In the face of a pandemic: adapting a mentalization-focused treatment that promotes attachment with birth parents and young children in foster care

ABSTRACT

The central focus of the Building Blocks Program is to increase the mentalizing capacity of high-risk birth mothers whose young children under the age of five have been placed in foster care. In Building Blocks, therapists are trained to provide dyadic psychotherapy with a birth mother and her child during court-mandated supervised visits, with the aim of reducing cycles of trauma, abuse and neglect, and facilitating a more secure attachment. The program is psychoanalytically informed, grounded in theories of attachment, mentalization and reflective functioning. On March 14, 2020, due to the rapidly spreading coronavirus, it became clear that the birth parents could no longer safely visit with their children in person. In addition, court hearings that might have allowed the retention of parental rights were postponed, leaving many parents devastated. In this paper, we first describe how we adapted the Building Blocks approach during the pandemic. Second, two case examples are presented that highlight the pre-pandemic work of Building Blocks, as well as the innovative and creative ways the treatment model was adapted when it became unsafe to conduct dyadic therapy at the clinic. Using virtual video platforms, the Building Blocks Program has applied the model of ‘Nested Mentalization,’ providing support and scaffolding for the therapists, parents and children.

KEYWORDS:

• Mentalization
• reflective supervision
• attachment
• foster care
• dyadic treatment of birth mothers and young children
• nested mentalization

Acknowledgments

We are grateful to the private funders who have generously supported the Building Blocks Program since 2012, including the Far Fund, the Kenworthy-Swift Foundation, and especially the Child Welfare Fund.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. We are keeping the American spellings for ‘Program’, ‘Mentalization’ and ‘Center’ throughout the paper, as this work is based in the United States. In all other instances, we are using British spellings.

2. The New Alternatives for Children (NAC) is a child welfare agency that serves families with children who have complex, chronic medical conditions and co-occurring mental health challenges. NAC is a combined New York State licenced health care center and a mental health clinic, located at 37 West 26 Street, New York City. Its Executive Director is Dr. Arlene Goldsmith.

3. All incoming cases to Building Blocks are asked about their Adverse Childhood Experiences using a 10-item questionnaire. Over four ACEs are correlated with physical and mental health problems (Felitti et al., 1998).

4. To analyse Building Blocks data, we have partnered with Dr. Jordan Bate and her team of research assistants at the Attachment and Psychotherapy Process Lab at Ferkauf Graduate School of Psychology, Yeshiva University (Bate, 2020).

5. It should be noted that during the pandemic there were some parents who did get to see their children at the agency in person; however, this did not occur with any of the Building Blocks therapists being present. Also, those children who had been placed in kinship foster care may have been able to see their parents in person.

6. The Building Blocks Training/Supervision Team consists of supervisors from the New York Institute for Psychotherapy Training (NYIPT), including Phyllis Cohen, Ph.D., Andrea Remez, Ph.D., Jill Bellinson, Ph.D., Claus Frank, M.S., Linda Jacobs, Ph.D., Barbara Gerson, Ph.D., Kirkland Vaughans, Ph.D., and Winslow Carrington, LMSW.

7. Under strict ethical standards of the APA, identifying details have been disguised. In addition, both therapists have obtained informed consent to share these vignettes.

8. Not all families who are referred to NAC are offered treatment in the Building Blocks Program. Many other services are provided at the agency, some mandated and others recommended. On the other hand, it has been noted that over time, more and more, NAC foster care case planners have been referring families to BB when there is involvement in the Child Welfare System.

Additional information

Funding

This work was supported by the The Far Fund; The Kenworthy-Swift Foundation; The Child Welfare Fund.

Notes on contributors

Phyllis Cohen

Dr. Phyllis Cohen is a consultant at New Alternatives for Children and serves as the Supervisory Director of Building Blocks. Dr. Cohen is also the Director of the New York Institute for Psychotherapy Training in Infancy, Childhood and Adolescence, and she teaches in the Trauma Program at the Manhattan Institute of Psychoanalysis. Dr. Cohen has co-authored, with Drs. Beatrice Beebe and Frank Lachman, ‘The Mother-Infant Picture Book: The Origins of Attachment,’ and she has co-edited ‘Mothers, Infants and Young Children of September 11, 2001: A Primary Prevention Project’ (Beebe, Cohen, Sossin and Markese), and ‘Healing after Parent Loss in Childhood and Adolescence: Theoretical Applications and Clinical Interventions’ (Cohen, Sossin and Ruth). Dr. Cohen is a psychologist/psychoanalyst in private practice in Brooklyn, New York.

Kate Hariton

Dr. Kate Hariton is a NY state licenced psychologist who currently works at New Alternatives for Children, where she provides psychotherapy and psychological assessment to children, adolescents and adults, and supervises psychology trainees. Dr. Hariton earned her doctoral degree from The George Washington University. She completed a two-year postdoctoral fellowship at the Parent-Infant Center at Mount Sinai St. Luke’s Hospital, where she specialised in early childhood mental health and parent-infant psychotherapy. She enjoys working with individuals across the lifespan.

Ashley Rodriguez

Dr. Ashley Rodriguez is a Post-Doctoral Psychologist at New Alternatives for Children. She is a bilingual bicultural clinician, passionate about working with children and families to break the cycle of intergenerational transmissions of trauma. Dr. Rodriguez has trained in working with children and families in a variety of settings including outpatient mental health clinics, a therapeutic nursery with preschool aged children, and a day treatment program with adolescents. She presently provides therapy, assessment, and parent consultation to individuals and families with complex trauma, and provides supervision with psychology trainees. Dr. Rodriguez teaches at the Fordham University Graduate School of Education.