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

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.