Within- and between-session changes of in-session reflective functioning of mothers in dyadic parent-infant psychotherapy.

This study investigated if in-session reflective functioning (RF) of mothers improved between and within sessions of brief dyadic focused parent-infant psychotherapy (fPIP) for the treatment of regulatory disorders in infants.In-session RF was coded for 44 therapy sessions from N = 11 mothers randomly selected from a RCT on the efficacy of fPIP as part of secondary analyses. A new rating system distinguished self-focused and child-focused in-session RF. Cumulative ordinal regression models were applied to analyze the dynamics of in-session RF within and across sessions, controlling for word count of each statement.While in-session RF improved significantly within sessions, between-session RF improved significantly only in the second session compared to the first with a significant decrease observed in the last session. Child-focused in-session RF was significantly lower than self-focused in-session RF at the beginning of the sessions but improved significantly stronger than self-focused in-session RF during sessions.In-session RF (particularly in child-focused statements) can be regarded as a dynamic change process relevant within each session of dyadic fPIP. Improvements made on a session-by-session basis may not be maintained until the next session. Implications for practitioners and in-session RF research are discussed.

Übersichtsarbeiten / Review Articles. Die Entwicklung von epistemischerWachsamkeit und epistemischem Vertrauen über die Lebensspanne: Perspektive aus der empirischen Forschung zum selbstregulierenden sozialen Lernen / The Development of Epistemic Vigilance and Epistemic Trust Across the Lifespan: Perspectives from Empirical Research on Self-Regulatory Social Learning.

The Development of Epistemic Vigilance and Epistemic Trust Across the Lifespan: Perspectives from Empirical Research on Self-Regulatory Social Learning This article examines what we know about the development of epistemic vigilance and epistemic trust between early infancy and adolescence.With this brief review, we intend to help put into perspective the hypotheses advanced by Fonagy and his colleagues within the socio-epistemic theory of psychopathology, according to which psychopathology reflects a closure to interpersonal communication resulting from unfavorable learning experiences in early development. Here, we will discuss how children become sensitive to overt interpersonal communication, and what cognitive skills underpin such sensitivity. Next, we shall discuss the empirical evidence that children in the second year of life already possess a rudimentary capacity for epistemic vigilance: they seem to evaluate the competence of different adult informants and appear to seek information and learn from adults based on such evaluations. Third, we will outline studies showing that in the third year of life children appear to increasingly trust ostensive communication, up to the point of becoming (at least apparently) less sensitive to the possibility of being misinformed or deceived. Finally, we will discuss how, between late childhood and adolescence, children first learn to distinguish lies, then irony, and increasingly engage in complex communication ecologies. Our review simultaneously supports the basic principles of the socio-epistemic theory of psychopathology and suggests that the theory needs further refinement of its ontogenetic predictions.

Originalarbeiten / Original Articles. Skills Lab Pädiatrie: Stärken kommunikativer Fertigkeiten für das Gespräch mit psychosozial belasteten Familien / Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families.

Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families To identify psychosocially burdened families early and motivate them to seek further assistance is a central aspect of pediatric preventivemedicine.The aim of the feasibility study was to develop the Pediatric Skills Lab to promote methods for identifying and addressing psychosocially burdened families, and to evaluate it. Thirteen primary care pediatricians participated in two trials of the Pediatric Skills Lab, an interdisciplinary developed two-part digital training.They answered questions regarding their work with psychosocially burdened families and their satisfaction with the Pediatric Skills Lab. Overall, there was a high level of satisfaction reported with the Pediatric Skills Lab. Specifically, the presentation of results on the effects of psychosocial stressors, the practical exercises, and the exchange with colleagues during the interactive webinar were highly praised. Criticisms included, for example, the short duration of practical exercises and the lack of sufficient examples and live demonstrations. The Pediatric Skills Lab is a training concept tailored to meet the existing needs. With widespread implementation, it could enhance psychosocial care provision. Consideration should be given to extending the duration of the training to allow formore practical exercises. Future studies building upon this feasibility study should examine the effects of the training. Additionally, ways to integrate the Pediatric Skills Lab into existing curricula formedical education should be explored.

Transactional Relations between Child Functioning and Parenting Stress in the First Years of Life: A Longitudinal Study among Psychosocially Burdened Families.

INTRODUCTION: Previous research reported transactional relations between child functioning and parenting stress. There is limited evidence whether a transactional developmental model also fits children below the age of 12 months, especially in psychosocially burdened families. This study aims to test the fit of a transactional model during the first 3 years of life and examines whether the model differs between families with low and high psychosocial burden. METHODS: A total of 302 psychosocially burdened families were observed over 3 years at age 4, 12, 24, and 36 months. Child behavioral problems and parenting stress were assessed via self-report while psychosocial burden was assessed via external rating at baseline. Cross-lagged panel analysis was used to investigate the fit of a transactional model. RESULTS: A transactional model fitted the data significantly better (Δχ2 = 81.87, p < 0.001) than an autoregressive model reaching acceptable to good fit indices (CFI = 0.96, RMSEA = 0.09). The model indicated moderate stability within and reciprocal effects between child behavioral problems and parenting stress from age 12 to 36 months. From age 4 to 12 months, parenting stress predicted child behavioral problems but not vice-versa. Model fit indices and transactional relations did not substantially differ between families with low and high psychosocial burden, except for child effects on parenting stress during the first year of life, which were only evident in higher burdened families. CONCLUSION: Transactional relations among child and parent variables are evident in the first 3 years of life. Child effects in the first year of life may be restricted to highly psychosocially burdened families. Future research may focus on potential mediating variables such as parental sensitivity or contextual variables like significant life events. Targeted prevention strategies should be adapted to the level of psychosocial burden to account for the differing transactional relations.

Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study.

Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

[The Personality Inventory for ICD-11 (PiCD): Reliability and Validity of the German Version in a Clinical and Non-Clinical Sample]. / Das Persönlichkeitsinventar für ICD-11 (PiCD): Reliabilität und Validität der Deutschen Version in einer klinischen und nicht-klinischen Stichprobe.

The 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) marks a paradigm shift in the diagnosis of personality disorders: In the near future, their classification will no longer be categorical, but dimensional along the severity of personality impairments and optionally regarding the presence of maladaptive personality traits. This study examines the reliability and validity of the German version of the Personality Inventory for ICD-11 (PiCD), a questionnaire designed to assess ICD-11 maladaptive personality domains, in a clinical and nonclinical sample (N=939). The factor structure of the PiCD was examined using Exploratory Factor Analysis (EFA) and showed a tendency for a four-factor model (Negative Affectivity, Dissociality, Detachment, and a bipolar factor Disinhibition-Anankastia). The subscales of the PiCD demonstrated acceptable to excellent reliability coefficients with Cronbach's α (0.79 - 0.89) and McDonald's ω (0.76 - 0.90). Convergent and discriminant validity were examined in conjunction with other questionnaires and were found to be satisfactory. The results suggest that the German version of the PiCD is a reliable and largely valid measurement instrument for assessing ICD-11 maladaptive personality traits. However, further research on factor structure, appropriate cut-off as well as norm values is needed.

[German S3 guidelines on borderline personality disorder]. / S3-Leitlinie Borderline-Persönlichkeitsstörung.

Research on the understanding and especially on the treatment of borderline personality disorder (borderline PD) has made considerable progress in recent years, so that evidence-based German treatment guidelines have now been produced for the first time. This article highlights the development as well as the main content priorities and recommendations of the guidelines: first, the recommendations on the diagnostics are presented and in this context the upcoming changes to the International Classification of Diseases 11th reversion (ICD-11) are also explained. Subsequently, the most important recommendations on guideline-compliant psychotherapy, pharmacotherapy and treatment settings are presented. Finally, the recommendations concerning relatives (or other significant persons for people with borderline PD) as well as parenthood and borderline PD are presented.

Mentalization-enhancing therapeutic interventions in the psychotherapy of anorexia nervosa: An analysis of use and influence on patients' mentalizing capacity.

OBJECTIVE: Improvement in patients' mentalizing capacities is considered a possible mechanism of change in psychotherapy. This improvement might take place via mentalization-enhancing interventions (MEIs) performed by psychotherapists. The study aimed to explore the use of MEIs in two evidence-based psychotherapeutic treatments for patients with anorexia nervosa (enhanced cognitive-behavior therapy, focal psychodynamic therapy) and their association with the patients' capacity to mentalize in sessions ("in-session reflective functioning" / in-session RF). Additionally, it was explored, if the amount of MEIs used could either predict change in in-session RF or outcome (end of treatment, one year follow-up). METHOD: 84 audiotapes from psychotherapy sessions of 28 patients of the ANTOP-study (three sessions per patient) were transcribed and rated with both the MEI Rating Scale and the In-Session RF Scale by trained raters. RESULTS: MEIs were applied in both treatments. A moderate correlation between the amount of MEIs and patients' in-session RF as well as its change over the course of treatment was found, but no relation to change in BMI or eating disorder symptoms. CONCLUSION: A greater use of MEIs was related to patients' in-session-mentalizing. However, there seems to be no simple relation between RF as shown in sessions and symptom change.

[On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany]. / Zum Stand der Aus- undWeiterbildung in Säuglings-/Kleinkind-Eltern-Psychotherapie in Deutschland.

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

["IThink it's Good that they Choose who they want to be Stroked by" -The Support Quality of Animal-BasedTherapy]. / "Ich finde es gut, dass sie sich aussuchen, von wem sie gestreichelt werden wollen" ­ Die Unterstützungsqualität tiergestützter Therapie.

For Adolescents with personality impairments it's often difficult to accept therapy offers. Personality impairment may be preceded by (early childhood) trauma, which undermines trust in others.Thus, adolescents with traumatic experience often have limited motivation to start psychotherapy, also due to the greater need for autonomy and the process of detachment in this age phase. However, adolescence is a particularly sensitive period, as personality impairments may consolidate and personality disorders (PD) develop. To address low trust and lowmotivation in adolescents with high risk for or already full PD an animal-assisted group therapy adjunct to individual mentalization-based therapy was developed and piloted. Two groups with a total of eleven patients each were conducted, four of whom agreed to talk about their experiences with animal-assisted therapy in an interview after completion of therapy. Interviews were analyzed qualitatively and evaluated with regard to the aspects of what the adolescents liked and disliked, what expectationsweremet or unmet, andwhat effects the adjunct intervention had on the adolescents' therapeutic success.The categorized statements are discussed related to the theories of human-animal interaction according to Hediger et al. (2019) and a new hypothesis about animals as teambuilding catalysts could be established. In sum, alpacas were perceived suitable as therapy animals for adolescents with personality impairments.

Parental Mental Illness, Borderline Personality Disorder, and Parenting Behavior: The Moderating Role of Social Support.

PURPOSE OF REVIEW: Parental mental disorders, particularly borderline personality disorder (BPD), impair parenting behavior. Consequently, the children exhibit an elevated risk for psychopathology across their lifespan. Social support for parents is thought to moderate the relationship between parental mental illness and parenting behavior. It may dampen negative effects and serve as starting point for preventive interventions. This paper provides a literature overview regarding the impact of social support on the sequelae of parental mental illness and BPD for parenting behavior. RECENT FINDINGS: Current literature highlights the increased burden of families with a mentally ill parent and associated changes in parenting behavior like increased hostility and affective dysregulation, especially in the context of parental BPD. Literature further demonstrates the powerful impact of social support in buffering such negative outcomes. The effect of social support seems to be moderated itself by further factors like socioeconomic status, gender, or characteristics of the social network. Social support facilitates positive parenting in mentally ill parents and may be particularly important in parents with BPD. However, social support is embedded within a framework of influencing factors, which need consideration when interpreting scientific results.

A longitudinal analysis of reflective functioning and its association with psychotherapy outcome in patients with depressive and anxiety disorders.

The ability to mentalize has been discussed as potential change mechanism in psychotherapy. Reflective functioning (RF) offers an empirical framework for the assessment of mentalization in therapy sessions. In the present study, we assessed RF longitudinally and examined its association with symptomatic distress, symptom severity of depression and anxiety, and interpersonal problems over the course of treatment. Thirty-seven patients diagnosed with depression or anxiety disorders received 25 ± 3 sessions of integrative cognitive-behavioral therapy (CBT) in an outpatient setting. The observer-rated in-session Reflective Functioning Scale (RFS) was applied to transcripts of therapy Sessions 1, 8, 16, and 24. The effects of RF were investigated both within and between patients using hierarchical linear modeling. RF significantly increased over the course of treatment, and this improvement in RF was significantly associated with depressive symptoms. This means that after a session where patients positively deviated from their own average RF during treatment, they reported lower depression severity. In post hoc analyses, we found a significant interaction effect of the within- and between-patient RF effects on interpersonal problems. Patients with overall higher levels of RF and with positive deviations from their own average RF over the course of treatment tended to have less interpersonal problems during psychotherapy. The present study contributes to the preliminary evidence that changes in RF may serve as a common factor in psychotherapy in contrast to being a specific factor in psychodynamic therapies. More longitudinal studies are necessary to gain a better understanding of RF as a change mechanism in psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Learning from mothers who received focused parent-infant psychotherapy for the treatment of their child's regulatory disorders.

OBJECTIVE: Gaining a deeper understanding of how focused parent-infant psychotherapy (fPIP) works by asking mothers about their experiences. METHOD: Purposeful sampling was used to select participants who before had participated in an RCT on fPIP. Nine mothers of infants with early regulatory disorders who had received fPIP were interviewed. Eight cases received full-protocol treatment, one case was a treatment drop-out. Semi-structured interviews were audio-recorded, transcribed verbatim and analyzed applying grounded theory methodology. RESULTS: Seven major categories evolved: (1) engaging in therapy while maintaining autonomy, (2) relating to an emotionally responsive therapist and resolving ruptures, (3) involvement of partners in therapy facilitates multiple perspectives, (4) understanding the meaning of the child's signals and increasing acceptance of difficult behaviors, (5) feeling supported by advice that is attuned to the families' needs, (6) insight into parental contributions to the child's problems and (7) feeling strengthened as a mother and recognizing one's own needs. CONCLUSION: Findings highlight which aspects of fPIP mothers find most helpful and most challenging. Aspects that compromised the change process seemed related to the specific needs of this population and therapeutic setting. The results may guide therapists and inspire future development in interventions for treating infant regulatory disorders.

Introduction to Mentalization-Based Approaches for Parents, Children, Youths, and Families.

Family members mentalize when they try to understand each other's behavior on the basis of intentional mental states. This article aims to introduce and briefly describe how the concept of mentalization can provide a useful framework for clinicians to understand psychopathology of children, youths, and families. The authors further outline how mentalization-based techniques and interventions can be applied to build epistemic trust and to reestablish mentalizing in families by presenting clinical vignettes of initial sessions from various clinical settings in the United Kingdom and Germany. The article concludes with a brief summary about the current evidence for mentalization-based interventions with children, adolescents, and families and provides an outlook for future clinical and research work.

The competence development of German psychotherapy trainees: A naturalistic, longitudinal and multidimensional outcome study.

Objectives:This study investigated the development of German psychotherapy trainees in professional, relational, and personal competence. Methods: The study followed a naturalistic pre-post design over 3 years and included a control group of non-trainee psychologists. The sample consisted of 219 participants, including 64 cognitive-behavioral trainees, 120 psychodynamic trainees and 35 control participants. Outcomes were knowledge (multiple choice exam), case-formulation competence (Case Formulation Content Coding Method), healing and stressful involvement (Therapist Work Involvement Scales), attributional complexity (Attributional Complexity Scale), introject affiliation, and affiliation in patient treatments (Intrex questionnaire). Multilevel Modeling was used to investigate change over time and group by time interactions. Comparisons to the control group were limited to knowledge, case-formulation competence, and attributional complexity. Results: Trainees improved in knowledge, case-formulation competence, healing involvement, and affiliation in treatments with small to medium effects. There was no change in stressful involvement, attributional complexity or introject affiliation. According to reliable change indices, the majority of trainees did not change reliably. Over time, trainees outperformed the control group only in case-formulation competence. There were several main and group by time effects regarding trainee orientation. Conclusions: Results imply benefits of training on professional and relational competence but only limited effects on personal competence.

[What Did You Like About the Therapy? - A Qualitative Study on the Evaluation of Mentalization-Based Treatment for Adolescents with Conduct Disorder]. / Was hat dir an der Therapie gefallen? ­ Eine qualitative Studie zur Evaluation der Mentalisierungsbasierten Therapie für Jugendliche mit Störungen des Sozialverhaltens.

Psychotherapeutic treatment for adolescents with conduct disorder (CD) is considered difficult for various reasons. On the one hand, patients frequently lack psychological strain, and striving for autonomy is part of typical adolescent development. On the other hand, therapists can react aversively to delinquent and violent behavior, and insufficient psychological models explaining aetiology and maintenance of symptoms can impede treatment of adolescents with CD. Mentalization-Based Therapy for adolescents with CD (MBT-CD) was developed with the aim of addressing these difficulties and improving psychotherapeutic treatment for this patient group. MBT-CD focuses on the promotion of the adolescents' autonomy by increasing their scope of action via an improvement of mentalizing ability. The aim of this qualitative study is to investigate the acceptance of MBT-CD by the adolescents in terms of their experience with MBT-CD and thus obtain information about aspects which enhance therapy motivation for this group of patients. For this purpose, we conducted semi-structured interviews with twelve adolescents after completion of therapy assessing their subjective therapy evaluation. Qualitative content analysis was used to analyze the data. The results show both helpful and hindering aspects of the mentalization-based interventions. In addition, the monthly family sessions included in the therapy were regarded as important. Adolescents also regarded emotion regulation strategies as helpful. Implications for the treatment of adolescents with CD are discussed.

[The Importance of Adaptive Treatment Strategies for Treatment Outcome in fSKEPT]. / Die Bedeutung adaptiver Behandlungsstrategien für den Therapieerfolg in der fokussierten psychodynamischen Säugling-/Kleinkind-Eltern-Psychotherapie.

The manualized focused infant/toddler-parent psychotherapy fSKEPT is a psychodynamic focal treatment of early childhood regulatory disorders, in which either a conflict-related or a personality functioning-related treatment focus is carried out. The aim of the study is to review the effectiveness of fSKEPT depending on two different therapeutic treatment focuses. For this purpose, n = 81 families who received fSKEPT were examined as part of secondary analyzes of a randomized controlled study. The therapeutic treatment focus did not predict the effectiveness for any of the examined target criteria (maternal psychological stress F(1,70) = 0.71, p = .401, maternal depression F(1,70) = 0.18, p = .678, infant regulatory symptoms F(1,70) = 0.11, p = .753, maternal self-efficacy F(1,70) = 0.038, p = .847, maternal reflective functioning F(1,50) = 0.56, p = .458). In a subsample of n = 33 families (40 % of the total sample) we tested whether the therapeutic interventions used in the therapy correspond to the treatment focus of the therapists. No significant difference was found between personality functioning-specific interventions (t(28) = 1.71, p = .099) and unspecific interventions (t(28) = 1.77, p = .087) when comparing the two treatment focus groups. In the conflict focus group significantly more conflict-specific interventions were used (t(28) = 2,71, p = .011). The results demonstrate the effectiveness of the focus concept of the fSKEPT treatment. The focus and the flexible individual adaptation of the interventions in the course of the treatment may help offering parents with different psychological vulnerabilities and ressources an equally effective treatment. In addition, the relevance of unspecific interventions and relationship-promoting aspects of the treatment are discussed.

[Evidence for Psychodynamic Therapy for Children and Adolescents]. / Evidenz für psychoanalytisch begründete Verfahren für Kinder und Jugendliche.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Parental mentalizing as a key resource for difficult transitions.

This commentary on Ruiz et al.'s study focuses on the relevance of parental mentalizing for child development within a transactional framework. This view takes into account what kind of challenges in the parent, in the infant, or in the interaction have effects on child development and if this mediated by parental mentalizing. Differences between maternal and paternal mentalizing seem unrelated to the general level of reflective functioning but strongly influenced by social roles of parents. However, more sophisticated measures of mentalizing are needed to better understand subtle problems with regard to a dimensional and multifaceted model of mentalizing as well as interactional processes. To master the transition to parenthood in challenging circumstances such as preterm birth, it would be especially valuable to know if one parent's lower mentalizing can be counterbalanced by higher mentalizing in the other parent.