Mentalizing in Clinical Practice: Working with Children Whose Mother is Suffering from Psychotic Symptoms

This paper considers whether the psychotic illness of a mother impacts on the development of the mentalizing capacity of her offspring and the consequences this may have for clinical practice as a child psychotherapist. It focuses on the current theoretical understanding that the secure state of mind of a mother with respect to attachment, as well as her mentalizing ability, influences the development of the child's mentalizing skills. After summarizing and evaluating evidence associated with the attachment behaviour and mentalizing capacity of a psychotic mother, the paper gives evidence that there is a strong association between mothers on the psychotic continuum and insecure-avoidant or disorganized attachment behaviour and impairment of the reflective function. This puts the infant at elevated risk of not fully developing mentalizing abilities. The issue of acquiring hypermentalization or undermentalization patterns is highlighted. In clinical practice, marked mirroring and transparency about the therapist's mental state allow the client to feel seen and to discover his or her own inner experiences in relation to external reality.