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 mentalization

Patrick Meurs^1,2,3,4*Dennis Schäfer¹Stefanie Hesemans^2,5Dilan Cinar¹Constanze Rickmeyer¹Felicitas Hug¹Tamara Fischmann⁶Terry Meyer^4,7Judith Lebiger-Vogel⁸

• ¹Sigmund-Freud-Institut, Frankfurt, Germany
• ²Katholieke Universiteit Leuven, Leuven, Belgium
• ³Odisee vzw Kenniscentrum Hoger Instituut voor Gezinswetenschappen, Brussels, Belgium
• ⁴Universitat Kassel, Kassel, Germany
• ⁵Ziekenhuis Oost-Limburg, Genk, Belgium
• ⁶Internationale Psychoanalytische Universitat Berlin, Berlin, Germany
• ⁷Heinrich-Boll-Stiftung, Berlin, Germany
• ⁸Frankfurt University of Applied Sciences, Frankfurt, Germany

Pretend play is considered to be of great importance in both normal and problematic child development (A. Freud, 1927; Piaget, 1951; Ekstein, 1977; Chethik, 1989; Nicolopoulou and Ilgaz, 2013; Koukourikos et al., 2021; Vliegen et al., 2023). 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 (Target and Fonagy, 1996). 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 traumatized 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 (Enckell, 2010; Brandell, 2017). The aims of this paper are to (1) consider conceptual ambiguity of the concept 'pretend (play) mode' in the mentalization 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 traumatized foster child who leaves the psychic equivalent mode behind on his therapeutic journey towards moments of mentalisation.