Mentalization-based Interventions in Child Psychiatry and Youth Protection Services II: A Model Founded on the Child’s Prementalizing Mode of Psychic Functioning

ABSTRACT

The systematic and rigorous observations of children in child psychiatry and Youth Protection Services in Quebec revealed that most of these children presented multiple, complex and often severe problems, and did not seem to benefit much from classic psychodynamic psychotherapy. Owing to a poorly developed mentalizing capacity, many of these children did not use symbolic play as a means of expressing their intrapsychic conflicts and relational difficulties and did not communicate much verbally with clinicians. It was noted also that these children’s inner world was dominated by prementalizing modes of thinking, namely, the teleological mode, the psychic equivalence mode, and the pretend mode. This article is the last in a series of three. The first concerns the clinical assessment of prementalizing modes of psychic functioning in children and their parents. The second lays out the general objectives, principles and interventions of a mentalization-based treatment for children. This third article presents specific intervention strategies adapted to children’s predominant mode of thinking. The objectives and techniques regarding each mode are discussed. Three clinical examples serve to illustrate the interventions. The authors suggest that these children must develop a certain degree of mentalizing capacity before they can benefit from classic psychodynamic psychotherapy.     

Self-harm prevalence and ideation in a community sample of cis,trans and other youth

Abstract

Background: Trans youth have been reported to have high rates of self-harm, depression and bullying, and find it difficult to seek support. However, much of this research comes from gender identity clinics; non-clinical samples and those who reject gender binaries remain under-researched.

Aims: This study investigated the experiences of a community school-based sample of Trans, identifying youth, Other, and cis-gendered adolescents in relation to their experiences of low mood, bullying, associated support, self-harm ideation and peer-related self-harm.

Methods: An online survey was completed by 8440 13–17?year olds (3625 male, 4361 female, 227 Other, and 55 Trans).

Results: Trans and Other students had significantly higher rates of self-harm ideation and peer self-harm, in comparison to cis-gendered students. These Trans and Other students reported significantly higher rates of bullying and self-reported depression and significantly less support from teachers and staff at school, in fact these students did not know where to go to access help.

Discussion: This community sample confirms findings of high rates of self-harm ideation, self-reported depression and bullying for Trans youth as previously reported in clinic-based samples. However, by accessing a community sample, the salience of the category “Other” was established for young people today. While Other and Trans identified students both struggled to find support, those who identified as Trans were more likely to have been bullied, and have experienced self-reported depression and thoughts of self-harm. Thus, those who identify as transgender represent a high-risk group that needs targeted support within schools and by statutory and nonstatutory community services. Unpacking the category of Other would be beneficial for future research, as well as exploring resilience within this group and intersecting identities such as sexuality, Autism, or experiences such as earlier abuse.     

Considerations Regarding Online Methods for Suicide‐Related Research and Suicide Risk Assessment

Frequent advances in technology provide new and exciting opportunities for conducting suicide research and suicide risk assessments. However, to the authors' knowledge, best practices for using technology, specifically the Internet, to conduct research protocols involving suicide risk assessments have not been examined. In research contexts, the use of technology for research on suicidal behavior and suicide risk assessment can offer benefits relative to other forms of data collection. These advantages, which include increased validity, feasibility, and efficiency, as well as improvements in data collection and management, are presented. Considerations regarding the implementation of an online system for suicide risk assessment as well as limitations and future directions are discussed.