L’attachement et la mentalisation en pédopsychiatrie : une fenêtre sur le fonctionnement des enfants et de leurs parents

Résumé Fr En

Le travail auprès de la clientèle en pédopsychiatrie et les défis qu’il pose amènent à revoir les pratiques cliniques afin de prendre en compte de façon systématique les notions d’attachement et de mentalisation chez les enfants et leurs parents. L’article traite d’abord des concepts d’attachement et de mentalisation et fait un résumé de l’état des connaissances sur ces derniers. Il est ensuite question d’un projet de recherche développé en pédopsychiatrie à la clinique spécialisée 0-5 ans de l’Hôpital en santé mentale Albert-Prévost (HSMAP). Nous présentons les résultats préliminaires de cette recherche de même que les défis rencontrés dans l’implantation du projet. Enfin, nous développons sur la façon d’aborder le travail clinique en considérant de manière systématique l’attachement et la mentalisation dans l’évaluation et l’intervention auprès des familles référées en pédopsychiatrie.

Objectives Mental health professionals who work with children face various challenges, requiring them to consider factors that aim to promote healthy adaptation in their clients. There is a growing body of literature showing that child attachment pattern, as well as mentalizing ability in both children and their parents, are related to various indicators of well-being including mental health. However, studies assessing these constructs in clinical samples are sparse. Method Forty-nine children (2-6 years of age) and their parents were recruited through the Clinique spécialisée 0-5 ans of the Hôpital en santé mentale Albert-Prévost (HSMAP). A two-hour laboratory visit was carried out where parents and children completed individual and parent-child dyad tasks and filled out questionnaires. Various dimensions of parent and child functioning were assessed including the mother-child attachment relationship and parents’ mentalization ability. Results Preliminary results indicated that child attachment pattern was related to children’s behavioral and executive functioning as well as parents’ psychiatric symptoms and parenting-related stress. Moreover, parents in our sample had lower levels of mentalizing abilities than those found in normative samples. Parents’ mentalizing ability was related to the presence of psychiatric symptoms, parenting-related stress, and a history stressful life events. Conclusion These results highlight the need for mental health professionals working in a child psychiatric clinic to consider the child’s attachment pattern and the mentalization ability of children and their parents, throughout the assessment process and subsequent implementation of interventions. In the last section of the manuscript, we present different ways we have integrated these concepts into our clinical work with children and parents referred to HSMAP.