Neuroscience & Biobehavioral Reviews, 37, 860–895.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sharon Palgi
    • 1
  • Yuval Palgi
    • 2
  • Menachem Ben-Ezra
    • 3
  • Amit Shrira
    • 4
  1. 1.Rambam Health Care CampusUniversity of HaifaHaifaIsrael
  2. 2.University of HaifaHaifaIsrael
  3. 3.Ariel UniversityArielIsrael
  4. 4.Bar-Ilan UniversityRamat GanIsrael

Personalised recommendations