The pandemic triggered a new crisis affecting the mental health of children and young people. In recent years, suicide has become one of the leading causes of death among adolescents, while severe anxiety, self-harm and difficulties with emotional regulation are appearing at increasingly younger ages. Teachers, parents and professionals alike are confronted with a lack of appropriate tools and sufficient care capacity to support young people experiencing a crisis.

Since its foundation, the MURMO Center for Clinical Psychology and Art Therapy has been committed to introducing the most up-to-date, evidence-based methods into Hungarian clinical practice, with particular emphasis on therapy for adolescents.

What Is MBT-A and Why Is It Important?

Mentalization-Based Treatment for Adolescents (MBT-A) is a structured, empirically supported approach developed and accredited by the Anna Freud Centre (AFC) in London. It has been shown to reduce self-harm and depressive symptoms in adolescents (Rossouw & Fonagy, 2012). The method combines weekly individual sessions with Mentalization-Based Family Therapy (MBT-F) and aims to help young people develop a more accurate understanding of their own and other people’s internal states, including when they experience difficulties with emotional regulation or impulsivity.

Mentalization is our ability to focus on our own and other people’s mental states and understand how these influence feelings, thoughts and behavior. This ability may be impaired in certain mental health conditions, particularly personality disorders.

MBT-A is an evidence-based intervention that has proved effective in treating young people experiencing self-harm, borderline personality difficulties and depression, while paying particular attention to the developmental characteristics of adolescence.

International research provides increasingly strong support for early identification and intervention. Carla Sharp, director of the Developmental Psychopathology Lab at the University of Houston, has demonstrated through her research that borderline personality pathology in adolescence can be treated and its symptoms reduced. At the same time, she warns that BPD is one of the leading causes of suicidal behavior and self-harm among young people and cannot be ignored.

MURMO’s Role in the Development of MBT-A in Hungary

MURMO is an active partner in establishing MBT-A in Hungary. In cooperation with the Anna Freud Centre in London, the Hungarian Mentalization Association and the Pro Juventa Foundation, we organize training programs in which internationally recognized lecturers provide parallel training in methods for adults (MBT) and adolescents (MBT-A). Our team regularly participates in international conferences and supervision processes so that the latest professional knowledge can be incorporated directly into clinical practice.

MBT-A training consists of a theoretical foundation course, three intensive training days and online supervision led by AFC London. Obtaining the therapist qualification also requires supervised clinical practice and video-recorded casework. Holly Dwyer Hall, PsyD, a child and adolescent psychoanalytic psychotherapist, trained mentalization-based treatment practitioner, clinical supervisor and trainer, supports our team in its work with children, adolescents and families.

On the day following the final day of the MBT and MBT-A training, we organized a one-day conference aimed at introducing the mentalization-based approach to a wider professional audience. We addressed not only clinical professionals, but also colleagues working in social care and education, including family support professionals and teachers who may benefit from understanding the theoretical and practical foundations of mentalization-based therapeutic work.

The following forms of mentalization-based therapeutic work are currently available at MURMO:

• MBT-I for parents within the Lotilko Program – 8 contact hours – https://murmo.hu/timetable/event/mbt-i-edukacios-szulocsoportok/
• Reflective Parent Group – 16 contact hours – https://murmo.hu/timetable/event/mbt-reflektiv-szulo-es-kamaszcsoport/
• Coping Skills Training for Adolescents within the Lotilko Program – 8 contact hours – https://murmo.hu/timetable/event/coping-skills/
• MBT-A egyéni terápia
• MBT-F család szintű terápiás munka

For information about training opportunities, please email kepzes@murmo.hu Annamária Szabó will be happy to provide further details.

Adolescence is not only a period of development, but also one of heightened vulnerability. The combined burden of identity formation, emotional intensity, and relationship challenges can lead some young people to develop serious difficulties in personality functioning—patterns that clinicians were long hesitant to diagnose and treat during adolescence. We now know that early recognition and targeted intervention can transform lives.

The MURMO Specialist Psychology and Art Therapy Centre is committed to ensuring that its team works according to the highest standards and internationally accredited methodologies. One of the cornerstones of this approach is Transference-Focused Psychotherapy for Adolescents (TFP-A). Over recent years, several members of our team have worked with the method’s leading international experts to gain specialist training and apply it in clinical practice under supervision.

What Is TFP-A?

TFP is an evidence-based treatment for adults experiencing severe personality disorders. It was developed on the basis of psychoanalytic object relations theory and provides an empathic yet clearly structured therapeutic framework. TFP-A is its adaptation for adolescents. It is based on Otto F. Kernberg’s contemporary object relations theory and takes account of the specific features of personality disorders during adolescence, including changes in symptoms over time and the critical process of identity development.

During its training in the TFP-A method, the MURMO team had the opportunity to work within an exceptional international professional community. Our supervisors are among the method’s most influential representatives.

Dr. Mathias Lohmer is a psychoanalyst, an accredited ISTFP supervisor and trainer, a member of the TFP Institute in Munich and a member of the ISTFP Training and Education Committee. His supervision brought the depth and precision of the German-speaking clinical tradition of the method closer to our team.

Dr. Lina Normandin is a professor of psychology at Laval University in Québec, Canada, a founding member of the ISTFP and an accredited TFP supervisor. She is also the lead author of the standard TFP-A manual (Normandin, Ensink, Weiner & Kernberg, 2021, American Psychiatric Association Publishing) and supports our colleagues throughout their supervision processes.

Brenda Tarragona is an accredited TFP therapist at Grup TLP in Barcelona and a member of the ISTFP TFP-A Committee, which aims to advance research into adolescent personality disorders and develop TFP-A therapist and supervisor training. Her participation in our supervision work also introduced our team to experience gained through the method’s clinical development in Spain and Latin America.

We do not currently provide training in this method. We recommend the training programs offered by the TFP Working Group.

What Is Clinical Neuropsychology?

Clinical neuropsychology focuses on the assessment and treatment of congenital or acquired disorders affecting cognitive functions, including perception, attention, executive functions, memory, language, writing, reading and numeracy.

When May Neuropsychological Assessment and Therapy Be Needed?

Neuropsychological assessment and therapy may be required in the following conditions or when the following symptoms are present:

• Atypical, slow or delayed psychomotor development (The child reaches developmental motor milestones late, their development becomes delayed or interrupted, or they experience difficulties with fine or gross motor skills.)
• Speech development or communication skills below the level expected for the child’s age (Speech or communication difficulties may affect expressive language alone or both speech production and comprehension.)
• Learning difficulties (Academic performance is below the level expected based on the child’s intellectual abilities, or their previous performance declines. Difficulties with reading, writing, spelling or numeracy may be suspected.)
• The child performs below their peers in tasks involving attention and executive functions
• The child has difficulty retaining newly learned information

The development of cognitive abilities is often affected by different forms of epilepsy. A neuropsychological assessment may be indicated following trauma, such as a head or brain injury, as well as before and after surgical procedures, including tumour removal or epilepsy surgery.

We carry out intelligence assessments from preschool age and school-readiness assessments from the age of five. A more detailed evaluation of cognitive abilities and the child’s cognitive profile—including strengths and areas of difficulty—may also be needed later in life, for example when making decisions about further education or career choices.

Neuropsychological Assessment for Adults

Our center also provides neuropsychological assessments for adults, which may be indicated in the following cases, among others:

• Adult ADHD
• Epilepsy
• Age-related cognitive decline
• Head or brain injury

The Diagnostic Phase

The diagnostic stage consists of 1–4 sessions, each lasting 45–90 minutes. During the first session, we take a detailed developmental history.

During the subsequent sessions, we develop an individualised therapeutic and rehabilitation plan as part of the differential diagnostic process. The number of diagnostic sessions is flexible, as the assessment process is tailored to each person’s individual needs.

The assessment is carried out using neuropsychological measurement tools, including paper-and-pencil tests and computer-based software. By establishing a cognitive profile, we perform both qualitative and quantitative analyses of the individual’s competencies, including preserved, impaired, and underdeveloped abilities and skills.

Therapy and Rehabilitation

Following the diagnostic stage, we provide recommendations for developmental support or therapy.

In cases of acquired disorders, our primary task is to rehabilitate and restore impaired cognitive functions. Cognitive abilities may need to be monitored periodically through follow-up assessments. Another important aspect of therapy is the assessment and treatment of associated behavioural difficulties, which are common in many cases.