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Silber, L.M. (2015). Why Does Nested Mentalization Make Me Want to Cry?. J. Infant Child Adolesc. Psychother., 14(3):341-344.

(2015). Journal of Infant, Child & Adolescent Psychotherapy, 14(3):341-344


Why Does Nested Mentalization Make Me Want to Cry?

Laurel M. Silber, Psy.D.

Hearing about the concept, nested mentalization, presented at the December 6th, 2014 conference on Wondering and Imagining, made me want to cry. I wasn’t the only one. When was the last time you attended a mental health conference and felt like tissues should have been distributed in the folders, along with the notepads? The conference was a rich interweaving of theoretical, clinical, and empirical dimensions of what it means to hold the child’s mind in mind. The sadness had to do with how often we as a culture miss the mark, but more pointedly, how we as a mental health field under function in creating a nested mentalized environment for promoting development in our most vulnerable citizens: children and their care-givers.

The concept of nested mentalization privileges relationships both internal and external. It involves a valuing and holding of the attachment system that surrounds the child, most notably the parent(s) for the child to feel held and properly understood. This simple fact has had a checkered history within child psychoanalysis. I have attended countless child analytic case presentations with an almost exclusive focus on the intrapsychic or fantasy life of the child. This act, to minimize the attachment ties, required a fair amount of dissociation to accomplish, and is unnecessary in the more complex theoretical holding of nested mentalization. The tears also felt like joy, to be nested in a theory that felt congruent with the work.

In a related vein, panelist, Leon Hoffman, pointed out in his presentation, the dearth of literature on countertransference in child analytic work. This absence in the literature is noteworthy. As I looked further into this problem, I discovered Marshall (1979) commented, “ a most significant feature in the area of countertransference towards children and adolescents is the limited literature” (p. 598). Thirty years later, Rasic’s (2010) article,” Countertransference in Child and Adolescent Psychiatry—A Forgotten Concept?” referred to countertransference as an “orphan concept without a theoretical home” (p.

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