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Mental health interventions for children vary with respect to the problem being addressed and to the age and other individual characteristics of the child. Although such interventions share some approaches, treatment methods can be quite different from each other. Terms describing child treatments may vary from one part of the world to another, with particular differences in the use of the terms "psychotherapy" and "psychoanalysis". For these reasons, readers should take special care to consider definitions of terms in this article. For attachment-based therapies see Attachment based therapy (children).

Contents 1 Psychoanalytic approaches 1.1 Parent-Infant Psychotherapy 1.2 Mentaliseren Bevorderende Kinder Therapy (MBKT) 2 Challenges to therapists 3 See also 4 References

Psychoanalytic approaches

There are several different techniques to approach the psychoanalytic treatment of children. If children are at a very young age an adapted psychoanalytic technique maybe necessary. In some cases parent-infant psychotherapy is a possibility. Two techniques will be discussed: Parent-Infant Psychotherapy and Mentaliseren Bevorderende Kinder Therapie (MBKT). Parent-Infant Psychotherapy addresses problems with normal relationships between parent and child. MBKT addresses problems with an infant’s ability to distinguish reality and fantasy.

Parent-Infant Psychotherapy

If the normal course of secure attachment between parent and infant is disrupted, parent-infant psychotherapy is one technique that can be used to restore this bond. This technique requires a three-way relationship between the parent, child and therapist. During the therapy sessions the parent expresses his or her thoughts and feelings which are based on a combination of factors including:

1. The parent’s experiences as a child
2. The parent’s expectations and hopes for the child’s future
3. The relationships the parent has with other people

The therapist’s role is as an observer and an interpreter of the interaction between the infant and the parent. He might share some of his thoughts about the behaviour of the child with the parent and by doing so offering the parent an alternative way of experiencing the child. This technique helps the parent to resolve issues with his or her own infancy-experiences in order to restore secure attachment with the infant. And it helps lower the risk for psychopathological developments of the child in the future.¹²

Mentaliseren Bevorderende Kinder Therapy (MBKT)

An important concept is “the ability to mentalise”. This is the capability of seeing one’s self or other people’s behaviour in terms of assumed mental conditions. With this concept different types of mental processes play a role. For example: reflection, representation, categorisation, fantasising and processing information.
The Nederlands Psychoanalytisch Instituut NPI (Dutch Psychoanalytic Institute) has been working with a form of therapy for children called “Mentaliseren Bevorderende Kinder Therapie” (MBKT) since 2003. Mentaliseren Bevorderende Kinder Therapie is translated as “therapy for children enhancing their ability to mentalise”. This therapy is partly based on the theory of Fonagy³ (2002) in which mentalization is the central theme. Mentalizing is accomplished when two developmental concepts can be integrated. Specifically, the equivalent modus and the pretend modus. A child that functions according to the equivalent modus only, doesn’t experience a difference between reality and fantasy. Inside and outside are equal. With a child that only functions in the pretend modus there’s a difference between reality and fantasy however they exist separately from each other. The child isn’t aware of the reality level when he’s pretending. When both modus are integrated the child is aware that he’s pretending and then we speak of mentalization.

Mentalization is a conscious as well as an unconscious process which enables people to see that actions and thoughts of themselves and others are motivated by internal thoughts, intentions and attitudes. A child’s development of self-regulating mechanisms and ability to mentalise (which, when taken together are called Interpersonal Interpretative Function, IIF) are dependent on their “early attachment relation”. Traumata can cause the child to refrain from very painful feelings connected to the events and or persons connected to the trauma. This incapability to integrate those feelings may influence the modus in which the child comes to operate. An overwhelming flow of anxiety for instance can cause the child to fall back in to an equivalent modus of operating.

Other components which are crucial in the development of the child and also mainly dependent on the quality of the attachment to the parent are “attention regulation” and “affect regulation”. When the regulation of either is not sufficient a therapy may help to influence the flow of both. The starting point in “attention regulation” is that the child is still functioning from the “equivalent modus” which means there are insufficient affect representations. Here the main goal is to direct and focus the attention of the child to the inner world (feelings, thoughts, wishes and impulses). This focuses their mental being more on physical reality.

In affect regulation the often diffuse affects of the child within the therapeutic relation are explored. Here it is important that the child goes through their own feelings and recognize them forming them into mental representations. As this ‘mentalization process’ develops the child functions in the pretend modus and is capable of using symbolic representations. Interventions are based on improving thinking about mental conditions and mental processes.

MBKT can be qualified as an intensive form of therapy with two to five sessions per week. These sessions are a combination of talk and play. The therapist will play and talk with the child in order to make contact with the inner world of the child and thus shape all the bits and pieces that needs to be integrated. An important tool is the transference/countertransference. These can lead the way to what needs to be treated.

Challenges to therapists

Children entering psychotherapy have most often been exposed to family violence or other traumatic experiences. Treating traumatized children may be unusually challenging for the therapist because of vicarious traumatization. Access to reflective supervision is needed to prevent a sense of helplessness and a "self-protective tendency to view complex clinical cases as intractable" ⁴

See also

• Clinical psychology
• Psychoanalysis
• Psychiatry
• Psychology
• Psychotherapy
• Play therapy
• Mental health
• Parent-Child Interaction Therapy (PCIT)

References

v • d • e Attachment theory Theory Affectional bond • Attachment in adults • Attachment in children • Attachment disorder • Attachment measures • Attachment parenting • Attachment theory • Human bonding • Maternal deprivation • Object relations theory • Reactive attachment disorder Notable Theorists Mary Ainsworth • John Bowlby • Erik Erikson • Sigmund Freud • Harry Harlow • Jerome Kagan • Melanie Klein • Konrad Lorenz • Tinbergen • Rene Spitz Controversy Attachment therapy • Candace Newmaker Clinical Applications Attachment-based therapy (children) • Attachment-based psychotherapy

v • d • e Human development: biological - psychological - Overview table Pre- and perinatal Prenatal development • Pre- and perinatal psychology Infancy Infant and child development (stages) • Infancy Childhood Child development (stages) Toddlerhood • Preadolescence Adolescence Youth development • Puberty Adulthood Early adulthood • Middle adulthood • Late adulthood • Ageing & Senescence Theorists-theories John Bowlby-attachment • Erik Erikson-psychosocial • Sigmund Freud-psychosexual • Lawrence Kohlberg-moral • Jean Piaget-cognitive • Lev Vygotsky-cultural-historical

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