Lack of mentalization in child psychotherapy: the role of the therapist

ABSTRACT

Unmentalized experiences comprise internal and external somato-sensory information that is not transformed into a mental representation and hence, cannot serve as substance for thoughts or feelings. Instead, unmentalized experiences, especially painful ones, are revealed implicitly through physical states, impulsive actions, or somatic symptoms. Therapeutic work with patients who lack mentalizing abilities presents therapists with the need to adjust their therapeutic thinking and interventions to help their patients develop the capacity to mentalize. This paper discusses some clinical implementations on the theoretical thinking of unmentalized experiences, by focusing on therapeutic work with children and the therapist’s role. The author suggests that children are relatively closer to the unmentalized areas in their mind, due to their developmental stage, and because of their ability to engage in more primary means of expression and behaviour, making access to the unmentalized areas relatively easy. Hence, clinical work with children offers fruitful possibilities in modifying a patient’s raw, vague, toxic unmentalized experiences into more structured and formed mental experiences. The therapist needs to immerse him or herself in primary mental functioning parallel to that of the child, in order to connect and transform the child’s unmentalized experiences. Clinical illustrations from a case of child psychotherapy are presented.

KEYWORDS:

• Unmentalized experiences
• countertransference
• working as a double
• Mitrani
• therapist’s role
• child psychodynamic psychotherapy

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. A thick disguise has been used following profound consideration of the patient’s confidentiality and best interests. The clinical illustration follows the process approach (Gabbard, 2000), with minimal identifying information about the patient. Informed consent was given by the family.

Additional information

Notes on contributors

Keren Hanetz Gamliel

Dr. Keren Hanetz Gamliel is a clinical psychologist and supervisor, serving as head of the clinical child track in the graduate programme in clinical psychology, School of Behavioral Sciences at The Academic College of Tel Aviv-Yaffo. Dr. Hanetz Gamliel works in a private clinic with children, adolescents, and adults, specialising in primary mental states, having graduated from the primary mental states’ programme of the advanced psychotherapy training programme at the Tel Aviv University Medical School. Dr. Hanetz Gamliel’s research interest focus is on interrelationships in family subsystems and their influence on child development. In addition, she explores the effectiveness of the psychotherapy supervision process for novice psychologists.