AMBIT: Working in anxious places A team-based mentalizing approach to high risk hard to reach complex youth Fundación Castilla del Pino 2013 Dr Dickon Bevington 1 Thanks Peter Fuggle (co-lead) Peter Fonagy Mary Target Eia Asen Neil Dawson Rabia Malik Suzanne Hare Garry Richardson Liz Cracknell Sally Zlotowitz All the AMBIT-trained teams 2 > 40 teams AMBIT: using versions of A Community of AMBIT manual Practice Wenger and Lave Derry - Omagh Edinburgh CAMHS MAC-UK AMASS - Islington CASUS Bexley CAMHS Education/Training (Total n = 70) No. of staff and working experience “At times I feel anxious working with complex hard to reach 7 youth.” “Strongly Disagree” 6 5 4 3 2 “Strongly Agree” 1 “At times I feel anxious working with complex hard to reach ( n = 67) youth.” “Strongly Disagree” 7 6 5 4 3 2 “Strongly Agree” 1 A Definition of Mentalizing The imaginative activity of making sense of behaviour • Of self and of others • By reference to present intentional mental states • Beliefs, Desires, Fears, Hopes… • A ‘bedrock’ neurodevelopmental capacity that is: Located primarily in the prefrontal cortex • Fostered (or rekindled) in the experience of relationship with a • trusted other, in which one has repeated experience of being accurately mentalized (“I find my mind in your mind”) Easily overwhelmed by powerful stress/arousal/attachment • 7 Anxiety & the Failure of Mentalization Genetic & early environmental The influence Disorganised Excessive demand for Self excellence Activation of INSIDE-OUT thinking Becoming attachment adult system (Psychic Equivalence) Rejection ELEPHANT-IN-THE-ROOM Current Disruption of ‘insurmountable’ mentalization thinking life challenges (Pretend Mode) QUICK FIX thinking Stress CSA reaction (Teleological Mode) Adverse (fight/flight) History of parenting physical maltreatment Genetic & early environmental influence Psychic Equivalence “INSIDE-OUT THINKING” Certainty about other minds and the way the world IS…