Mentalizing techniques used by psychodynamic therapists working with children and early adolescents

The aim of this study was to identify, categorize, and develop a conceptual frame of mentalization-based interventions used by experienced child and adolescent psychodynamic therapists. Two experienced therapists selected 14 sessions that represented their work during the first year of treatment. Sessions were transcribed and segmented to identify interactional units for coding. QDA Miner software was used to facilitate data analysis. A systematic qualitative, inductive/deductive approach was followed starting from categories identified in the literature, but also including newly emerging categories and interventions. Seven sessions were double coded to stabilize the coding tree and a "member check" was completed where therapists rated their own transcripts. A total of 24 mentalization-based techniques were identified, including 17 additional techniques. A conceptual framework organizing all observed mentalization-based interventions is proposed. The findings of this study provide a framework for studying techniques that may enhance the capacity to mentalize, and that could be features of therapeutic practice across a range of modalities of psychotherapy

Mentalizing Mediates the Association Between Childhood Maltreatment and Adolescent Borderline and Narcissistic Personality Traits

Background: Childhood maltreatment is theorized to undermine the development of mentalizing and to disrupt the development of healthy narcissism and the integration of personality at the level of affect and interpersonal regulation. Consistent with this, mentalizing can be expected to mediate the relationship between childhood maltreatment and vulnerable and grandiose narcissism as well as borderline personality traits, but this has not been examined in adolescents. Objective: The aim of this study was to examine associations between childhood maltreatment and adolescent personality disorder traits and test the mediating role of mentalizing in a sample of 263 adolescents and young adults aged 12 to 21. Methods: Participants recruited from school and a tertiary institution completed the Childhood Experiences of Care and Abuse Questionnaire (CECA-Q), the Borderline Personality Features Scale for Children (BPFS-C), the Pathological Narcissism Inventory (PNI) and the Reflective Function Questionnaire for Youth (RFQ-Y). Results: Adolescents with histories of sexual and physical abuse reported significantly more borderline personality features, as well as vulnerable and grandiose narcissism. They also reported signficantly more mentalizing difficulties including confusion regarding mental states and excessive certainty regarding mental states of others. Confusion regarding mental states partially mediated the relation between emotional abuse and borderline personality traits, as well as vulnerable and grandiose narcissism. Excessive certainty regarding the mental states of others mediated the relationship between childhood experiences of role reversal and grandiose narcissism. Conclusion: The findings are consistent with a mentalization model of adolescent personality difficulties and show that the relation between childhood maltreatment and personality disorder traits in adolescents may be in part understood in terms of the impact of such experiences on different dimensions of mentalizing

Mentalization and dissociation in the context of trauma: Implications for child psychopathology

Dissociation is a common reaction subsequent to childhood sexual abuse (CSA) and has been identified as a risk factor for child psychopathology. There is also evidence that mentalization contributes to resilience in the context of abuse. However, at this stage little is known regarding the relationship between mentalization and dissociation, and their respective contributions to psychopathology. The aim of this study was to examine pathways from CSA to depressive symptoms, externalizing behaviour difficulties and sexualized behaviour, through mentalization and dissociation. These pathways were examined in a sample of 168 mother-child dyads including 74 dyads where children (aged 7–12) had histories of sexual abuse. Maternal mentalization was assessed using the Parent Development Interview-Revised and children’s mentalization was assessed using the Child Reflective Functioning Scale. Children completed the Child Depression Inventory and parents completed the Child Dissociative Checklist, the Child Behavior Checklist and the Child Sexual Behavior Inventory. Direct and indirect paths from CSA to child psychopathology via children’s mentalization and dissociation were examined using Mplus. Two distinct paths from abuse to psychopathology were identified. Child mentalization partially mediated the relationship between CSA and depressive symptoms. The effects of CSA on externalizing symptoms and sexualized behaviour difficulties were sequentially mediated through mentalisation and dissociation

Intergenerational Pathways From Reflective Functioning to Infant Attachment Through Parenting

The aim of this prospective study was to examine temporal pathways from mothers’ reflective functioning (RF) through parenting to infant attachment measured more than 16 months later. Participants were 88 mother–infant dyads from demographically diverse backgrounds and included a group of mothers with histories of childhood maltreatment. RF was assessed using the RF rating of the Adult Attachment Interview before the birth of the baby. Parenting was assessed when the infants were 6 months old using the Maternal Sensitivity scale, as well as when they were 16 months using the Disconnected and Extremely Insensitive Parenting scale. Infant attachment was assessed when the infants were 16 months old using the Strange Situation. As hypothesised, the study findings showed that mothers’ mentalization regarding their own early attachment relationships was associated with later parenting and infant attachment. Negative parenting behaviours explained the link between mothers’ RF about their own attachment relationships and infant attachment disorganization. The findings suggest that mothers’ mentalization about their early attachment relationships has important implications in the transition to becoming parents themselves. Mentalization appears to be particularly important in helping mothers screen and inhibit negative parenting behaviours that would otherwise undermine infant attachment security and organization

Post-traumatic stress disorder in sexually abused children: secure attachment as a protective factor

The aim of the present study was to examine the hypothesis that attachment and CSA interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing PTSD and trauma symptoms. Participants (n = 111, ages 7-12) comprised two groups, child CSA survivors (n = 43) and a matched comparison group of children (n = 68) recruited from the community. Children completed the Child Attachment Interview as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate identification children most at risk have important implications for understanding risk and resilience processes

Parental reflective functioning as a moderator of child internalizing difficulties in the context of child sexual abuse

The objective was to examine pathways from child sexual abuse (CSA) and maternal mentalizing to child internalizing and externalizing difficulties and to test models of MRF as moderator of the relationships between CSA and child difficulties. The sample was comprised of 154 mothers and children aged 2–12 where 64 children had experienced CSA. To assess parental mentalizing the Parental Development Interview was rated with the Parental Reflective Functioning Scale. Child internalizing and externalizing difficulties were assessed with the Child Behavior Checklist (CBCL). Results indicate that there were significant inverse relationships between maternal mentalizing and child internalizing and externalizing difficulties. When maternal mentalizing was considered together with CSA, only maternal mentalizing was a significant predictor of child difficulties. Furthermore, maternal mentalizing moderated the relationship between CSA and child internalizing difficulties. These findings provide evidence of the importance of the parents’ mentalizing stance for psychiatric symptoms of children aged 2–12, as well as children’s recovery from CSA. The clinical implications of the findings are discussed

Childhood Maltreatment, Adolescent Psychological Difficulties and Borderline Personality Features: A Person-Centered Approach

Childhood maltreatment is a well-known risk factor for poor psychological outcomes across the lifecycle, including internalizing and externalizing difficulties, personality pathology and non-suicidal self-injury (NSSI). Much less is known regarding the associations between specific types and combinations of maltreatment and these difficulties during adolescence. Given the limitations of variable-centered approaches that focus on correlations and associations, the present study used a person-centered approach (Latent Class Analysis) to examine whether groups of adolescents who experience specific types and combinations of maltreatment reported more internalizing and externalizing difficulties, borderline personality features, or NSSI. Participants were 327 adolescents and young adults aged 12 to 21 from the community, with 32% reporting some experiences of maltreatment. The findings indicate that for adolescents and young adults in the community, sexual abuse, as well as neglect and antipathy in combination with other forms of maltreatment were associated with significantly higher self-reported distress and dysfunction. Sexual abuse was linked to more internalizing difficulties, borderline personality features and NNSI, whereas both neglect and antipathy were associated with more internalizing and externalizing difficulties. Furthermore, neglect was associated with significantly more episodes of NNSI and antipathy with more self-reported borderline personality features

Measuring Reflective Functioning in Adolescents: Relations to Personality Disorders and Psychological Difficulties

Background: Reflective Functioning (RF) is considered to play a central role in risk and resilience for psychological difficulties such as borderline personality disorder (BPD) and has become an important treatment target of transdiagnostic psychosocial interventions like Mentalization Based Therapy. However, a lack of measures to assess RF in adolescents has hampered research that can further elucidate the role of RF in different types of psychopathology. Objective: The objective of the present study was to examine the validity of the Reflective Functioning Questionnaire for Youth (RFQ-Y), examine the factor structure of the french RFQ-Y, the relationship between RFQ-Y and social cognition, psychological difficulties, BPD and narcissistic personality disorders. Methods: A total of 533 adolescents and young adults (age 12 - 21) from the community completed the RFQ-Y, the Child Behaviour Checklist, the Borderline Personality Features Scale and the Pathological Narcissism Inventory. A subsample of 150 participants completed the Movie for the Assessment of Social Cognition (MASC). Results: Three factors were identified. Uncertainty/confusion was strongly positively correlated with psychological difficulties, especially symptoms of borderline personality disorder. Interest/curiosity was negatively correlated with and psychopathology and Excessive Certainty correlated significantly with grandiose narcissism. RFQ-Y factors correlated more strongly with psychopathology than the MASC scales. Conclusion: This study demonstrates the validity of self-report measures like the RFQ-Y and its utility for identifying problematic styles of mentalizing associated with increased risk of psychopathology in general, as well as difficulties like narcissism in particular

Assessing Reflective Parenting in Interaction with School-Aged Children

The aim of this study was to examine whether it was to develop a reliable and valid assessment of reflective parenting implicit in interaction with school-aged children using an adaptation of the Squiggle paradigm developed by Winnicott and a manualized coding system. A total of 158 mother-child dyads participated when children were aged 5-12. Of this group, 89 children had experienced sexual abuse (CSA). Inter -rater reliability using the manualized coding system was excellent. The factor analysis identified a Reflective Parenting Stance factor, in addition to an Affectionate Support factor and a Negative Parenting factor. Furthermore, there was a medium strength relationship between the mother’s Reflective Parenting Stance evident in her interactions with her child and parental reflective functioning assessed using the Parent Development Interview, suggesting the Parental Reflective Stance is a good indicator of parental reflective functioning in interaction. With regard to parent reports of child internalizing and externalizing behaviors, the Reflective Parenting Stance, was the only predictor of internalizing difficulties and a significant predictor of externalizing difficulties in addition to CSA

Pathological Narcissism in Adolescents: Relationships with Childhood Maltreatment and Internalizing and Externalizing Difficulties

Background: There are significant gaps in our understanding of vulnerable and grandiose narcissism in adolescents and whether it is associated with psychosocial difficulties as well as risk factors such as child maltreatment. Objective: The aim of this study was to examine vulnerable and grandiose narcissism in adolescents and young adults. Method: 570 participants (ages 14-21) from the community completed an online survey. Vulnerable and grandiose narcissism were assessed with the Pathological Narcissism Inventory, while psycho-social difficulties were assessed with the Child Behaviour Checklist and maltreatment with the Childhood Experiences of Care and Abuse Questionnaire. Results: Gender-specific age trends were identified, with narcissism appearing to decrease with age for females, while increasing for males into early adulthood. For females, vulnerable and grandiose narcissism was associated with maltreatment and partially mediated the relationship between abuse and neglect and internalizing and externalizing difficulties. Conclusion: These findings underscore the importance of considering the relationship between childhood maltreatment experiences and suggest that the relationship between such experiences and adolescent psychosocial difficulties may be partially accounted for by the negative impact that maltreatment has on narcissism