Conference Agenda
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Symposium 6.F - Parental Mentalizing Under Pressure: New Measures and Clinical Work With Mothers With Borderline Personality Disorder
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4:30pm - 5:30pm
Parental Mentalizing Under Pressure: New Measures and Clinical Work With Mothers With Borderline Personality Disorder Parents with borderline personality disorder face heightened challenges in caregiving, often marked by intense parenting distress, reduced self-efficacy, and diminished sensitivity toward their children. These difficulties unfold within a broader pattern of affective instability and interpersonal dysregulation, increasing the risk for maladaptive parent–child interactions and the intergenerational transmission of psychopathology. Parental mentalizing—the capacity to understand behavior in terms of underlying mental states—has emerged as a key protective mechanism, yet is especially vulnerable to collapse under emotional arousal. Understanding how parental mentalizing deteriorates under pressure, and how it can be effectively strengthened in treatment, is therefore essential. This symposium brings together innovative empirical and clinical work targeting parental mentalizing stress in mothers with BPD. The first two presentations introduce novel, ecologically valid approaches to measuring the impact of emotional arousal on parental mentalizing. One study uses virtual reality (VR)–based assessment to evaluate mentalizing in attachment-relevant contexts with high emotional salience. A second study employs a simulated baby paradigm to elicit caregiving stress while capturing moment-to-moment changes in reflective functioning. Together, these methodologies provide new windows into stress-induced shifts from adaptive to maladaptive mentalizing. The next two presentations highlight clinical applications and assessment in high‑risk caregiving contexts. One presentation outlines a Mentalization‑Based Treatment program for young parents with personality pathology (MBT‑P), illustrating how maladaptive mentalizing patterns are identified and targeted therapeutically to restore reflective functioning in moments of misattunement or emotional overload. The final presentation focuses on a mentalization-focused program for high-risk parents, using the Parental Insightfulness Assessment (IA) to evaluate parents’ capacity to understand their child’s internal states through structured, video‑based observations—an approach particularly suited to families experiencing psychosocial stress. Together, these empirical and clinical contributions offer an integrated perspective on how parental mentalizing can be measured, supported, and strengthened across diverse high‑risk caregiving contexts. Presentations of the Symposium Using Virtual Reality to Measure Parental Mentalizing in Individuals with Borderline Personality Disorder Measures of parental mentalizing face several methodological challenges and are often time consuming and resource intensive. Virtual reality (VR) may represent a promising tool for enhancing ecological validity in the assessment of parental mentalizing. This study presents preliminary findings on parental mentalizing responses to infant-related stress in a VR environment among a healthy control sample and a clinical sample of individuals with borderline personality disorder (BPD). We further examine associations between VR-based parental mentalizing responses and baseline measures of adult attachment, mentalizing capacity, and psychopathology, as well as the extent to which these variables predict responses within the VR context. Findings may contribute to evaluating the feasibility and potential utility of VR as a novel method for assessing parental mentalizing. Stress and Parental Mentalizing in Mothers With Borderline Personality Disorder: Evidence From a Simulated Baby Paradigm Early parenthood places high emotional demands on mothers, which may be particularly challenging for those with Borderline Personality Disorder (BPD). BPD is characterized by emotional dysregulation, identity instability, and relational difficulties that can interfere with caregiving under stress. During heightened stress, mothers may struggle to mentalize—that is, to understand their own and their infant’s behavior in terms of underlying mental states. Neurobiological research indicates that stress can impair mentalizing, especially in individuals with histories of trauma or insecure attachment, which are highly prevalent in BPD. However, experimental evidence on how child-focused stress affects maternal mentalizing remains limited. This study investigates the impact of child‑focused stress on parental mentalizing in mothers with BPD compared to healthy control mothers (N = 80) using a computer‑controlled baby simulator (BSIM). The BSIM is a realistic doll with the weight of a 3-month-old baby that can be programmed to respond to certain caregiving actions. Mothers are asked to care for the BSIM in two conditions: a low‑stress condition during which the BSIM remains calm, followed by a high‑stress condition in which the BSIM is intentionally difficult to soothe. Galvanic skin response and heart rate variability are continuously monitored via a wearable device, while subjective stress is assessed after each condition using self-report ratings. Mentalizing is assessed through (a) the Parental Mentalizing Difficulties Questionnaire, (b) a brief interview and (c) behavioral observations of mother–BSIM interactions. Baseline predictors—childhood trauma, attachment anxiety and avoidance, baseline parental mentalizing—are examined to better understand individual differences in stress reactivity and mentalizing vulnerability. During the presentation the experimental design, results and clinical implications—particularly for supporting mothers facing emotional and relational vulnerabilities in early caregiving—will be discussed. Strengthening Parental Mentalizing Under Stress in Young Parents With Personality Disorder: Clinical Work Within MBT-P Parental mentalizing difficulties are a core clinical feature in parents with personality disorder, particularly borderline personality disorder (BPD), and are most pronounced under conditions of attachment-related stress. Breakdowns in parental mentalizing pose significant risks for parent–child interaction and the intergenerational transmission of relational trauma. This presentation describes a Mentalization-Based Treatment program for young parents (MBT-P) with personality pathology, with a specific focus on the assessment and clinical treatment of parental mentalizing difficulties. Drawing on clinical material, the presentation outlines how maladaptive parental mentalizing patterns are identified during assessment, including sensitivity to stress-related fluctuations in reflective functioning within the parent–child relationship. The presentation then focuses on how MBT-P translates these assessment findings into targeted clinical interventions aimed at restoring and strengthening parental mentalizing. Across individual and group-based components, clinicians actively support parents in keeping the child’s mind in mind, particularly in moments of misattunement or emotional overload. Clinical vignettes illustrate how parental mentalizing can be gradually re-established, contributing to safer parent–child interactions and reduced risk of intergenerational transmission of trauma. / / | ||