Children who are exposed to trauma often develop difficulties with reflective functioning, affect, and emotion regulation. These problems are thought to arise from and are reflective of disruptions in the process of mentalization, or the human capacity to interpret and reflect upon the thoughts, feelings, wishes, and intentions of oneself and others. This scoping review sought to describe the empirical support for focusing on mentalization processes in psychotherapy for children who have been exposed to trauma. Two independent researchers searched electronic databases, Psychology and Behavioral Sciences Collection, MEDLINE, PsycARTICLES, PsycINFO, and Cochrane. Search terms child, trauma, mentalization and mentalization-based therapy were applied. A total of 425 studies were screened against the inclusion criteria, to include 18 studies comprising quasi-experimental, cross-sectional, naturalistic, case-control, and case studies. In all, 3 themes were identified across the articles: (a) trauma and mentalization, (b) measurement of mentalization, and (c) charting recovery. The literature suggests the role of mentalization treatment in the remission of symptoms for internalizing and externalizing disorders and shaping mentalization deficits over time. Mentalization focused treatments may also improve reflective functioning, emotional regulation capacity and the quality of attachment. The implementation of a child mentalization-based model as a preventative intervention may contribute to increased positive outcomes for vulnerable children. This scoping review presents an overview of the evidence for program developers, mental health services, family support services and those in independent practice that wish to adopt a mentalization approach in child psychotherapy. Future systematic reviews are needed to support this evidence.
Clinical Impact StatementQuestion: What is the applied clinical practice question this article is hoping to address? This article explores the role of mentalization in child psychotherapy, interpersonal trauma, and recovery and considers the evidence for the association of mentalization with improved symptoms in children exposed to trauma. Findings: How would clinicians meaningfully use the primary findings of this article in their applied practice? This scoping review reveals that mentalization-based therapy could be an effective treatment for child mental health difficulties. Although the authors do not ignore that mentalization theory and some of its core processes are linked to the analytic schools such as the psychoanalytic and psychodynamic approaches, mentalization in practice goes well beyond explaining early development relative to attachment trauma, to the "how" of repairing damaged mentalization and to the measures used in charting milestones of recovery. By establishing that this treatment works in the context of childhood interpersonal trauma, there may be a need for clinicians to examine therapeutic characteristics that would more likely capture the mentalizing stance to promote ...