Mentalising in Child Therapy

Psychoanalysis has always been a developing field. For the treatment of children whose development has come to a standstill, mentalization-based child therapy'previously known as developmental therapy'is the latest branch on this tree of knowledge. 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 very well be understood on the basis of psychoanalytic frameworks. These new insights into people's mental functioning also serve to foster collaboration, resulting in an integration of the more relationship-oriented treatments and the more competence-oriented treatments. This book will fill a growing need in mental health care for children and young people: integrated treatment, that is, using several different modes of treatment at the same time 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 behavioral 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.

Acknowledgements	p. xi
Series Foreword	p. xiii
About the Editors and Contributors	p. xvii
Foreword	p. xxi
Introduction	p. 1
Theoretical concepts	p. 7
Introduction	p. 8
Developmental tasks of the infant	p. 9
Gergely and Watson's social biofeedback theory of parental affect mirroring: the representation loop	p. 12
Limitations in the capacity to mentalize	p. 15
Actual mode, pretend mode, and integrative mode	p. 16
Manifestations of the inability to mentalize	p. 18
In conclusion	p. 20
Assessment of mentalizing problems in children	p. 22
Target population	p. 23
Theoretical and psychiatric description of the target population	p. 23
Indicator criteria for mentalization-based child therapy	p. 28
Standardized diagnostics	p. 31
Introduction	p. 31
Attachment representation	p. 31
Personality dynamics	p. 36
Cognitive function	p. 38
Questionnaires for anxiety and depression	p. 39
Behavioural problems according to parents and teacher	p. 40
In conclusion	p. 40
Treatment strategy	p. 41
Introduction	p. 42
Backgrounds	p. 43
Framework of the treatment	p. 48
Working with the adults in the child's life	p. 48
The representational mismatch	p. 49
Setting of child therapy	p. 49
The therapist as development object	p. 50
Working "in" the transference	p. 52
Principles behind the technique of mentalization-based child therapy	p. 55
Working in the here and now of the relationship	p. 55
Recognizing the child's level of mental functioning and meeting at the same level	p. 57
Giving reality value to inner experiences	p. 59
Playing with reality	p. 61
The process is more important than the technique	p. 64
Ending the treatment	p. 66
Notes	p. 67
Helping parents to promote mentalization	p. 69
Introduction	p. 69
General aspects of guidance for parents	p. 71
Helping parents to promote mentalization	p. 74
The parent guidance framework	p. 75
Mentalizing techniques	p. 79
Giving reality value to the inner experience of the parents with their child	p. 79
Learning to observe and read the child's inner world	p. 81
Working in the here and now	p. 83
Repairing misattunement	p. 84
Parent guidance: one, two, or more parents	p. 86
Collaboration with other therapists	p. 88
In conclusion	p. 90
Observation method	p. 91
Identifying intervention techniques: a brief history	p. 92
Working method for the observation of interventions in mentalization-based child therapy	p. 93
Introduction	p. 93
Selection of suitable cases	p. 93
Agreements prior to data collection	p. 96
Reactions of children to the observer and the video recorder	p. 97
Systematic collection of the observations	p. 101
Discussing interventions in peer review meetings	p. 105
In conclusion	p. 107
Note	p. 107
Intervention techniques: attention regulation	p. 108
Introduction	p. 108
What is attention regulation?	p. 110
Accepting the child's regulation profile and attuning to the same level	p. 111
Attention to the content of the child's play or activity/introducing structure in play or story	p. 113
Naming/describing physical states	p. 114
Naming/describing behaviour aimed at the naming of mental content (cognitions and feelings)	p. 115
Naming/describing anxiety and feeling threatened	p. 116
Naming/describing a state of animosity	p. 117
Working on the ability to make contact	p. 119
Maintaining contact and introducing continuity in contact	p. 120
Creating a safe environment	p. 121
Naming/describing explicit interactions	p. 122
Working on the basis for intentional behaviour	p. 124
Joining into the child's activities visually and/or in gestures	p. 125
Giving reality value to preverbal interactions by taking the child's own style seriously	p. 127
Directing attention at describing behaviour	p. 128
Focusing on the child's qualities	p. 130
In conclusion	p. 131
Intervention techniques: affect regulation	p. 132
Introduction	p. 132
Playing within boundaries	p. 135
Introduction of fantasy to facilitate the pretend mode	p. 135
Focus on separating fantasy and reality	p. 136
Setting boundaries	p. 136
Joining in the pretend mode	p. 138
Giving reality value to affect states	p. 139
Giving reality value to an affect state of a play figure	p. 139
Giving reality value to an affect state of a child	p. 142
Deducing second-order affect representations	p. 144
Guiding and differentiating affect	p. 145
Looking for your own share in enactments	p. 147
In conclusion	p. 150
Intervention techniques: mentalization	p. 152
Introduction	p. 152
Comments on mental contents	p. 154
Making comments on mental content in pretend mode	p. 155
Discussing thoughts and feelings with respect to attachment figures	p. 156
Comments on mental content of the child	p. 159
Additions of positive content	p. 161
Comments on mental processes of the child	p. 163
Making comments on mental processes of the child such as remembering, asking, wanting, fantasizing, and making connections	p. 163
Verbalization of wish and/or intention in the pretend mode	p. 166
Verbalization of wish and/or intention of the child	p. 167
Verbalization of thoughts about the mental life of others/objects	p. 170
Stressing the individual character of the child's mental world	p. 172
Comments on interactive mental processes	p. 173
In conclusion	p. 177
Treatment in practice	p. 179
Introduction	p. 179
The setting	p. 181
The frequency	p. 181
The therapy room, the toys	p. 181
Playing	p. 182
The first therapy session	p. 183
The initial stages	p. 185
The therapeutic relationship	p. 185
Midway	p. 187
Transference, development object, and countertransference	p. 187
Setting boundaries	p. 188
Interruptions	p. 189
Shifting the level of interventions	p. 190
The final stages	p. 191
Criteria for termination	p. 192
Research strategy	p. 195
Research in child and adolescent psychotherapy	p. 196
Theory and research on the nature of the clinical disorder	p. 197
Theory and research on change processes and treatment mechanisms	p. 198
Specification of the treatment	p. 201
Assessment of the treatment results	p. 202
Assessment of the moderating factors	p. 205
Assessment of the generalizability and applicability	p. 206
In conclusion	p. 207
Intervention techniques	p. 209
Glossary	p. 211
References	p. 219
Index	p. 233
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