War: Mentalization and Totalitarian State of Mind

For most residents of Europe, war is a new experience in which they find themselves both as witnesses and participants. In this paper the war in Ukraine serves as an illustration and case example. Like any unfamiliar experience, war elicits profound emotional responses which can be so overwhelming that an individual may be unable to fully process them and to create mental representations of the reality of war. When the psyche becomes entrapped in an unprocessed state, without the capacity to derive meaning from it, this results in the "fossilization" of the psyche akin to what McGinley and Segal describes as a totalitarian state of mind. Subjectivity and individual differences come under collective or personal attack, or both. This state of being prioritizes the needs of the collective psyche over the individual psyche. The image of Gorgon Medusa, who transformed living people into "fossilized" ones, is presented as a metaphor of total identification with the collective dimension. In contrast, the psyche can reveal a creative approach to resolving war-induced trauma. This is depicted in the concept of the Alchemical Stone and its creation, which symbolizes a harmonious connection between the external and internal realms, the subjective and objective experiences, and the real and the imaginal dimension.

Mothering from the Inside Out: Results of a community-based randomized efficacy trial testing a mentalization-based parenting intervention for mothers with addictions

Mothering from the Inside Out (MIO) is a mentalization-based parenting intervention developed to address challenges common among mothers experiencing substance use disorders (SUDs) and previously deemed effective when delivered by research clinicians. This randomized clinical trial was designed to test the efficacy of MIO when delivered by community-based addiction counselors in Connecticut, USA. Ninety-four mothers [M(SD)age = 31.01(4.01) years; 75.53% White] caring for a child 11-60 months of age were randomly assigned to participate in 12 sessions of either MIO or psychoeducation. Caregiving, psychiatric, and substance use outcomes were assessed repeatedly from baseline through 12-week follow-up. Mothers who participated in MIO showed decreased certainty about their child's mental states, and decreased depression; their children demonstrated increased clarity of cues. Participation in MIO was not associated with the same degree of improvement that was observed in prior trials where MIO was delivered by research clinicians. However, when delivered by community-based clinicians, MIO may be protective against a deterioration in caregiving over time often seen in mothers with addictions. The drop in efficacy of MIO in this trial raises questions about intervention-intervenor fit. Research should examine factors influencing MIO effectiveness to close the science-to-service gap common in the dissemination of empirically validated interventions.

Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder

Despite the fact that family involvement is encouraged in early interventions for borderline personality disorder (BPD), there is a limited knowledge on the experience of caring for adolescents with BPD. This is an exploratory retrospective study nested within a randomized controlled trial that compared mentalization-based treatment (MBT) in groups to treatment as usual for adolescents with BPD. Caregivers received six MBT-Parents sessions or standard care over one year. Three months after end of treatment (EOT), 75 caregivers (35 in MBT, 40 in TAU) filled out the Burden Assessment Scale, and 71 (34 in MBT, 37 in TAU) the Family Satisfaction Survey. The adolescents filled out the Borderline Personality Features Scale for Children at baseline and after twelve months at EOT. We tested whether caregiver demographics, adolescents' severity of BPD, treatment and adolescents' dropout from treatment predicted levels of caregiver burden and satisfaction with treatment. The caregivers reported high levels of burden on the BAS (M = 40.3, SD = 12.2). Our study suggests that higher BPD severity at EOT among the adolescents predicted caregiver burden (p = .03), whereas higher baseline BPD severity predicted satisfaction with treatment (p = .04) and that biological mothers could be more burdened than other types of caregivers but also might be more satisfied with treatment. Treatment and adolescents' dropout from treatment were not related to caregiver burden or satisfaction with treatment. To help inform future research and to devise appropriate interventions for caregivers and adolescents with BPD, it is important to identify possible predictors of caregiver burden. The results of this initial exploratory study indicate that caregivers (and particularly biological mothers) of adolescents with more severe levels of BPD could be particularly vulnerable toward feelings of burden and therefore are in need of support.

Higher maternal reflective functioning is associated with toddlers' adaptive emotion regulation

Parental reflective functioning (RF), the ability to consider the child's behavior as a function of mental states (cognitions, emotions), is theorized to promote emotion regulation in children via its positive impact on parenting sensitivity. Using a sample of mothers and toddlers (N = 151 dyads; 41% Latinx; 54% girls; M_Age  = 21 months; SD_Age   =  2.5 months), we measured mothers' self-reported RF (high RF = low certainty/high interest-curiosity/low prementalizing), toddlers' distress during a standardized challenging behavioral task (toy removal), and three methods of children's coping with distress. Then, we tested whether RF moderated the association between children's observed distress and coping during the task (mother-directed adaptive coping, task-directed adaptive coping, maladaptive aggression) as an index of emotion regulation. Although RF was not associated with toddlers' distress, indices of RF moderated the associations between distress and coping. As maternal RF increased, the positive association between toddler distress and mother-oriented behavior increased, whereas the association between toddler distress and child aggression decreased. Findings were present only for certainty of mental states, whereas no effects were present for prementalizing or interest/curiosity. We discuss these findings in terms of their contributions to theory regarding parent-child relationships, maternal RF, and child emotion regulation.

Mind-mindedness versus mentalistic interpretations of behavior: Is mind-mindedness a relational construct?

Mind-mindedness is a measure of the tendency to represent significant others in internal state terms and is central to supportive parent-infant relationships. The two studies reported here explored whether mind-mindedness generalizes to representations of unknown individuals, using a novel task that assessed individual differences in adults' tendency to interpret others' behavior with reference to their internal states: the Unknown Mother-Infant Interaction Task (UMIIT). We compared UMIIT performance with measures of mind-mindedness from (a) adults' descriptions of close friends and partners (Study 1, N = 96) and (b) mothers' appropriate versus nonattuned comments on their infants' internal states (Study 2, N = 56). In line with the proposal that mind-mindedness is a relational construct, UMIIT performance was unrelated to mind-mindedness in both studies.

IMPLEMENTATION OF AN EVIDENCED-BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING

The process of mental health intervention implementation with vulnerable populations is not well-described in the literature. The authors worked as a community-partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low-income community. We used qualitative ethnographic methods to document the adaption of an evidence-based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0- to 84-month-old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.