MENTALIZING INTERVENTIONS IN A PSYCHOTHERAPY GROUP FOR ADOLESCENTS WITH INTERNALIZING SYMPTOMS: AN EXPLORATORY SINGLE-CASE STUDY

Introduction: Both cognitive-behavioural and psychodynamic approaches have emphasised the role of mental representations or cognitive-affective schemas in explaining vulnerability to general psychopathology and specifically depression (Beck et al., 1979; Blatt, 1974, 2004). Indeed, more recent psychodynamic treatments have shifted attention to the role of disorders of mentalization, defined as “the mental process by which an individual implicitly and explicitly interprets the actions of himself and others as meaningful on the basis of intentional mental states such as personal desires, needs, feelings, beliefs, and reasons” (Bateman & Fonagy, 2004, p. xxi), which seemed to play a central role in depression and other disorders (Luyten et al., 2019; Segal & Teasdale, 2018; Watkins & Teasdale, 2004). Ten to 20 per cent of children and adolescents orldwide have mental health problems (WHO, 2017) and depression is the most common disorder in adolescence (Mental Health Foundation, 2018; Royal Society for Public Health, 2017). In the field of adolescent mental health, group therapy is becoming an important choice, and recent meta-analytic evidence suggested that group psychodynamic psychotherapy is linked with significative improvements in adolescents’ well-being Grigoriadou, 2021). Despite the theoretically close relationship between mentalization and depressive conditions in adolescents (Fischer-Kern & Tmej, 2019) and the importance accorded to enhancing mentalising abilities in psychodynamic group therapy, only few studies have examined the therapist’s mentalising nterventions in psychotherapy groups foradolescents. The aims of this single-case study were a) to explore what type of mentalizing interventions are mostly used in a group therapy for adolescents with internalising disorders and b) how the characteristics of these interventions changed over time (during the first five months of therapy). Methods: Participants were recruited from patients in charge of the Child Neuropsychiatry service in Naples (DS 24). The group consisted of eight participants (5 female, 3 male; Mage=15.90±1.07) with a developmental diagnosis of internalising disorder (anxiety, depression, social withdrawal), who completed the Difficulties in Emotion Regulation Scale (DERS), the DSM-5 Cross-Cutting Symptom Measure (CCSM), the UCLA loneliness scale (UCLA), the Iowa-Netherlands Comparison Orientation Measure (INCOM), the Multidimensional Scale for Perceived Social Support (MSPSS) and the Rosenberg Self-Esteem Scale (RSES) at treatment intake (T0) and termination (T1). The group psychotherapy lasted five months and was led by a therapist with a psychodynamic approach. All group sessions were audio-recorded and transcribed verbatim. In the current study, 5 sessions were analysed (1 for each month of therapy), and the therapist’s interventions were coded by 2 rates according to Mentalization Based Group Therapy Adherence and Quality Scale (MBT-G-AQS; Karterud, 2015). Results: At T0 participants showed a score of 57.00 (±18.23) at DERS, 41.00 (±5.48) at CCSM, 47.25 (±6.40) at UCLA, 34.50 (±7.85) at INCOM, 45.25 (±14.55) at MSPSS and 21.75 (±6.60) at RSES; at T1 participants’ scores were 52.75 (±17.76), 48.75 (±11.24), 46.00 (±8.83), 37.00 (±8.98), 43.00 (±15.81) and 24.00 (±4.76), respectively. Preliminary analyses revealed that 27.47% of the therapist interventions were rated as compliant with the MBTG-AQS; furthermore, analysis showed that the therapist’s most frequent mentalization-oriented interventions were: Exploration, curiosity and not-knowing stance (23.33%); Managing group boundaries (16.67%); Engaging group members in mentalizing external events (16.67%). The comprehensive results will show the visual inspection of the longitudinal trend of therapist’s interventions across the five months of therapy, and how these interventions are matched with the clinical patient’s characteristics. Conclusions: The current preliminary results suggest that assuming a not-knowing stance and working on group boundaries and engagement are common techniques and features for psychodynamic and Mentalization-based group psychotherapy.