[From Pretending to Play to Playing Pretend: The Role of Epistemic Trust in Mentalization-Based Therapy with Children].

Abstract

From Pretending to Play to Playing Pretend: The Role of Epistemic Trust in Mentalization-Based Therapy with Children Although all forms of psychotherapy encourage the patient to focus on their mental states and those of other people, it is a distinguishing characteristic of Mentalization-Based Therapy (MBT; Fonagy u. Bateman, 2006; Bateman u. Fonagy, 2016) to place such focus at the center of treatment. In MBT-Child there is the added element of play, which is considered a primary vehicle for enhancing mentalization (Midgley, Ensink, Lindqvist, Malberg, Muller, 2017). However, pre-mentalizing modes during play are developmentally normative in children. Thus, it can be difficult to distinguish between play as a goal of treatment, and the psychic equivalence and pretend modes. This paper presents some thoughts about how we can unravel the relationships between restoring mentalizing and the process by which children in therapy learn to play . We begin by introducing the theoretical principles that underlie MBT and MBT-C, with particular focus on defining the pre-mentalizing modes. Then, we discuss recent innovations in thinking about the role of epistemic trust in psychotherapy and present a possible use of this concept in understanding pre-mentalizing modes during playing. We suggest ways in which mentalization-based techniques used when children are in pre-mentalizing modes may restore epistemic trust and act as a mechanism of change in child psychotherapy, opening up the child s capacity to both play and mentalize in relation to their social environment. Finally, we present a clinical case of a mentalization focused treatment with a 9-year old child to illustrate our views.