MINDING THE BABY
Mentalization-based treatment in families with parental substance use disorder: Theoretical framework
Abstract
The primary aim of this article is to give a theoretical and empirical background for clinical interventions in family-oriented treatment for substance use disorders. The article refers to an ongoing research project, which is based on the concepts of mentalization and parental reflective functioning. Theory of mentalization and attachment theory is explored as explanatory tools of both addictive problem and risk/resilience factors in offspring. Mentalization is defined as the competence to envision mental states in self and others and to understand behaviour in terms of mental states. Substance use is discussed as clinical expressions of impaired mentalizing skills and disorders of state- and affect regulation. Parental reflective function particularly refers to parents’ competences to interpret the mind of their own infant or child. Parental reflective functioning, as ‘minding the baby’, promotes sensitive care, which again serves to protect the infant and the immature brain from potentially dangerous stress and physiological arousal. Substance use often makes the parent ‘absent-minded’ and thus imposes a risk of impaired interactions between caregivers and the extra vulnerable substance exposed child.
Without a lifeline to the caregivers’ mind, the development of self regulation and social competences is endangered. High-risk families need substantial support to break the burden of intergenerational transmission of internal representations of caregiving experiences, and to promote good enough care for the infant. The mentalization-based treatment programs (MBT) briefly outlined here, propose a long-term multidisciplinary treatment and follow-up.
References
2006). Handbook of mentalization-based treatment. West Sussex: John Wiley & sons Ltd.
(2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing, Inc.
(in press ). Mentalization-based family therapy. In , Mentalizing in mental health practice. Washington DC: American Psychiatric Publishing, Inc.2005). The practice of psychoanalytic parent-infant psychotherapy. Claiming the baby. East Sussex: Routledge.
(1995). Mindblindness: An essay on autism and theory of mind. Cambridge: MA: MIT Press.
(2006). Attachment and the Perils of Parenting. London: National Parenting and Family Institute.
(2004). Mentalization-Based Treatment of BPD. Journal of Personality Disorders, 18(1), 36–51.
(2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165, 631–638.
(2003). Bridging the attachment transmission gap: The role of maternal mind-mindedness. International Journal of Behavioral Development, 27(4), 11p.
(2006). Treating professionals in crisis: A mentalization-based specialized inpatient program. In , Handbook of mentalization-based treatment, (pp. 233–248). West Sussex: John Wiley & Sons, Ltd.
(1979). The making & breaking of affectional bonds. London: Tavistock Publications.
(2008). Mentalization: Ontogeny, assessment and application in the treatment of borderline personality disorder. American Journal of Psychiatry, 165, 1127–1135.
(2001). The human genome and the representational world: The role of early mother-infant interaction in creating an interpersonal interpretive mechanism. Bulletin of the Menninger Clinic, 65(3), 427.
(2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press.
(1991). The Capacity for Understanding Mental States: The Reflective Self in Parent and Child and Its Significance for Security of Attachment. Infant Mental Health Journal, 12(3), 201.
(1996). Playing with reality: I. Theory of mind and the normal development of psychic reality. Int J Psychoanal, 77 (Pt 2), 217–233.
(unpublished ). Reflective functioning manual, Version 5 Unpublished manuscript.2005). Maternal reflective functioning, mother-infant affective communication, and infant attachment: Exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attachment & Human Development, 7(3), 299.
(2007). Tidlig intervensjon på rusområdet. Sentrale perspektiver – aktuelle målgrupper og arenaer. Oslo: Sosial- og Helsedirektoratet, Avdeling rusmidler
. (unpublished ). The holding Tight-project. unpublished manuscript.2007). Seminar on Psychoanalytic Parent Infant Psychotherapy,
(Personal communication . Anna Freud Centre, London.2005). Mentalized affectivity. Psychoanalytic Psychology, 22 (3), 426–444.
(1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocain dependence. American Journal of Psychiatry, 142, 1259–1264.
(1977). The restoration of the self. New York: International University Press.
(1962). The opiate withdrawal syndrom as a state of stress. Psychiatric Quarterly, 36, 53–65.
(1982). Adolescence and the tendencies to develop substance dependence. Psychoanalytic Inquiry, 2, 581–617.
(1970). Drug dependence. Detroit: Wayne State University Press.
(1997). A nationwide Study of Norwegian Drug Abusers in Treatment: Methods and Findings. Nordisk alkohol- og narkotikatidssskrift (14), 43–63.
(2005). Looking for Poppa: Parenting Status of Men Versus Women Seeking Drug Abuse Treatment. American Journal of Drug & Alcohol Abuse, 31(1), 79.
(2008). Drug abuse and responsible fathering: a comparative study of men enrolled in methadone maintenance treatment). Addiction, 103(2), 269–283.
(2002). Prenatal drug exposure and the conceptualization of long-term effects. Scandinavian Journal of Psychology, 43(1), 41.
(2007). “Keeping the baby in mother’s mind”. Paper presented at the Barnet og Rusen conference, Sandefjord.
(2006). Enhancing the effectiveness of residential treatment for substance abusing pregnant and parenting women: Focus on maternal reflective functioning and mother-child relationship. Infant Mental Health Journal, 27(5), 448.
(2002). Finding poppa in substance abuse research. Addiction, 97(9), 1119–1120.
(2002). The application of Bowlby’s attachment theory to the psychotherapy of the addictions. In , Jhe psychodynamics of addiction (pp. xviii, 178 s.). London: Whurr.
(2006). Minding the baby: a mentalization -based parenting program. In , Handbook of mentalization-based treatment. West Sussex: John Wiley & sons Ltd.
(2001). Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1–2), 7–66.
(in press ). Minding the body. Mentalization-based therapy in eating disorders. In , Mentalizing in mental health practice. Washington DC: American Psychiatric Publishing, Inc.2005). Parental reflective functioning: An introduction. Attachment & Human Development, 7(3), 269.
(2006). Reflective Parenting Programs: Theory and Development. Psychoanalytic Inquiry, 26(4), 18p.
(2005 ). PDI-R2; Parent Development Interview-Revised. Unpublished Manual.2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development, 7(3), 283.
(2005). Minding the baby: A reflective parenting program. The Psychoanalytic Study of the Child. Vol 60 2005, 74–100. Yale Univ Press. Yale Univ Press.
(2006). Tilbud til barn av foreldre med rusmiddelproblemer. Oslo: SIRUS.
(2005). Barn innlagt sammen med foreldre som er i behandling for rusmiddelproblemer. Oslo: SIRUS.
(1985). The interpersonal world of the infant: a view from psychoanalysis and developmental psychology. New York: Basic Books.
(1991). Maternal Representations: A Clinical and Subjective Phenomenological View. Infant Mental Health Journal, 12(3), 12p.
(1998). The motherhood constellation: a unified view of parent-infant psychotherapy. London: Karnac Books.
(2005). How Early Bonding, Depression, Illicit Drug Use, and Perceived Support Work Together to Influence Drug-Dependent Mothers’ Caregiving. American Journal of Orthopsychiatry, 75(3), 431–445.
(1996). Playing with reality. 2. The Development of psychic reality from a theoretical perspective. International Journal of Psycho-Analysis, 77, 459–479.
(1997). Substance use disorders. In , Disorders of affect regulation. Alexithymia in medical and psychiatric illness (pp. 166–189.). Cambridge: Cambridge University Press.
(1997). Disorders of affect regulation. Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press.
(2003). The neurobiological consequences of early stress and childhood maltreatment. Neurosci Biobehav Rev, 27(1–2), 33–44.
(1989). Emotions and emotional communication in infants. American Psychologist, 44(2), 112–119.
(2006). Transforming violent social systems into non-violent mentalizing systems: An experiment in schools. In , Handbook of mentalization-based treatment (pp. 289–306). West Sussex: John Wiley & Sons, Ltd.
(2005). The incredible years: a trouble-shooting guide for parents of children aged 2–8. Seattle, Wash.: The Incredible years.
(1960). The theory of the parent-infant relationship. Int J Psychoanal, 41, 585–595.
(1978). The hidden dimension. New York: Aronson.
(1984). More respect for the neurotic process: Comments on the problem of narcissism in severe psychopathology, especially the addictions. Journal of Substance Abuse Jreatment(1), 37–45.
(2006). Parent Management training, Oregon-modellen PMTO. In , Foreldre og fagfolk i samspill: behandling av psykiske vansker hos barn og unge (pp. s. 143–152). Stavanger: Hertervig forl.
(