Medium 9781855755819

Mentalizing in Child Therapy

Views: 1218
Ratings: (0)

Mentalization-based child therapy, previously known as developmental therapy, is the latest branch on the psychoanalytic tree of knowledge. It comprises a number of techniques that address deficiencies in specific areas of psychological development. It aims to treat children whose development has come to a standstill. A combination of data from psychoanalysis, infant research, attachment research, and neurobiology was of decisive significance in reaching this point. It is becoming clear that neurobiological processes can be understood very well on the basis of psychoanalytic frameworks. These new insights into peoples mental functioning also serve to foster collaboration, resulting in an integration of the more relationship-oriented and the more competence oriented treatments. This book aims to fill a growing need in mental health care for children and young people to recieve an integrated treatment.

List price: $37.99

Your Price: $30.39

You Save: 20%

Remix
Remove
 

13 Chapters

Format Buy Remix

CHAPTER ONE: Introduction

ePub

Marcel G. J. Schmeets, Annelies J. E. Verheugt-Pleiter, Jolien Zevalkink

Psychoanalysis has always been in a process of development, and mentalization-based child therapy—previously known as developmental therapy—for the treatment of children whose development has come to a standstill is the latest branch on this tree of knowledge (Bateman &Fonagy, 2004; Hurry, 1998a). A combination of data from psychoanalysis, infant research, attachment research, and neurobiology was of decisive significance in reaching this point. It is becoming clear that neurobiological processes can be understood very well on the basis of psychoanalytic frameworks (Kaplan-Solms &Solms, 2000). These new insights into people's mental functioning also serve to foster collaboration, resulting in an integration of the more relationship-oriented and the more competence-oriented treatments. This book aims to fill a growing need in mental health care for children and young people for an integrated treatment—that is, one using several different modes of treatment simultaneously when the problems are complex. Treating complex problems in children with new psychoanalytic techniques is expected to add a new dimension to the practice of treatment, one that is interesting to cognitive behavioural therapists and psychoanalytically schooled psychotherapists alike. One step further, mental health care for children and adolescents may well draw benefits from the achievements of psychoanalysis, thus embedding psychoanalysis more firmly in the field of mental health care. To achieve this, not only will the various forms of psychotherapy need to be integrated, but the therapists as well (Bateman &Fonagy, 2004; Bleiberg, 2001).

 

CHAPTER TWO: Theoretical concepts

ePub

Marcel G. J. Schmeets

This chapter takes a closer look at the concept of mentalization and the way in which this ability comes into being. The quality of the mother-child relationship seems to play a crucial role in this respect. In the process of learning to make representations, it is important that the child is given space by another person—for example, the mother—between the direct primary experience of the affect and being able to think about the affect. At this juncture, the capacity of the mother to make her own representations is decisive for the extent to which the child “learns” this ability from her. Intrapsychic processes in the mother are formative for the degree to which a child learns to mentalize. Traumatic experiences that are unmentalized in the mother will lead to blind (unmentalized) spots in the child. They are part of the information stored on a daily basis that helps to shape the structure of the brain, leading to personality traits and possibly also to psychopathology.

 

CHAPTER THREE: Assessment of mentalizing problems in children

ePub

Jolien Zevalkink

Having described in Chapter 2 the theory underlying our thinking about how problems with mentalization develop, the next step is to make these problems more easily recognizable by demarcating the group of children suitable for mentalization-based child therapy and by enlisting diagnostic instruments. Based on theory and clinical experience, Anne Hurry and Miriam Steele drew up a list of criteria to identify children for whom mentaliza-tion-based child therapy is appropriate. These criteria can be clinically observed during treatment sessions with the child. But it is also possible to make use of standardized instruments. Useful information can be obtained from instruments that yield data about attachment classifications, personality dynamics, cognitive functioning, anxiety, depression, and behavioural problems. By comparing and combining the results from clinical observation and instruments, it is possible to describe prototypes of children who may fall within the group suited to this form of treatment. Further research will have to show whether the criteria developed for this specific form of treatment were correct. This chapter gives a theoretical and psychiatric description of the target population, followed by the treatment indicator and the diagnostic instruments.

 

CHAPTER FOUR: Treatment strategy

ePub

Annelies J. E. Verheugt-Pleiter

In this chapter the most important strategic underpinnings of mentalization-based child therapy are discussed. First we briefly review a number of important authors who proffered innovative ideas with respect to this technique; then we go on to discuss the framework and principles of treatment. The framework of treatment includes the notion of involvement of and cooperation between therapists and other adults, the representational mismatch, the setting, the therapist as development object, and working “in” the transference. Treatment principles include working in the here and now, accepting the child's level of mental functioning and relating at the same level, giving reality value to inner experiences, playing with reality, and the importance of the process, which takes precedence over the technique. The chapter concludes with some remarks on ending the treatment.

Introduction

The most significant disorder in children who have difficulty with mental processes is one in the perception of the self as agent.1 For these children, the most important objective in treatment is to foster the emergence of a coherent self, a sense of agency, and a capacity to defer, modulate, and regulate emotional responses (Tyson, 2005). This objective is different from that in traditional psychoanalytic treatment aimed at children with a mental representation disorder involving conflict in or between their mental representations. Gaining insight into and resolving unconscious conflicts cannot be the objective when a disorder in a mental process is involved. It might possibly come up in a later stage of treatment, when children can mentalize and may develop conflicts. But mentalization-based child therapy is first and foremost intended for children who have little or no ability to mentalize.

 

CHAPTER FIVE: Helping parents to promote mentalization

ePub

MarjaJ. Rexwinkel and Annelies J. E. Verheugt-Pleiter

This chapter focuses on guidance for parents, which takes place parallel with the child's therapy, as discussed in Chapter 4. A number of specific characteristics of parent guidance are examined, and the following techniques are discussed: giving reality value to the inner experiences of parents with their child, learning to observe and read the child's inner world, working in the here and now, and repairing misattunement. The specific difficulties of parent guidance in composite families are also considered. In conclusion, we touch on the importance of working together with other disciplines and the idea of representational mismatch.

Introduction

A child's specific psychopathology is an important reason to request therapy for a child, but every time a child is registered, it can also be seen as an expression of problems experienced in parenting. It is often the parents who experience problems in their relationship with the child. When parents register a child, it should thus also be viewed as way of expressing their uncertainty about themselves as parents. From this point of view, it is the parent who asks for help as a parent. In response to this request, a therapeutic relationship is offered which has come to be called parent guidance. When children are in psychoanalysis or psychotherapy, the parents are always offered parent guidance.

 

CHAPTER SIX: Observation method

ePub

Jolien Zevalkink

Observing children systematically during treatment has greatly expanded our knowledge and understanding of mentaliza-tion and significantly contributed to the development of the treatment model explained in the next chapters. Therapists turned out to be invaluable in this process. From behind a one-way screen therapists observed interventions of other therapists and systematically described interventions they considered beneficial to the child's ability to mentalize. These observations have opened the door to empirical research into mentalization-based child therapy and—perhaps more importantly—given other therapists an opportunity to learn to work with the method. This chapter describes a brief history of the process of this project. Furthermore, it describes the selection of suitable cases for treatment, agreements prior to data collection, reactions of children to the observer and to the video recorder, the systematic collection of observations, and discussion of the interventions in peer review meetings. As the observation method was refined, it gradually became an observation system that can be used to study the types of interventions used in therapy sessions. The categories used in the observation system are described in the following chapters.

 

CHAPTER SEVEN: Intervention techniques: attention regulation

ePub

Annelies J. E. Verheugt-Pleiter

The objective of Chapters 7, 8, and 9 is to give a picture of mentalization-based child therapy intervention techniques so that therapists in a clinical setting can learn to recognize what strategy they can best adopt in their relationship with the child in order to set the mentalization process in motion. As we began to list interventions, it soon became clear that they could be classified roughly into three groups as distinguished by Anthony Bateman (symposium, December 2002) in discussing the treatment of adult borderline patients: attention regulation, affect regulation, and mentalization. This chapter discusses intervention techniques that have to do with attention regulation. For each type, examples of interventions illustrate the intervention technique.

Introduction

The general basic principles of mentalization-based child therapy as discussed at length in Chapter 4 are worked out in a practical sense in Chapter 7 (attention regulation), Chapter 8 (affect regulation), and Chapter 9 (mentalization) by relating them to concrete categories observed during treatment sessions. The principles are:

 

CHAPTER EIGHT: Intervention techniques: affect regulation

ePub

Annettes /. E. Verheugt-Pleiter

The objective of Chapters 7, 8, and 9 is to demonstrate mentali-zation-based intervention techniques. In Chapter 7 we showed intervention techniques that have to do with attention regulation; in this chapter we discuss those that have to do with affect regulation: keeping play within boundaries, giving reality value to affect states, and deducing second-order affect representations. Examples of interventions illustrate the intervention technique.

Introduction

What is affect regulation? The affective experiences of a child take on their full meaning, their emotional quality, in the child's relationship with his primary caregivers. The way in which children can regulate their affects also has implications for the development of the self. According to Fonagy, Gergely, and colleagues (2002, p. 95), regulation of affects largely takes place outside consciousness. Affect regulation may refer to the type of emotion, to the moment when it occurs and when it subsides again, the style in which it is experienced, and the way in which it is expressed. Meurs, Vliegen, and Cluckers (2005) studied modes such as intensity, pleasantness, control, and frequency of occurrence. If affect regulation is faulty, it may be the result of difficulty in understanding affect states, in linking them to something, and in the ability to verbalize them. The marked and contingent recognition of a person's own affect in a significant other, an attachment figure, should serve as a crystallization point for the child in developing his own affect regulation (Fonagy, Gergely, et al., 2002).

 

CHAPTER NINE: Intervention techniques: mentalization

ePub

Annelies J. E. Verheugt-Pleiter

In discussing what mentalization-based intervention techniques look like, Chapters 7 and 8 were devoted to attention regulation and affect regulation, respectively. This chapter is about interventions that are intended to promote thinking about mental states and mental processes, and about interactive mental processes, with examples of interventions to illustrate the intervention technique.

Introduction

It will be clear that the regulation of affects changes once children have learned to mentalize—that is, when they are able to start from the fact that not only they themselves, but others, too, have an internal world, with feelings, thoughts, and desires. In normal development a child can mentalize reasonably at around age 4, which means that he also uses affects to regulate the self. The most mature form of affect regulation is termed “mentalized affectivity” by Fonagy, Gergely, and colleagues (2002, p. 5). This refers to the capacity to discover the subjective meanings of a person's own affect states. Mentalized affectivity implies the ability to think about your own affects while you are affectively involved, not talking about yourself from a distance. Fonagy, Gergely, and colleagues (2002, p. 435) consider men-talized affectivity to be a form of affect regulation that is particularly important for adults: “Mentalized affectivity is a sophisticated kind of affect regulation that denotes how affects are experienced through the lens of self-reflexivity”.

 

CHAPTER TEN: Treatment in practice

ePub

Froukje M. E. Slijper

A number of elements in the practice of mentalization-based child therapy require specific attention. This chapter discusses the practical aspects of treatment and the practical agreements to be made. This refers to becoming acquainted with the treatment and the setting—for instance, the frequency, the therapy room, and the toys and play material available. The various stages of treatment are described as well. What can you expect at the end of mentalization-based child therapy?

Introduction

Mentalization-based child therapy is not possible unless the parents also receive guidance (see Chapter 5). If the child's therapy is to progress and be successful, it is important that the parents support the treatment. They are asked to make a considerable investment: they need to take part in parent guidance, they will have to bring the child to therapy and pick the child up afterwards, they need to motivate the child and offer support. Parents have a certain perception of their child, their own feelings about the child, and a more or less fixed reaction pattern to this. Moreover, parents may have several very different perceptions of their child. This is often clearly the case with divorced parents. First and foremost, it is necessary that the parent counsellor and the child's therapist reach agreement, together with the parents, both about the child's issues and about the objective of treatment. Unless both parents support the treatment, there is no point in starting. A child must be able to feel that she has the permission of both parents to entrust herself to the therapist. If this is not the case, the child will intentionally or unintentionally be burdened with a conflict, which often expresses itself in loyalty problems. Divorced parents often use their disagreement with respect to their child's needs assessment to fight their own feuds. It is sometimes helpful to work with the parents, together or separately, to make them aware of this and able to talk about it.

 

CHAPTER ELEVEN: Research strategy

ePub

Jolien Zevalkink

Empirical research into the effectiveness of mentalization-based child therapy is a next step after having identified therapeutic interventions and having constructed a manual that can be used to train new therapists in this method. Such an endeavour is subject to a number of specific considerations. Following Kazdin (2002), a six-step procedure is presented in this chapter, highlighting a number of general and methodological factors that play a role in setting up this kind of research.

The first step is to include the theoretical background of the treatment programme in the research question. If the treatment is aimed at promoting the ability to mentalize, then it is important that the research investigates whether this was indeed attempted. In addition, a research design must be chosen that includes aspects such as setting up a comparison group. At each step, specific research questions aimed at clarifying and assessing the effectiveness of mentalization-based child therapy as a treatment method are formulated.

 

APPENDIX A: Intervention techniques

ePub

 

APPENDIX B: Glossary

ePub

Glossary

Abstinence, rule of: According to this psychoanalytic principle, the therapist should try to remain neutral and may not assume the role of a substitute from whom the patient is able to obtain satisfaction or any other feelings (Stroeken, 2000).

Actual mode: see Mode.

Affect: Literally, the noun “affect” means something done to one; it emphasizes the passive aspect. It is an older word for feeling or emotion (Stroeken, 2000). We follow Damasio in the use of the term “affect” because he uses it to refer to both feelings (invisible inner states) and emotions (visible conduct) (Damasio, 2004).

Affect regulation: The capacity to modulate affect states. It is a precursor to mentalization. As soon as mentalization occurs, affect regulation can develop further, primarily thanks to the great influence of mentalization on the sense of self (Fonagy, Gergely, et al., 2002, pp. 4-5).

Affect representation: Mental structure used in thinking about affect, which may or may not be closely related to the affect state experienced.

 

Details

Print Book
E-Books
Chapters

Format name
ePub
Encrypted
No
Sku
B000000020457
Isbn
9781780494418
File size
1.64 MB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata