MINDS AT PLAY: pretence-reality confusion in child art therapy

Pretend play capacity is often impaired in maltreated children. In therapy, theysometimes treat their symbolic art or pretend play overly literally, as though it reallywere what it represents. Some clinicians maintain that, at these times, children fail todistinguish pretence and reality, leading to risks of injury or deterioration. I ask, firstly,whether these are cases of pretence-reality confusion and, secondly, how therapistsshould respond when pretend play becomes “too real”. In order to pretend, a childmust be able to “mentalize”, or understand that mental states can misrepresentreality. I hypothesise that such children fail to read specialised (“ostensive”) socialcues that their art and play are “only pretend”. I recommend that therapists may needto developmentally scaffold the child’s sensitivity to these social cues. I conclude thatthis phenomenon points to the role of social learning in scaffolding innate mentalizingcapacities during social stress.