Reflective functioning skills mediating the relationship between attachment security and therapeutic alliance in mentalization-based treatment for children.
Pelinsu Bulut Özer, Z Deniz Aktan, Sibel Halfon
✦ AI-curated · Sources linked
In 30 seconds
This study examined whether pre-treatment attachment security and reflective functioning (RF) were associated with early therapeutic alliance among 71 children aged 7–12 receiving Mentalization-Based Treatment for Children (MBT-C). Conducted within a randomized controlled trial of MBT-C, the analysis used a mediation model. Children’s RF skills significantly mediated the relationship between attachment security and alliance as rated by the children at the third week of treatment. The corresponding association was not significant for therapist-rated alliance. The findings identify a link between children’s capacity to understand mental states and their own early perceptions of the therapeutic relationship.
Key findings
- Children’s reflective functioning significantly mediated the relationship between attachment security and child-rated therapeutic alliance.
- The mediation finding was not significant for therapist-rated alliance.
- Early alliance was assessed at the third week of MBT-C in 71 children aged 7–12.
Why it matters
The results suggest that children’s own perceptions of the early therapeutic relationship may be linked to both attachment security and their ability to understand mental states. Considering these child-specific factors may help clinicians interpret differences between child- and therapist-rated alliance. The study offers a potential explanatory pathway in MBT-C, but does not establish that changing reflective functioning will improve alliance or treatment outcomes.
What to keep in mind
The reported mediation analysis concerns early alliance in children receiving MBT-C; the abstract provides no evidence about later alliance or psychotherapy outcomes.