Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

A qualitative examination of attachment based concepts in probation supervision.

Attachment theory is familiar to probation workers, with its broad messages that early care can leave a lasting legacy, and that patterns of relating can be repeated throughout the lifespan. Up close however, attachment theory is complex, and research findings sometimes vague or contested. This empirical research examined the use of four key attachment-based concepts in generic probation practice over a period of six months. The concept of the probation officer as a potential secure base was a useful one, as was the idea that service users' early attachment history could help to understand relationships and offending. Other concepts (the reflective function and attachment style) were less useful

The Risk-Taking and Self-Harm Inventory for Adolescents: Validation of the Italian Version (RTSHIA-I)

The aim of the present paper is to establish the factorial validity and reliability of the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA), proposed by Vrouva and colleagues in 2010, in an Italian sample. The RTSHIA measures both Risk-Taking and Self-Harm behavior in adolescents. We administered the scale to a total of 1292 Italian adolescents from 9th to 12th grade; to verify the validity of the scale, we also assessed emotion regulation and psychopathological traits. The exploratory factor analysis (EFA) (N = 638) and the confirmatory factor analysis (CFA) (N = 660) confirmed the original two-factor structure of the RTSHIA (Risk-Taking and Self-Harm). The only differences in the Italian version of the RTSHIA (RTSHIA-I) were that one item was moved from the original Risk-Taking factor to the Italian Self-Harm factor, and another item that was not included in the original RTSHIA is now part of the Risk-Taking factor in the Italian version. The reliability of the RTSHIA-I is also confirmed, and both factors correlate with emotion regulation and externalizing/internalizing traits. Our results suggest that the RTSHIA-I is a useful tool for assessing Risk-Taking and Self-Harm behaviors in Italian adolescents, and the correlational patterns indicate that these behaviors may be related to difficulties in mentalization skills

Improving treatment outcomes for adolescents with borderline personality disorder through a socioecological approach

Background There is a dearth of studies evaluating treatment efficacy for adolescents diagnosed with borderline personality disorder. The few available randomized controlled trials that have been conducted show modest results and treatments appear to have equivalent effects. The current paper draws on (a) the lessons learnt from the last 50 years of psychotherapy research in general and (b) recent advances in mentalization-based understanding of why treatment works, which together point to the importance of following a socioecological approach in the treatment of personality problems in adolescence – a developmental period that insists on a treatment approach that goes beyond the therapist-client dyad. Case presentation Here, we describe such an approach, and offer a clinical case example with a young 16-year old girl diagnosed with borderline personality disorder, to illustrate what a shift toward a more socioecological approach would entail. Conclusions The clinical impact of the socioecological approach and the potential benefits as illustrated in the current case illustration, offers a framework that justifies and allows for the expansion of service delivery for youth with borderline personality disorder beyond dyadic therapist-client work

Learning to mentalize: a mediational approach for caregivers and therapists

Mentalization-based therapies (MBTs) are rigorous, theoretically grounded, and evidence-based interventions. However, dissemination of this psychodynamically informed intervention lags behind that of more skills-based therapies because of a lack of concrete operationalization of its key components. In this proof-of-concept paper, we describe how the learning (mediational) components of an educational intervention, the Mediational Intervention for Sensitizing Caregivers (MISC), can operationalize key components of MBTs in behaviorally anchored ways. We suggest that the process of the recovery of mentalizing can be operationalized through five learning components: focusing, affecting, expanding, rewarding, and regulating. In operationalizing the process of rebuilding mentalizing using these observable, behaviorally anchored concepts focusing on creating epistemic trust, we hope to increase the accessibility of MBTs to a wider audience

Maternal mind-mindedness as a predictor of child behavioural and cognitive outcomes in a socio-economically disadvantaged population

Aims: Childhood abuse has been shown to be associated with a range of aspects of social cognition in adulthood. Among them, mentalization – the ability to attend to and interpret one’s own behavior and the behavior of others in terms of mental states – has been a popular topic of research. However, the literature remains limited to single dimensions of mentalization, as opposed to the broader multi-dimensional concept, and there has been no systematic review or meta-analysis on this topic. Methods: This multilevel meta-analysis provides a synthesis of all empirical literature examining the relationship between childhood abuse and mentalization abilities in the general adult population. Mentalization was operationalized using 8 distinct constructs: reflective functioning, mentalization, mind-mindedness, insightfulness, social cognition, theory of mind, alexithymia, and emotion recognition. Systematic electronic searches were conducted across 5 databases, and 57 outcomes across a total of 27 studies were included. An additional metaanalysis was also conducted examining the relationship between general childhood maltreatment, as distinct childhood from abuse, and mentalization in adulthood. Results: A significant weighted average correlation of r=.14, 95%CI [.09, .19] was found for the relationship between childhood abuse and adult mentalization, representing a small effect size. Moderation analyses revealed that younger participants, members of minority groups, and female participants reported poorer mentalization in adulthood after childhood abuse. An additional meta-analysis examining the relationships between general childhood maltreatment and mentalization in adulthood reviewed 18 studies and yielded a significant weighted average correlation of r=0.17, 95%CI [.07, .27]. Conclusions: The current meta-analysis confirms that childhood abuse and childhood maltreatment are both associated with poorer mentalization in adulthood. The results contribute clinically to the shape and form of early interventions and treatments. Future research may seek to compare the effects of abuse and neglect, and account for a clinical population

Children and Elephants: A Study of Mentalization, Empathy, and Attitudes Towards Conservation in Participants of an Elephant-Based Environmental Intervention in West Africa

Recent research suggests that children\u27s identification with animals and propensity to learn from animal experiences might make animal-focused interventions ideal for social and emotional development. A child\u27s ability to understand their own and others\u27 feeling states has been linked to emotional resilience and has been identified as a protective factor against the development of pathology later in life (Allen & Fonagy, 2006). This study examined the impact of an ongoing conservation-based intervention in Burkina Faso on conservation attitudes, mentalization and empathy. Participants were 106 Burkinabe students, 56 male and 50 female, ages 9-15. Participants were split into four groups, a direct exposure, indirect exposure in the field, indirect exposure in the classroom, and a control group. Primary outcome measures were modified versions of the Children\u27s Environmental Attitude and Knowledge Scale (CHEAKS; Leeming, O\u27Dwyer & Bracken, 1995), the Mentalizing Stories test for Adolescents (MSA; Vrouva & Fonagy, 2009), and the Basic Empathy Scale (BES; Jolliffe & Farrington, 2006). Significant between-group differences in change scores were found on the modified CHEAKS. The group with direct exposure to elephants showed greater positive change scores than all three other groups. No significant between-group differences were found on the modified MSA or BES. Pre-post changes in qualitative data were also examined