# Rethinking the role of the pretend play mode in mentalisation-focused psychoanalytic child therapy for adopted and foster children with attachment trauma: from a pre-mentalising mode to a developmental achievement and a milestone on the trajectory towards mentalisation

## TL;DR

This paper explores how pretend play can help children with attachment trauma develop mentalisation skills through psychoanalytic therapy.

## Contribution

The paper reinterprets pretend play as a developmental milestone rather than a non-mentalising mode in trauma therapy.

## Key findings

- Pretend play can be a therapeutic tool for children with attachment trauma when guided by a skilled therapist.
- Trauma disrupts a child's ability to engage in pretend play, but it can be restored through targeted interventions.
- Metaphors and 'as-if' language help integrate transference elements and express hidden trauma.

## Abstract

Pretend play is considered to be of great importance in both normal and problematic child development. However, the developmental and therapeutic value of pretend play has perhaps been somewhat overshadowed by the classification of the pretend mode as a non-mentalising mode, a perspective from literature on mentalisation-based psychotherapy with personality disordered adults. In this article, we highlight this difference in emphasis. After having situated this subtle and not seldom unacknowledged difference in meaning surrounding the concept of pretend mode, we focus on psychodynamic child psychotherapy for attachment-traumatised children. Early experiences of traumatic breakdowns in attachment can severely limit a child’s ability to use creative imagination in pretend play. To help the traumatised child make use of the growth opportunities of pretend play, a psychodynamic child therapist is needed who can use metaphors to integrate in an ‘as-if’ language transference-countertransference elements in their interventions, thereby creating opportunities for the child to express previously hidden trauma-related aspects. The aims of this paper are to (1) consider conceptual ambiguity of the concept ‘pretend (play) mode’ in the mentalisation literature; (2) discuss the recent diagnosis of complex relational (attachment) trauma; and (3) elucidate the role of pretend play in the psychotherapeutic process of a complexly traumatised foster child who leaves the psychic equivalent mode behind on his therapeutic journey towards moments of mentalisation.