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Objective: To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. Method: Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. Results: The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. Conclusion: Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process. [ABSTRACT FROM AUTHOR]

Dynamic Interpersonal Therapy (DIT) is a brief psychodynamic therapy for depression, developed from the fundamental competences of evidence-based psychoanalytic/dynamic therapeutic methods. The 20-Day DIT training programme at the Anna Freud Centre in London is offered for clinicians who do not meet these psychoanalytic/dynamic competences. 28 therapists, each with three patients, underwent the 20-Day DIT training in 2019. The current study evaluated the 20-Day DIT training by investigating factors associated with the successful patient outcomes of this cohort. Reliable recovery and reliable improvement of patients was 69% and 90%, respectively. Quantitative analyses found that patients who have positive outcomes were likely to have lower baseline Patient Health Questionnaire-9 (PHQ-9) scores and lower patient complexity. A thematic analysis of the therapists' perspectives suggested that the most important elements of DIT perceived to be associated with successful patient outcomes cluster around four superordinate themes: aspects of the DIT model/training, characteristics of the patient, aspects of the patient-therapist relationship, and characteristics of the therapist. The results suggest that the DIT protocol can be acquired by novice therapists in psychoanalytic/dynamic methods and offer insight into the factors that may be associated with successful outcomes. [ABSTRACT FROM AUTHOR]

to identify and describe trajectories of change in general psychopathology (p) levels among depressed adolescents who received one of three types of short-term therapies (namely Cognitive–Behavioural Therapy, Short-Term Psychoanalytic Psychotherapy, and a Brief Psychosocial Intervention). Participants were 465 adolescents with MDD who participated in an RCT comparing three treatments for depression. Narrow-band measures of depression, anxiety, obsessions-compulsions, and conduct problems were assessed at six-time points, and bifactor analysis was performed to extract p factor scores. These scores were submitted to Latent Class Growth Analyses to identify patterns of change over time. Three different trajectories of change in p were identified. Two trajectories displayed reductions in p across time-points: one a rapid decrease, and the other slower but steady improvement. The third trajectory indicated a limited decrease in p up until the 12th week after baseline but no further improvement at subsequent time-points. Patients' baseline p significantly predicted their outcome trajectories. Exploring change in p seemed to describe more parsimoniously the patients' outcomes than the narrow-band assessment of depressive symptoms. Patients with high baseline p were more likely to have poorer outcomes, potentially indicating a need to develop more intensive and tailored treatments for this population. [ABSTRACT FROM AUTHOR]

Diagnosis and treatment of congenital heart disease (CHD) can present challenges to the developing parent-child relationship due to periods of infant hospitalization and intensive medical care, parent-infant separations, child neurodevelopmental delay and feeding problems, and significant parent and child distress and trauma. Yet, the ways in which CHD may affect the parent-child relationship are not well-understood. We systematically reviewed the evidence on parental bonding, parent-child interaction, and child attachment following CHD diagnosis, according to a pre-registered protocol (CRD42019135687). Six electronic databases were searched for English-language studies comparing a cardiac sample (i.e., expectant parents or parents and their child aged 0–5 years with CHD) with a healthy comparison group on relational outcomes. Of 22 unique studies, most used parent-report measures (73%) and yielded mixed results for parental bonding and parent-child interaction quality. Observational results also varied, although most studies (4 of 6) found difficulties in parent-child interaction on one or more affective or behavioural domains (e.g., lower maternal sensitivity, lower infant responsiveness). Research on parental-fetal bonding, father-child relationships, and child attachment behaviour was lacking. Stronger evidence is needed to determine the nature, prevalence, and predictors of relational disruptions following CHD diagnosis, and to inform targeted screening, prevention, and early intervention programs for at-risk dyads. [ABSTRACT FROM AUTHOR]

Most research on alliance rupture-repair processes in psychotherapy has been carried out with adults and little is known about the alliance dynamics with adolescents, especially in psychodynamic treatments. Objective: This study aimed to better understand the process of alliance rupture–resolution and its role in a good-outcome case of a depressed adolescent treated with short-term psychoanalytic-psychotherapy (STPP). Method: A longitudinal, mixed-methods empirical single-case approach was employed. Multiple sources of information (questionnaires, interviews, sessions recordings) from various perspectives (adolescent, therapist, observer) were assembled and analysed. Results: The different sources of evidence converged and showed that, despite the presence of frequent alliance ruptures, patient and therapist managed to resolve these and develop a good and collaborative relationship. Both patient and therapist regarded the evolution in their relationship as the treatment factor mainly responsible for the positive changes experienced by the adolescent. Based on both theoretical and empirical data, a preliminary model of how to explore and repair alliance ruptures in STPP is presented. Conclusion: This study illustrates one way of applying an empirical, mixed-method approach to a single case. Its finding supports the idea that the process of repairing ruptures is an important mechanism of change. Strengths, limitations, and possible implications are discussed. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic has both a profound effect on mental health and affects how psychosocial interventions are delivered. In this paper, we outline particular difficulties patients with Borderline Personality Disorder (BPD) may encounter as a result of the pandemic. We also consider changes in the provision of treatment, specifically the transition from face to face encounters to remotely delivered sessions. Building on a mentalization-based developmental framework, we use clinical vignettes to chart some of these challenges for patients, clinicians and teams. We then make practical recommendations for adaptations to work during the pandemic via the phone or video-link with BPD patients and other groups characterized by a vulnerability to unstable and imbalanced mentalizing. We conclude that the response to these challenges benefits from an existing treatment context that aims at fostering mentalizing and resilience, in which practitioners address the hierarchy of patient needs and their individual responses to the experience of remote treatment during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The COVID-19 crisis has required many therapists to switch to video conferencing psychotherapy (VCP). Knowledge about the importance of epistemic trust and its determinants has been accumulating over the last few years, with important implications for psychotherapy and specific significance for the transition to VCP. The present paper provides a brief background on the concept of epistemic trust, research on the determinants of its development and the integrative framework it provides for some traditional concepts in psychotherapy, such as the therapeutic alliance. In particular, research on ostensive cuing, which requires significant modification in a remote delivery context, has important implications in the transition to VCP. We will advance some suggestions while illustrating the ideas with clinical case studies. This knowledge may be of value to psychotherapists, who are required to make substantial changes in the nature of the encounter with their patients, and may help them identify benefits and hindrances that might arise from this transition, as well as pointing out techniques that may encourage effective adaptation to the change. [ABSTRACT FROM AUTHOR]

The article explores ideas about the role of group mentalizing—the experience of joint attention and shared intentionality—as a process that can support the emergence of more collaborative and salutogenic social functioning. This is based on developmental and evolutionary thinking about the importance of joint attention in human social cognitive development and functioning. The importance of experiencing rupture and repair as part of the process of thinking together—while also working with the separate nature of our thoughts—is described, emphasizing that it is through an understanding of the complex and inevitably uneven and challenging nature of joint attention and social cooperation that such cooperation is itself made possible. [ABSTRACT FROM AUTHOR]

Objective: The Working Alliance Inventory short form (WAI-S) is one of the most commonly used alliance measures with adolescents. Yet, its factor structure has received minimal attention in the youth alliance literature. This study investigated the factor structure of the WAI-S in psychotherapy for adolescent depression and explored its measurement invariance across time, therapeutic approaches and patients' and therapists' perspectives. The existence of method effects associated with the negatively worded items of the scale was also assessed. Method: The setting of this study is the IMPACT trial, a randomized controlled trial assessing the effects of three therapeutic interventions in the treatment of adolescent depression. The WAI-S was completed at 6, 12 and 36 weeks after randomization by 338 adolescents and 159 therapists. Data were analysed using confirmatory factor analysis. Results: The hypothesized Bond-Task-Goal alliance structure was not supported and a general, one-factor model was found to be more psychometrically valid. The existence of a method effect and measurement invariance across time and treatment arms were also found. Conclusions: While the distinction between the specific alliance dimensions is conceptually and clinically interesting, at an empirical level the alliance features of the WAI-S in youth psychotherapy remain strongly intercorrelated. [ABSTRACT FROM AUTHOR]

Theoretical conceptualizations of mentalizing postulate a close relationship between the ability to mentalize and the regulation of emotional states. The former is viewed as a key process to modulate the latter, with the origins of the link between the two established in early attachment relationships. However, there is a lack of research testing this association empirically. In the present cross-sectional study, the hypothesis of a positive relationship between the two constructs was tested based on data collected on more than 500 nonclinical adult participants. Various self-assessments and an experimentally derived instrument of mentalizing were employed to this end. Correlational analyses confirmed the expected associations between emotion regulation and mentalizing. In addition, regression models showed that adaptive as well as maladaptive emotion regulation, independent of age, gender, and native language, could be predicted only by self-focused mentalizing. [ABSTRACT FROM AUTHOR]

The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers' capacity for mentalization. However, little is known about its psychometric properties. The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors. Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded. The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified. [ABSTRACT FROM AUTHOR]

Background: Little is known about the "active ingredients" of psychological therapy for Borderline Personality Disorder (BPD) despite a growing evidence base documenting its clinical effectiveness. This information can be used by clinicians to inform service planning and care pathways. Aims: The aim of this study was to review published empirical research investigating the potential mechanisms underlying therapeutic change in Dialectical Behaviour Therapy (DBT) and Cognitive Behaviour Therapy (CBT) for BPD. Method: A thorough search of the PsychInfo, CINAHL Plus, PubMed, MEDLINE and EMBASE databases revealed research into potential mechanisms of change. Results: A total of 52 abstracts were reviewed. After a full text screen of the most relevant studies, 14 met inclusion criteria. Twelve examined DBT and two CBT. Mechanisms of change identified broadly fell into three categories: emotion regulation/self-control, skills use and therapeutic alliance/investment in treatment. Outcomes measured included general mental health diagnoses (e.g. anxiety, depression) and BPD-specific symptoms (e.g. self-harm/suicidality, impulsivity, substance misuse, anger). Conclusion: Further empirically robust research is required to test hypotheses about the influence of the proposed mechanisms on therapeutic change in psychological therapies for BPD. [ABSTRACT FROM AUTHOR]

The paper describes the development of Dynamic Interpersonal Therapy for use with complex depression (DITCC), and a pilot study testing DITCC's effectiveness. The pilot found large pre-post improvements in well-being and distress; moderate rates of reliable improvement and clinically significant change; and curvilinear declines in depression and anxiety. Treatment completers and near-completers (N= 19) showed a significant curvilinear decline in symptoms of depression (PHQ-9) and anxiety (GAD-7). The results provide preliminary evidence that DITCC can be used as an effective treatment approach for complex depression. However, further research is needed to test its effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions to further elaborate the short-term and long-term effects. [ABSTRACT FROM AUTHOR]

Background: Patients with treatment-resistant depression (TRD) suffer very significant morbidity and are at a disadvantage concerning optimal clinical management. There are high associated societal costs. Aims: A detailed analysis of health economic costs in the United Kingdom in a group manifesting a severe form of TRD in the 12 months before their participation in a major randomized controlled treatment trial. Methods: The sample consisted of 118 participants from the Tavistock Adult Depression Study. Recruitment was from primary care on the basis of current major depression disorder of at least 2 years' duration and two failed treatment attempts. Service utilization was assessed based on self-report and general practitioner (GP) medical records. Generalized linear models were used to identify predictors of cost. Results: All participants used GP services. Use of other doctors and practice nurses was also high. The mean total societal cost was £22 124, 80% of which was due to lost work and care required of families. Level of general functioning was found to be the most consistent predictor of costs. Conclusions: Severe forms of TRD are associated with high costs in which unpaid care and lost work predominate. Treatments that improve functioning may reduce the large degree of burden. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine whether it was possible 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 (1968) and a manualized coding system (Normandin, Leroux, Ensink, Terradas, & Fonagy, 2015). A total of 158 mother–child dyads participated when children were age 5 to 12. Of this group, 89 children had experienced sexual abuse. Interrater 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 (Slade, Aber, Bresgi, Berger, & Kaplan, 2004), 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 sexual abuse. [ABSTRACT FROM PUBLISHER]

AbstractObjectiveMethodResultsConclusionThe present study introduces and validates the Epistemic Trust Rating System (ETRS), an observer-based measure designed to assess epistemic trust (ET) within psychotherapy. ET in psychotherapy has gained much theoretical attention as a critical component in the therapeutic context, given its inherent link to social communication. However, its empirical validation remains pending, largely due to the absence of a refined instrument to gauge ET levels within the therapy environment. Therefore, this study aimed to translate ET’s theoretical construct into tangible markers within the therapeutic context.One hundred eighteen patients enrolled in a randomized controlled trial received psychodynamic psychotherapy for depression. Incorporating top-down theoretical considerations with bottom-up empirical observations yielded an overall ETRS score accompanied by three distinct sub-scales, each assessing a singular ET element: one gauges the patient’s propensity to share; another measures the degree to which “we-mode” moments are achieved within the session; and the third evaluates the patient’s receptiveness to learning.The findings demonstrate the psychometric robustness of the ETRS, with good internal consistency, interrater reliability (ICC(1,8) = .86-.90), and convergent (r = .23-.29) and discriminant validity (r = -.10).The current study highlights the ETRS as a promising tool bridging theory and empirical exploration, enhancing our understanding of epistemic trust in psychotherapy. [ABSTRACT FROM AUTHOR]

This article sets out the relevance of recent theoretical developments in the areas of mentalizing, attachment and epistemic trust in relation to group therapy. It begins with an account of the role of mentalizing in the attachment context in the development of epistemic trust—defined as trust in the authenticity and personal relevance of interpersonally transmitted knowledge about how the social environment works. It then explains the particular way in which this emphasis on social communication is pertinent to group therapy and its function as a training ground for mentalizing and the initial experimentation with the opening of epistemic trust in a social context. The article finishes with an account of how mentalization-based group work is undertaken. [ABSTRACT FROM PUBLISHER]

Although several studies have highlighted the relationship between attachment states of mind and personality disorders, their findings have not been consistent, possibly due to the application of the traditional taxonomic classification model of attachment. A more recently developed dimensional classification of attachment representations, including more specific aspects of trauma-related representations, may have advantages. In this study, we compare specific associations and predictive power of the categorical attachment and dimensional models applied to 230 Adult Attachment Interview transcripts obtained from personality disordered and nonpsychiatric subjects. We also investigate the role that current levels of psychiatric distress may have in the prediction of PD. The results showed that both models predict the presence of PD, with the dimensional approach doing better in discriminating overall diagnosis of PD. However, both models are less helpful in discriminating specific PD diagnostic subtypes. Current psychiatric distress was found to be the most consistent predictor of PD capturing a large share of the variance and obscuring the role played by attachment variables. The results suggest that attachment parameters correlate with the presence of PD alone and have no specific associations with particular PD subtypes when current psychiatric distress is taken into account. [ABSTRACT FROM PUBLISHER]

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. 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 mentalization and dissociation. [ABSTRACT FROM PUBLISHER]

Translations of summary In this paper we make the case for a psychoanalytically informed reconsideration of the phenomena of consciousness. Classically, following Freud, who viewed consciousness as merely a reflection or perception of unconscious mental activity, psychoanalysts have tended to regard a focus on conscious experience as potentially reductionistic and at risk of overlooking the mind's deeper structures. We describe the case of Mr K, a patient who experienced disturbances of consciousness that forced us to consider the possibility that the capacity to experience ourselves as conscious, intentional agents in a coherent world of objects is not merely a modality of perception but rather a maturational and developmental achievement that to some degree depends on adequate experiences of caregiving and is vital in ensuring the possibility of human communication. As such, it is a capacity that is vulnerable to experiences of neglect and maltreatment. We suggest that as well as compromising the capacity to think about one's own and other people's feelings, such experiences may have the further adverse consequence of leading the individual to experience and risk becoming conscious of certain dangerously maladaptive, destructive states of mind which in normal development remain inaccessible to conscious experience. Phenomenologically, such states of mind are experienced as fragmentation and disturbances of consciousness. We discuss the clinical implications of these reflections and the limitations they place on psychoanalytic work in the context of their impact on the work with Mr K. [ABSTRACT FROM AUTHOR]

Background: Sexual abuse is a well-recognised risk factor for child psychopathology. Little is known regarding whether child and maternal mentalization can be considered a potential resource or protective factor in this context, respectively, mediating or moderating the relationship between sexual abuse and psychopathology. Objective: The aims of this study were (1) to explore the relationships between child and maternal mentalizing, measured as reflective functioning (RF), and child depressive symptoms and externalising difficulties; and (2) to examine whether child mentalizing mediates the relationship between child sexual abuse (CSA) and psychopathology. Method: A total of 168 children aged 7-12 years and their mothers participated in the study. The sample included 74 dyads where children had experienced sexual abuse. The Child Attachment Interview was rated by using the Child Reflective Functioning Scale to assess children's mentalization, and the Child Depression Inventory was used to assess depressive symptoms. Mothers completed the Parent Development Interview to assess maternal RF and the Child Behavior Checklist to assess their child's externalising difficulties. A model involving direct and indirect paths from CSA, child and maternal RF to child psychopathology was examined using Mplus software. Results: Child mentalization partially mediated the relationships between CSA and depressive symptoms, as well as the relationship between CSA and externalising difficulties. Maternal mentalization was an independent predictor of child externalising difficulties, with higher maternal RF associated with less externalising difficulties. Discussion: The findings indicate that by ages 7-12, child mentalization is an important inner resource associated with lower depression and externalising. In addition, this study provides new evidence of the importance of the parent's mentalizing stance for the development of self-regulation and externalising difficulties in both abused and non-abused children. The clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Behavioral research has found evidence supporting reward dominance in adolescence with externalizing disorders, but findings from neuroimaging studies have been largely heterogeneous. We examined the Feedback-Related Negativity (FRN) and P3b in relation to self-reported externalizing behavior among 78 adolescents (11–18 yrs) during a monetary gambling task with concurrent high-density electroencephalogram. As expected, the P3b and the FRN demonstrated greater evoked activity to reward and punishment, respectively. Further, high externalizing behavior was associated with greater P3b difference and reduced FRN difference in response to reward and punishment, suggesting that externalizing behaviors may be associated with both reward dominance and reduced feedback-monitoring. [ABSTRACT FROM PUBLISHER]

This article celebrates Ed Tronick’s contribution to psychodynamic developmental psychology. Tronick’s ideas have implicitly and explicitly influenced late 20th-century and early 21st-century psychoanalytic thinking, and his contribution is here acknowledged in relation to the work on the developmental ideas concerning mentalizing. Tronick’s (1989, 2007) mutual regulation model (MRM) is outlined and examined from the point of view of the attachment-theory-based mentalization model of interpersonal interaction and psychopathology. The article identifies common ground between clinical implications of Tronick’s MRM and the mentalization model as independent but complementary ways of expanding ideas originating in attachment theory, and highlights ways in which the MRM provides greater clarity for several concepts which are frequently used in writings about mentalizing such as the background of safety and the holding environment. [ABSTRACT FROM PUBLISHER]

Adolescent Mentalization-Based Integrative Treatment (AMBIT) is a developing approach to working with “hard-to-reach” youth burdened with multiple co-occurring morbidities. This article reviews the core features of AMBIT, exploring applications of attachment theory to understand what makes young people “hard to reach,” and provide routes toward increased security in their attachment to a worker. Using the theory of the pedagogical stance and epistemic (“pertaining to knowledge”) trust, we show how it is the therapeutic worker’s accurate mentalizing of the adolescent that creates conditions for new learning, including the establishment of alternative (more secure) internal working models of helping relationships. This justifies an individual keyworker model focused on maintaining a mentalizing stance toward the adolescent, but simultaneously emphasizing the critical need for such keyworkers to remain well connected to their wider team, avoiding activation of their own attachment behaviors. We consider the role of AMBIT in developing a shared team culture (shared experiences, shared language, shared meanings), toward creating systemic contexts supportive of such relationships. We describe how team training may enhance the team’s ability to serve as a secure base for keyworkers, and describe an innovative approach to treatment manualization, using a wiki format as one way of supporting this process. [ABSTRACT FROM PUBLISHER]

This article begins with a reflection on the tensions that have existed at the intersection of attachment theory, psychoanalysis, and the use of empirical research methods. This discourse is described as having evolved considerably, involving some elements of intellectual détente and other elements of entrenchment (on both sides). It is suggested that future debate may revolve around the idea that many forms of psychopathology may be understood as fundamentally social in nature. Recognizing the salience of the communication of social knowledge—transmitted via epistemic trust—may be key to reconceptualizing both the origins of psychological disorder, and the processes that underlie effective treatments. [ABSTRACT FROM AUTHOR]

While the neurobiology of post-traumatic stress disorder has been extensively researched, much less attention has been paid to the neural mechanisms underlying more covert but pervasive types of trauma (e.g., those involving disrupted relationships and insecure attachment). Here, we report on a neurobiological study documenting that mothers’ attachment-related trauma, when unresolved, undermines her optimal brain response to her infant’s distress. We examined the amygdala blood oxygenation level-dependent response in 42 first-time mothers as they underwent functional magnetic resonance imaging scanning, viewing happy- and sad-face images of their own infant, along with those of a matched unknown infant. Whereas mothers with no trauma demonstrated greater amygdala responses to the sad faces of their own infant as compared to their happy faces, mothers who were classified as having unresolved trauma in the Adult Attachment Interview (Dynamic Maturational Model) displayed blunted amygdala responses when cued by their own infants’ sadness as compared to happiness. Unknown infant faces did not elicit differential amygdala responses between the mother groups. The blunting of the amygdala response in traumatized mothers is discussed as a neural indication of mothers’ possible disengagement from infant distress, which may be part of a process linking maternal unresolved trauma and disrupted maternal caregiving. [ABSTRACT FROM AUTHOR]

The concept of mentalizing has captured the interest and imagination of an astonishing range of people—from psychoanalysts to neuroscientists, from child development researchers to geneticists, from existential philosophers to phenomenologists—all of whom seem to have found it useful. According to the Thompson Reuter maintained Web of Science, the use of the term in titles and abstracts of scientific papers increased from 10 to 2,750 between 1991 and 2011. Clinicians in particular have enthusiastically embraced the idea, and have put it to innovative use in their practices. Mentalization-based treatment (MBT)—making mentalizing a core focus of therapy—was initially developed for the treatment of borderline personality disorder (BPD) in routine clinical services delivered in group and individual modalities. Therapy with mentalizing as a central component is currently being developed for treatment of numerous groups, including people with antisocial personality disorder, substance abuse, eating disorders, and at-risk mothers with infants and children (A. Bateman & Fonagy, 2011). It is also being used with families and adolescents, in schools, and in managing social groups (Asen & Fonagy, 2011; Fonagy et al., 2009; Twemlow, Fonagy, & Sacco, 2005a, 2005b). In this article, we focus on MBT in the treatment of BPD. [ABSTRACT FROM PUBLISHER]

This article outlines the development of a manualized, brief (16 session) psychodynamic intervention—Dynamic Interpersonal Therapy (DIT)1—for the treatment of depression. DIT is based on a distillation of the evidence-based brief psychoanalytic/psychodynamic treatments pooled together from manualized approaches that were reviewed as part of the competence framework for psychological therapies first commissioned in the United Kingdom by the Department of Health. This article begins with a description of the methodology underpinning the competence framework, followed by an overview of the model, its relevance to depression, and, finally, its strategies and techniques, which are illustrated through a case study.1DIT is easily confused with Interpersonal Therapy (IPT), because both therapies are interpersonal in their focus. However, IPT is not a psychodynamic therapy and this is reflected in the competences required to deliver it (Lemma, Roth, and Pilling, 2010), which are quite different to the psychoanalytic competences required to deliver DIT. [ABSTRACT FROM PUBLISHER]

It is well known that there is a lack of consensus about how to decide between competing and sometimes mutually contradictory theories, and how to integrate divergent concepts and theories. In view of this situation the IPA Project Committee on Conceptual Integration developed a method that allows comparison between different versions of concepts, their underlying theories and basic assumptions. Only when placed in a frame of reference can similarities and differences be seen in a methodically comprehensible and reproducible way. We used 'enactment' to study the problems of comparing concepts systematically. Almost all psychoanalytic schools have developed a conceptualization of it. We made a sort of provisional canon of relevant papers we have chosen from the different schools. The five steps of our method for analyzing the concept of enactment will be presented. The first step is the history of the concept; the second the phenomenology; the third a methodological analysis of the construction of the concept. In order to compare different conceptualizations we must know the main dimensions of the meaning space of the concept, this is the fourth step. Finally, in step five we discuss if and to what extent an integration of the different versions of enactment is possible. [ABSTRACT FROM AUTHOR]

Mothers in prison represent a high-risk parenting population. New Beginnings is an attachment-based group intervention designed specifically for mothers and babies in prison. This cluster randomized trial examined the outcomes for 88 mothers and babies participating in the New Beginnings program and 75 dyads residing in prisons where the intervention did not take place. Outcomes were measured in terms of parental reflective functioning, the quality of parent–infant interaction, maternal depression, and maternal representations. Mothers in the control group deteriorated in their level of reflective functioning and behavioral interaction with their babies over time, whereas the mothers in the intervention group did not. There were no significant group effects on levels of maternal depression or mothers’ self-reported representations of their babies over time. An attachment-based intervention may mitigate some of the risks to the quality of the parent–infant relationship for these dyads. [ABSTRACT FROM PUBLISHER]

The opposition between psychoanalysis and systematic interdisciplinary research is to be regretted. The target article attempts to bridge the intellectual divide and for this aim as well as the intellectual adroitness shown it is to be celebrated. Much harder to understand is the high level of affect generated by the debate. Accusations of “doublethink” are helpful. The present paper, like the target paper it follows, attempts to develop an understanding of the position of those who are categorically opposed to interdisciplinary systematic research linked to psychoanalysis. Appreciating the perspective of those deeply opposed to such work could help to create a shared agenda from which our troubled discipline could benefit. This is predicated on the possibility of an open collegial dialogue which this journal was founded to create. [ABSTRACT FROM PUBLISHER]

Patients with functional somatic disorders (FSD) represent a sizeable group in our health care system. FSD are associated with high health care use and considerable personal and economic costs. Evidence-based treatments for FSD are only modestly effective in a large subgroup of patients, particularly in the long run, which emphasizes the need to develop more effective treatments rooted in extant knowledge about the nature of FSD. This paper presents a contemporary psychodynamic perspective on the conceptualization and treatment of patients with FSD rooted in attachment and mentalization theory. First, we review animal and human research demonstrating the close relationships among attachment, stress regulation, and immune and pain-regulating systems. We highlight research findings concerning the high interpersonal and metabolic costs associated with the use of insecure secondary attachment strategies (i.e. attachment deactivating and hyperactivating strategies) leading to increased vulnerability for stress. Next, we review evidence for the role of impairments in (embodied) mentalization in patients with FSD both as cause and consequence of functional somatic complaints, leading to the re-emergence of so-called non-mentalizing modes, i.e. modes of subjectivity that antedate the capacity for full mentalizing. Based on these views, a novel brief psychodynamic intervention for patients with functional somatic complaints is presented. [ABSTRACT FROM AUTHOR]

This paper describes a protocol for a brief psychodynamic intervention (Dynamic Interpersonal Therapy; DIT) for use with depressed patients and a pilot study set out to test its acceptability and compatibility with session-by-session monitoring as a prelude to a future randomized controlled trial. Sixteen consecutively referred, depressed patients (aged 20-53) were offered 16 sessions of DIT. Patient outcomes were collected pre-post, and on a session-by-session basis, using the PHQ-9 and GAD-7. Therapist and supervision feedback indicates that this structured psychodynamic treatment could be effectively taught, and that the key competences involved were acquired and demonstrated in the clinical work supervised. Patients found the treatment acceptable and relevant to their problems. The treatment appeared compatible with session-by-session monitoring of symptoms of anxiety and depression. DIT was associated with a significant reduction in reported symptoms in all but one case, to below clinical levels in 70% of the patients. Random regression models revealed highly significant linear and quadratic components, confirming the decrease in reported symptom severity but cautioning about slight increase in symptoms around the ending phase of the treatment. The results suggest that DIT is promising in its acceptability and effectiveness with an unselected group of primary care patients, and is easily acquired by psychodynamically trained clinicians. [ABSTRACT FROM AUTHOR]

This paper outlines the development of a manualized, brief (16-session) psychodynamic intervention - Dynamic Interpersonal Therapy (DIT)1 - for the treatment of depression. DIT is based on a distillation of the evidence-based brief psychoanalytic/psychodynamic treatments pooled together from manualized approaches that were reviewed as part of the competence framework for psychological therapies first commissioned by Skills for Health. DIT has now been selected as the brief psychodynamic protocol that will be provided nationally in the UK as part of the IAPT programme. This paper will first describe the methodology underpinning the competence framework followed by an overview of the model, its relevance to depression, and finally its strategies and techniques. [ABSTRACT FROM AUTHOR]

Four close colleagues reflect on Stuart T. Hauser's legacy to developmental psychology, adolescent psychiatry, and psychoanalytic research. Peter Fonagy highlights Hauser's unique contribution to the science of resilience. Alan Jacobson reflects on Hauser's groundbreaking investigations of the psychosocial dimensions of juvenile diabetes. Robert McCarley discusses Hauser's remarkable record of mentorship, and David Reiss poignantly captures defining qualities of Hauser's life that enabled his scientific contributions, and his gifts of mentorship and friendship. Together, these articles underscore the extraordinary breadth and depth of Hauser's influence on the science of understanding adolescents' interpersonal and intrapsychic journeys toward adulthood. [ABSTRACT FROM AUTHOR]

A conference paper about the future of psychoanalysis psychotherapy and the changes in clinical practice is presented. The author discusses three changes that have occurred since 1960 to the practice of psychoanalysis including the distribution of treatment lengths, axis I symptoms in patients with personality pathology and influences from developmental theories on technical changes.

The article reviews several articles including "The psychology of depression in young adolescents: A psychoanalytic view of origins, inner workings, and implications," by Margaret Rustin, "The development of children of postnatally depressed mothers: Evidence from the Cambridge longitudinal study," by Lynne Murray, and "Consenting to be robbed so a not to be murdered," by David Taylor.

Data about the quality of attachment between infants and parents in high-risk populations suggests that early intervention may be advantageous for positive developmental outcomes for the child. Mothers in prison represent a high-risk parenting population in terms of both attachment histories and economic and social risk factors. New Beginnings was constructed as a short term, experience-based programme for mothers and infants in the Mother and Baby Units of two UK women's prisons. It is based on the early intervention model developed at the Anna Freud Centre. The programme was piloted in 2004-5, with 27 participating dyads. This paper presents an overview of the pilot stage. Our aim is to introduce the thinking that went into the programme and to present initial observations concerning the effect of the programme. We describe the development of a framework for the programme and its preliminary evaluation using pre- and post-interview protocols concerning the mothers' thoughts and feelings about their babies. We used the Parent Development Interview, for both a qualitative analysis of the major themes in connection to child rearing and quantitative measures of reflective capacity in relation to the child on the part of mother-participants. [ABSTRACT FROM AUTHOR]

In this chapter, we will outline how the concept of mentalizing helps us understand some of the common problems associated with borderline personality disorder and how the theoretical understanding is translated into psychotherapeutic intervention. Mentalizing is the process by which we interpret the actions of ourselves and others in terms of underlying intentional states such as personal desires, needs, feelings, beliefs and reasons. This capacity develops within the context of attachment relationships during infancy and childhood. Borderline personality disorder is conceived of as being a disorder of mentalizing. Vulnerability to a loss in mentalizing particularly in interpersonal or stressful circumstances is a core feature of the disorder. If treatment is to be successful it must either have mentalization as its focus or at the very least stimulate development of mentalizing as an epiphenomenon. Treatment focusing on mentalizing itself is described. [ABSTRACT FROM AUTHOR]

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services.Aplacement prevention model, outlined as an alternative "mentalising social system" approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care. [ABSTRACT FROM AUTHOR]

In this study we examined whether antisocial boys show evidence of a reduced interpersonal interpretation of events (intentionality) specifically in story stem responses to social challenges that provoke fear and distress responses. Two conflict and two distress stems were administered to 5 - 8 year old boys, 41 referred for disruptive behaviour problems and 25 non-referred boys. Raters blind to group membership scored dysregulated aggression and intentionality from transcripts of story responses. Referred boys had elevated aggression and lower intentionality scores across all stems compared to non-referred. However, there was a story type by group interaction; referred boys had substantially lowered intentionality in response to the distress stems, but not the conflict stems. Avoidant strategies that reduce threat related anxiety or fear also contribute to disruptive behaviour problems. [ABSTRACT FROM AUTHOR]

The authors explore the interpersonal aspects of the early development of an experience of external reality and the roots of this experience in primary intersubjectivity. They suggest some implications that this has for psychoanalytic work with the patient's experience of external reality. They argue that the external world is not an independently existing 'given', for the infant to discover, as is sometimes implicitly assumed. Infants acquire knowledge about the world not just through their own explorations of it but by using other minds as teachers. The experience of external reality is invariably shaped through subjectivities. The authors argue that at fi rst the infant assumes that his knowledge is knowledge held by all, that what he knows is known by others and that what is known by others is accessible to him. Only slowly does the uniqueness of his own perspective differentiate so that a sense of mental self can develop. In clinical work we frequently observe the undoing of this process of differentiation, and understanding the underlying mechanisms can be helpful in managing the transference and countertransference consequences when the process has been derailed. [ABSTRACT FROM AUTHOR]

The article introduces several papers within the issue, including one about the application of Dialectic Behavior Therapy for borderline personality disorder and another about nidotherapy, which is a protocol for the management of chronic and persistent mental disorders.

Background: Mentalization-based treatment is a model of psychodynamic therapy rooted in attachment theory that aims to enhance the individual's capacity to represent thoughts, feelings, wishes, beliefs and desires in themselves and in others in the context of attachment relationships. Aims: To describe the normal development of mentalization as well as anomalies in mentalization that can arise and can ultimately lead to the development of personality disorder. Method: Description of the basic principles of mentalization-based treatment as well as the rationale for use of these techniques. Results: Summaries of randomized controlled trial and a description of an ongoing RCT for the outpatient treatment of BPD. Conclusion: MBT is a generic psychotherapeutic treatment which shares many features with other psychotherapeutic approaches but is unique in focusing on enhancing the patient's capacity to think about and regulate mental states. [ABSTRACT FROM AUTHOR]