Broadening the scope of time-limited psychodynamic psychotherapy
A potentially more fruitful approach to considering what we are actually asking of the therapeutic process, and how this may be assessed, is that of the broader relationship based ‘mentalisation’ framework developed by Mary Target, Peter Fonagy, Nick Midgley and other research psychoanalysts and therapists working out of the Anna Freud Clinic; in particular Bateman and Fonagy (2008, 2013). Ways of utilising the mentalisation framework in work with children, young people and families is described by Midgley and Vrouva (2012) as the cornerstone of therapeutic change, as it is focused on the capacity to think and reflect upon, feelings and actions of the self and others. The mentalisation framework has its foundation in attachment, developmental research and findings from neuroscience, as well as psychoanalysis. The authors refer to ‘mentalising-enhancing interventions’ that can be applied outside of the immediate clinical setting, for example with hard to reach adolescents. The approach can also be applied in school settings where the mentalisation approach takes a more systemic stance. For example in tackling bullying in schools, the focus is on the relationship between all the members in the school rather than on simply identifying the ‘culprits’.
A promising approach to working with adolescents with complex mental health needs that uses Adolescent Mentalisation-Based Integrative Therapy (AMBIT) is described by Bevington et al. (2013).
Mentalisation in this context is used as an ‘organising framework’ where a number of ‘multiple modalities’ both with respect to care for the young person, as well as support for the network, are contained within a single worker. This approach places a particular emphasis on preventing the breakdown not only of the young person, but also of the key professional relationships that surround the young person.
Finally, broadening the scope of time-limited therapeutic intervention has also been shown to be effective at the other end of the age range in work with under-fives. Whilst not officially part of a research study, the usefulness of a parent inclusive approach is demonstrated in the long-standing Tavistock Clinic Under-Fives Counselling Service. This service has gone from strength to strength in demonstrating the considerable capacity for change and positive outcome following a brief psychotherapeutic intervention of usually five sessions. Maria Pozzi (2003) in her detailed account of the work of the Under-Fives Counselling Service, describes how it benefits from an amalgam of a psychoanalytic as well as a systemic framework, which succeeds in bringing the presenting problems and their history, into the ‘here and now’ of the sessions so that they can be contained and understood.
In the context of this therapeutic work with under-fives, Pozzi- Monzo, Lee and Likierman (2012) carried out research that involved clinical description and quantitative data, drawn from videotaped clinical material. The results demonstrated a significant lessening of the presenting symptoms, albeit with a small sample of families.