Towards a comprehensive approach to mentalization-based treatment for children with autism: integrating attachment, neurosciences, and mentalizing.

Autism spectrum disorder (ASD) is diagnosed based on socio-communicative difficulties, which are believed to result from deficits in mentalizing, mainly evidenced by alterations in recognizing and responding to the mental states of others. In recent years, efforts have been made to develop mentalization-based treatment (MBT) models for this population. These models focus on enhancing individuals' ability to understand and reflect on their own mental states, as well as those of others. However, MBT approaches for people with ASD are limited by their existing theoretical background, which lacks a strong foundation grounded in neuroscience-based evidence properly integrated with attachment, and mentalizing. These are crucial aspects for understanding psychological processes in autism, and as such, they play a pivotal role in shaping the development of tailored and effective therapeutic strategies for this specific population. In this paper we review evidence related to the neurobiological, interpersonal, and psychological dimensions of autism and their implications for mentalizing processes. We also review previous mentalization-based frameworks on the psychosis continuum to provide a comprehensive understanding of attachment, neurobiology, and mentalization domains in therapeutic approaches for autism. After presenting a synthesis of the literature, we offer a set of clinical strategies for the work with children with autism. Finally, we provide recommendations to advance the field towards more robust models that can serve as a basis for evidence-based therapeutic strategies.

The contemporary psychodynamic developmental perspective.

Authors address the transformations taking place in the last 25 years in the theory and practice of developmental psychoanalysis. They emphasize the role of attachment theory in this process and its clinical applications to the work with children and families and the social systems supporting them. The article also describes and explores a move toward an integrative and systemic developmental psychodynamic approach and its relevance to today's practitioner.

Commentary on Victoria Todd's paper. Saving the treatment: affect intolerance in a boy, his parents, the mental health community, and his analyst".

Ms. Todd's paper illustrates both the value of the analytic frame and the relevance of a flexible approach in response to the external reality. In this case, the impingement of the outside environment became an ongoing threat to the analyst's thinking and to the development of a safe and predictable therapeutic relationship. Ms. Todd's narrative of Joey's three-and-a-half-year analysis emphasizes the impact of external interference on the analyst's capacity to experience difficult affects with and for the patient. In addition, it highlights the importance of recognizing and working through one's countertransference resistance. This commentary focuses on Ms. Todd's work with Joey, so I will only refer to her work with his parents and other providers as it is reflected in her analysis.