From Attachment Theory to Mentalization Table 1. The elements and the feasibility of the development of attachment according to maternal types Element

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1 Review Article Psychoanalysis 2013;24:9-20 ISSN Copyright c 2013 Korean Association of Psychoanalysis From Attachment Theory to Mentalization: Historical Background and Clinical Implications Geon Ho Bahn Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea 애착이론으로부터정신화까지 : 배경과임상적의의 반건호 경희대학교의학전문대학원소아정신과학교실 John Bowlby linked the pre-existing psychoanalysis theory with ethology theories and emphasized the mother-baby interaction instead of the individual psychosexual development theory. The attachment which develops in the interaction with the care-giver, can be categorized into secure and insecure attachment types. Insecure attachment can continue throughout the adulthood and influence personal relations and social life. Mostly affect regulation problems occur. Peter Fonagy developed the mentalization theory based on the attachment theory. Mentalization is the ability to understand other people s feelings, emotions and thoughts. Currently various evidence based studies are being carried out. In order to objectively assess attachment and mentalization, Fonagy and other researchers are developing various assessment tools such as brief reflective functioning interviews, mentalizing stories for adolescents and mental state tasks. Recently, by applying mentalization-based treatment techniques on patients with borderline personality disorder, symptomatic improvements can be seen. Psychoanalysis 2013;24:9-20 KEY WORDS: Mentalization Attachment Bowlby Fonagy Transition. Received: March 14, 2013 Revised: April 9, 2013 Accepted: April 10, 2013 Address for correspondence: Geon Ho Bahn, MD, PhD Department of Psychiatry, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul , Korea Tel: , Fax: , mompeian@khu.ac.kr - -? 9

2 From Attachment Theory to Mentalization Table 1. The elements and the feasibility of the development of attachment according to maternal types Elements Mental retardation Depression Maternal types Borderline personality disorder Harsh character Bowlby? - Good-enoughmother Sensitivity Good Low Good/low Too much Good Responsibility Good Low Good/low Too much Good Availability Low Low Low Low Good Feasibility of the development Low Too low Too low Low or disguised Good of attachment 10 Psychoanalysis 2013;24:9-20

3 11 GH Bahn - -

4 From Attachment Theory to Mentalization - -? James Robertson(1911~1988) Psychoanalysis 2013;24:9-20

5 13 GH Bahn Mary Ainsworth(1913~1999)

6 From Attachment Theory to Mentalization -? - Table 2. The comparison of the theories between Bowlby and Ainsworth Issues Bowlby Ainsworth Attachment bond Universal, general Universal, individual Nature of attachment Biologically determined instinct Environmental Research objects Thieves, war orphans Modest families, Uganda and Baltimore Trauma Discrete Cumulative Table 3. The comparison between Anna Freud and John Bowlby Issues Anna Freud ( ) John Bowlby ( ) Mentor analyst Sigmund Freud Joan Reviere Beginning of child analysis Memorable work Hampstead Nursery report A two-year-old goes to the hospital (1952) Main job Hampstead child therapy course & clinic ( ) WHO mental health consultant, since 1950 Best colleagues Dorothy Tiffany Burlington James Robertson Mary Ainsworth Major difference Psychosexual development Mother-child interaction WHO: World Health Organization 14 Psychoanalysis 2013;24:9-20

7 15 GH Bahn -? - - -

8 From Attachment Theory to Mentalization 16 Psychoanalysis 2013;24:

9 GH Bahn Medial prefrontal cortex Anterior insula Orbitofrontal cortex Superiotemporal gyrus Figure 1. Human brain side view diagram. Fusiform gyrus Amygdala Anterior cingulate Temporal pole Figure 2. A sagittal view (cut in half) of the brain to show the internal structure

10 From Attachment Theory to Mentalization Psychoanalysis 2013;24:9-20

11 GH Bahn Acknowledgments Conflicts of Interest The author has no financial conflicts of interest. REFERENCES Aber L, Slade A, Berger B, Bresgi I, Kaplan M. The Parent Development Interview. New York: Barnard College, Columbia University;1985. Ainsworth MDS. Infancy in Uganda: infant care and the growth of love. Baltimore, MD: The Johns Hopkins University Press;1967. Ainsworth MDS, Blehar MC, Waters E, Wall S. Patterns of attachment: a psychological study of the strange situation. Hillsdale, NJ: Erlbaum;1978. Allen JG, Fonagy P, Bateman AW. Mentalizing in clinical practice. Washington: American Psychiatric Publishing, Inc;2008. Bahn GH. Holding environment. J Korean Psychoanalytic Society 2008; 19: Bahn GH. Study of Anna Freud s life. Psychoanalysis 2011;22: Bahn GH. The past, present, and future of attachment theory. J Korean Med Assoc 2008;51: Bateman A, Fonagy P. Mentalization-based treatment for borderline personality disorder: a practical guide. 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12 From Attachment Theory to Mentalization cent (MIPAdo) for enhancement of mental health in school children. J Korean Acad Child Adolesc Psychiatry 2012;23: Park MC. The life and work of Sigmund Freud. J Korean Psychoanalytic Society 2007;18:3-13. Pedersen A, Koelkebeck K, Brandt M, Wee M, Kueppers KA, Kugel H, et al. Theory of mind in patients with schizophrenia: is mentalizing delayed? Schizophr Res 2012;137: Pietromonaco PR, Barrett LF. Working models of attachment and daily social interactions. J Pers Soc Psychol 1997;73: Robertson J. Going to hospital with mother [film]. London: Tavistock Child Development Research Unit;1958. Rossouw TI, Fonagy P. Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2012;51: e3. Rudden MG, Milrod B, Target M. The Brief Reflective Functioning Interview. New York: Weill Cornell Medical College;2005. Rutimann DD, Meehan KB. Validity of a brief interview for assessing reflective function. J Am Psychoanal Assoc 2012;60: Schur M. Discussion of Dr. John Bowlby s paper. Psychoanal Study Child 1960;15: Sharp C, Ha C, Carbone C, Kim S, Perry K, Williams L, et al. Hypermentalizing in adolescent inpatients: treatment effects and association with borderline traits. J Pers Disord 2013;27:3-18. Spitz R. Discussion of Dr. John Bowlby s paper. Psychoanal Study Child 1960;15: Target M, Fonagy P. Playing with reality: II. The development of psychic reality from a theoretical perspective. Int J Psychoanal 1996;77(Pt 3): Tomasello M. The cultural origins of human cognition. Cambridge, MA: Harvard University Press;1999. Twemlow SW. A community of schools: Psychoanalytic influences on peaceful and academically strong schools in USA, Australia, New Zealand and Jamaica. Int J Psychoanal 2010;91: Twemlow SW, Fonagy P, Sacco FC. A developmental approach to mentalizing communities: II. The Peaceful Schools experiment. Bull Menninger Clin 2005;69: van der Horst FCP. John Bowlby: from psychoanalysis to ethology. Oxford: Wiley-Blackwell;2011. Verheugt-Pleiter A, Deben-Mager M. Transference-focused psychotherapy and mentalization-based treatment: brother and sister? Psychoanal Psychother 2006;20: Vrouva I, Fonagy P. Development of the mentalizing stories for adolescents (MSA). J Am Psychoanal Assoc 2009;57: Yun K, Chung D, Jang B, Kim JH, Jeong J. Mathematically gifted adolescents have deficiencies in social valuation and mentalization. PLoS One 2011;6:e Psychoanalysis 2013;24:9-20

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon