The psychiatric infant—family ward at Tampere University Hospital

This article describes a new integrated evaluation and intervention program for infants, small children and their families, a child psychiatric infant–family ward treatment model at Tampere University Hospital. A centerpiece of the model is a 3-week treatment period for the whole family at the infant–family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are used as tools, including a reflective working model and sharing concrete interaction with the family. Theoretically, the treatment is based on an integrative model where psychoanalytical and systems theories as well as a behavioral approach are applied in defining the strengths and problems of the family and of the infant and in choosing the best intervention techniques. The fact that the whole family is present at the ward creates a strong therapeutic holding relationship context and an open therapeutic reflection, which are the cornerstones of this new and encouraging treatment model. © 1998 Michigan Association for Infant Mental Health     

The use of multitreatment modalities in early intervention: A quantitative case study

A quantitative single case study is presented to illustrate how an early intervention program used two therapeutic modalities to treat a depressed mother and her 2-month-old son. Drawing upon an ecological, transactional model of development, the case study utilized a multimethod, longitudinal approach to assess the infant's developmental competence and attachment status, the mother's history and current psychosocial functioning, patterns of mother-infant interaction, and components of the family's social ecology. Measures were administered during a baseline period to assess pre-intervention functioning and were systematically repeated throughout the 2-year period of intervention. The treatment modalities included psychodynamically oriented individual therapy and Parent-Infant Relationship Treatment (PIRT) in which the dyad was also seen by a second therapist to foster more adaptive mother-infant transactional patterns. The findings indicated increased infant developmental competence and a shift from an insecure to a secure attachment classification, improved maternal psychosocial functioning, and a decline in the dyadic interactional pattern of maternal intrusiveness and infant withdrawal. The advantages of using two treatment modalities and a single case approach to evaluation are discussed.     

Demonstrating Support for the Formative and Summative Assessment Paradigm in a School-Based Intensive Mental Health Program

We illustrate the use of formative and summative assessment in evaluating a therapeutic classroom program for children with serious emotional disturbances. Information was analyzed based on data gathered for clinical decision-making during treatment (formative assessment) and measurement of outcomes at discharge (summative assessment) from a school-based Intensive Mental Health Program. Results indicated that overall ratings of daily indicators of behavior across all environments (therapeutic classroom, neighborhood school, and home) were predictive of functioning at discharge. An ecological approach during the formative assessment period of evaluation is important as compared to only examining individual environments. Formative assessment techniques can predict scores on a summative assessment measure. Thus, we found supportive evidence for the formative and summative procedures used in the Intensive Mental Health Program for therapeutic interventions, clinical decision-making, and outcomes assessment.     

A note on the effects of anonymity,response consequence information,and sex on the self-assessment of fear

Despite an increasing emphasis on the direct observation and measurement of behavior in the assessment of fear (e.g. Bernstein, 1973. Goldfried and Sprafkin, 1974: Hersen, 1973). the Fear Survey Schedule (FSS; Geer, 1965: Wolpe and Lang, 1964) has remained popular as a paper-and-pencil instrument for screening large populations of potential treatment subjects prior to behavior avoidance tests (BATs; e.g. Bernstein and Nietzel, 1973). The utility of the FSS for this purpose is largely dependent upon its ability accurately to predict avoidance behavior in the presence of specific fear targets (Hersen, 1973) but. unfortunately, correlations between self-reported fear intensity on the FSS and overt behavior during BATs usually range from low to moderate (Lang, 1968; Schroeder and Craine, 1971). There is evidence that this disparity between FSS reports of fear and subsequent avoidance behavior are due in part to the operation of situational and contextual variables within the BAT which affect overt responses (Bernstein, 1973). and it seems reasonable to suspect that procedural variations in the self-assessment situation (e.g. method of test administration, instructions regarding the nature and purpose of testing, test form. and physical/interpersonal context) could modify FSS responses in a similar fashion. While research on projective and other assessment instruments has clearly established the influence of such variables on test responses (e.g. Azrin, Holz and Goldiamond, 1961; Henry and Rotter, 1956; Page and Yates, 1975). it is presently unknown to what extent ‘impression management’ strategies (Braginsky, Grosse and Ring, 1966) based upon cues in the testing situation bias verbal reports of fear. Preliminary investigation of this problem was undertaken in the present experiment by directly manipulating (a) the degree to which subjects could be identified with and held ‘accountable’ for their reported levels of fear and (b) the amount of information provided about the probable consequences of their responses.     

Paradox explored: Climate shame,moral agency,the church,and the birds

This article explores shame and moral agency in relationship to the climate catastrophe, and the moral situation of the world's relatively high-consuming people who are implicated in greenhouse gas emissions that cause climate change. The author complexifies that situation in the conundrums of climate colonialism, climate racism, structural sin, and the moral ambiguities they raise, including such questions as: “What are the moral demands of climate sin grounded in historically rooted economic systems that one did not create but upon which the material conditions of one's life depend? To what extent, if any, is the individual morally accountable for the social structures of which one is a part and from which one benefits?” From there, the essay moves to its central question. It is whether shame theory might help to enable moral agency for what is desperately needed now by people of climate privilege and economic privilege in the North Atlantic world—wise and courageous action to address climate change and climate injustice. The article probes shame theory for clues to what disables moral agency and what catalyzes it. The author finds in shame theory pathways for transforming shame-based moral inertia into moral agency. Those pathways suggest vital roles for the church.     

Going against the grain: supporting lesbian, gay and bisexual clients as they 'come out'

It has been acknowledged in principle that those who provide counselling or support should respect differences and the diversity inherent within any society or culture. In this article we focus upon sexual orientation as a resource: a means by which it is possible to expand upon skills and understand the experiences of those who have embarked upon alternative trajectories of sexual development. We consider the process of development from the perspective of the 'everyday' and, based upon interviews with 16 lesbians and gay men, explore the process of identity formation and the role of those professionals and volunteers who provide support during this transitional period in a person's life. We suggest that it is important for those providing counselling or support to an individual who is lesbian, gay or bisexual to understand the role of context and social influence in their personal and interpersonal development. We suggest that working with lesbian, gay and bisexual clients can provide the practitioner with insights and opportunities to further expand their supportive skills through an exploration of what it means to grow up as a member of a minority group.     

A comparison of parental attention and preferred items during tummy time: A consecutive controlled case series evaluation

Tummy time is an activity for infants to practice their early motor skills. Although most pediatricians recommend tummy time, parents may avoid the procedures due to indices of infant discomfort during this period. This consecutive controlled case series evaluation compared the effects of preferred items selected from a preference assessment with those of parental attention on head evaluation and negative vocalizations during tummy time. In addition, we directly evaluated parental choice by inviting parents to select which tummy time treatment they wanted to implement. We found that both preferred items and parental attention effectively increased head elevation and decreased negative vocalizations during tummy time; however, parents tended to prefer the treatment that included the preferred item.     

The clinical utility of Piagetian-based scales of infant development

The clinical utility of assessment scales based on Jean Piaget's theory of infant development is described. A clinical process is presented which permits one to determine (a) whether a child is showing delayed or non-delayed sensorimotor performance, (b) whether a child is showing normal or atypical patterns of sensorimotor development, (c) the extent to which deviations in a child's patterns of development are present, (d) the exact nature of such deviations, if any, and (e) what types of interventions are most appropriate for enhancing a child's acquisition of sensorimotor competencies. Four examples of the application of the clinical process are presented.     

Treatment issues during pregnancy and lactation

The lifetime incidence of mood disorders is twice as great in women compared with men, with the highest risk occurring during the childbearing years. The management of mental illness during pregnancy and lactation is a particularly complex clinical situation. The cornerstone of such a clinical decision is a completion of an assessment of the risks of the illness vs the risks of treatment. The following article reviews the factors influencing infant outcome and outlines the essential elements of the process of determining risk for the use of psychotropics in women during pregnancy and lactation. As the available data rapidly change, the facets of the risk benefit assessment are consistent and often the issue of specific medication is decided by prior history and exposure.     

Parent – infant psychotherapy,the transition to parenthood and parental narcissism: Implications for treatment

In this article the author discusses some of the indications for short- or long-term parent?–?infant psychotherapeutic interventions in terms of what he defines as ‘problems of parenthood’ and ‘problems of parental narcissism’. Brief parent?–?infant psychotherapeutic interventions are most frequently indicated in the case of the former: more neurotic problems of parenthood where the parents present a manic or counter-depressive type of narcissism. Masochistic problems of parenthood are also susceptible to treatment through brief parent?–?infant interventions, although in such cases treatment may have to be continued in another modality of long-term psychotherapy. More dissociated problems of parental narcissism constitute a contraindication for brief psychotherapeutic parent?–?infant interventions. The persecutory narcissism of these parents contributes to a ‘negative pre-transference’ which creates a major resistance to the therapeutic process.     

Dyadically expanded states of consciousness and the process of therapeutic change

This paper addresses an intersubjective issue that arises out of our model of therapeutic change: Why do humans so strongly seek states of emotional connectedness and intersubjectivity and why does the failure to achieve connectedness have such a damaging effect on the mental health of the infant? A hypothesis is offered—the Dyadic Expansion of Consciousness Hypothesis—as an attempt to explain these phenomena. This hypothesis is based on the Mutual Regulation Model (MRM) of infant–adult interaction. The MRM describes the microregulatory social-emotional process of communication that generates (or fails to generate) dyadic intersubjective states of shared consciousness. In particular, the Dyadic Consciousness hypothesis argues that each individual, in one case the infant and mother or in another the patient and the therapist, is a self-organizing system that creates his or her own states of consciousness (states of brain organization), which can be expanded into more coherent and complex states in collaboration with another self-organizing system. Critically understanding how the mutual regulation of affect functions to create dyadic states of consciousness also can help us understand what produces change in the therapeutic process. © 1998 Michigan Association for Infant Mental Health     

Evaluating a home‐based dyadic intervention: Changes in postpartum depression,maternal perceptions,and mother–infant interactions

Psychotherapeutic treatments that focus on improving the relational processes between mothers with postpartum depression (PPD) and their infants, as well as the mother's individual therapeutic needs, have a great potential to positively impact the mother, her infant, and their relationship (K.J. Nylen, T.E. Moran, C.L. Franklin, & M. O'Hara, 2006 ). Utilizing pilot data from an evaluation of a home‐based dyadic therapy for mothers with PPD and their infants, this article reports on a recent academic–community partnership study. The effectiveness of the intervention was examined, specifically regarding changes in mother's mood, parenting experience, and relationship with her infant. In addition, associations were examined among maternal self‐report variables measuring change from pre‐ to posttreatment in PPD, psychological distress, and maternal perceptions of parenting and those variables measuring change in observer ratings of maternal–infant interactions. Results showed improvements in mothers' depression, distress, and perceptions of parenting as well as many ratings of mothers' interactions with their infants. However, only improvements in maternal perceptions of parenting, such as maternal self‐esteem and parenting stress, were associated with better mother–‐infant interactions. Importance of this research for the field of infant mental health as well as clinical implications are discussed.     

Postpartum maternal mood,feeding practices,and infant temperament in Barbados

Maternal mood, infant feeding practices, and infant temperament, using the Carey-R scales, were assessed in 226 healthy, well-nourished Barbadian mothers and their infants during the first 6 months of life. Maternal moods were assessed by self-report using the Zung depression and anxiety scales and a morale scale. Even after correcting for background variables, maternal depression and anxiety ratings and reports of despair at 6 months postpartum were significantly associated with infant temperament ratings at 6 months, using the original Carey-R scales, with factors derived from principal components analysis of the Carey items, and with summary difficulty scores. Maternal depressive symptoms were associated with decreased infant adaptability, reduced approach, negative mood and an increased sensory threshold. Infants of depressed and anxious mothers were more resistant to change and preferred constancy. These significant relationships were linear across the range of maternal mood scores and were not limited to diagnosed cases of depression or anxiety. In contrast, feeding practices were not significantly correlated with infant temperament, although infant difficulty on the temperament scales was associated with an increase in difficult feeding behaviors and with fathers’ involvement in the feeding of their infants. We conclude that interventions focused on improving maternal mood in the postpartum period are likely to impact positively upon maternal perceptions of their infants, with implications for improving child behavioral development and health in this underserved population.     

Assessment Center Graduate Selection: Decision Processes,Validity, and Evaluation by Candidates

In this contribution, results are presented of research on the predictive validity of a procedure for the career-oriented selection of graduates in The Netherlands. After selection on account of applicant letter, the selection procedure consists of four selective steps: interview with a ‘recruitment officer’, mental test, interview with line manager, and an assessment center comprising two situational exercises. Performance indicators investigated are present salary, average annual changes in function, appraisal of performance, appraisal of management potential, and average annual salary progression. We report on the relationships between the predictors, between the criteria, and between predictors and criteria. The assessment center, together with other steps from the selection procedure, appear to be valid for a number of performance indicators. The correlation between the overall assessment center rating and present salary, corrected for restriction in range, equals 0.55. Stepwise regression indicates that elements from all procedure steps contribute to the prediction of the criterion of average annual salary progression. The disturbing influence of possible ‘crown prince’ -effects on these results, are discussed. Also, the decision process taking place during the end meeting of the assessors is investigated. Finally, the evaluation of the procedure, both by accepted and by rejected candidates, is discussed. These and other results are compared to what is generally known about assessment centers.     

The trial period and the creation of analytic patients

Just as there are many roads to Rome, the trial period may be considered one of many opening moves in psychotherapy or psychoanalysis. The responsive – and responsible – therapist must be many things to many patients, some of whom know nothing about the psychotherapeutic/analytic process. Freud advocated the trial period to help him take a “sounding” when he knew little about the patient and when the patient knew little about psychoanalysis. R.I.P.? This brief communication laments the apparent demise of this promising procedure and makes an effort at resurrection by describing the hitherto unmapped latent structure of the trial period. Even if there are fewer patients in psychoanalysis today, there may be a number of reasons to recommend a trial period, no matter what we name this period of optimistic uncertainty at the beginning of every treatment. Even if “consultation” is the term de jour, the psychoanalytic psychotherapist cannot escape certain role responsibilities at the beginning of every treatment, which has been made clear in the ethical principles of the American Psychoanalytic Association. What we will learn about the trial period should serve our understanding of what must also occur in the beginning of every psychotherapy or psychoanalysis. Conceptually, I propose that a trial analysis (1) will serve as a discriminative stimulus, signaling, to the patient, the unique nature of the analytic conversation; (2) will permit an in vivo assessment of the patient's suitability for psychoanalysis, and, more importantly, the fit between analyst and patient; (3) will provide anticipatory socialization for the unfamiliar and difficult roles of patient and therapist within the analytic process; (4) will offer true informed consent about the task facing therapist and patient; and (5) will facilitate an opportunity for therapeutic assessment, all of which will help the naive patient acquire the skills and lived experience to become an analytic patient. The trial period is the perfect host for all that must happen – and what we can do– to help naive patients become analytic patients.     

The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence‐Based Clinical Approach to Suicidal Risk

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence‐based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF‐based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem‐focused clinical intervention that is designed to target and treat suicidal “drivers” and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well‐powered RCTs are under way, and various new CAMS‐related projects are also being pursued. The clinical and empirical evolution of CAMS—how it was developed and what are the next steps for this clinical approach–are described here.     

Disorders of excessive crying,feeding, and sleeping: The Munich Interdisciplinary Research and Intervention Program

The Munich Interdisciplinary Research and Intervention Program (MIRIP 1991) is an inter-disciplinary diagnostic and intervention service for families with regulatory disturbed infants (excessive crying, feeding/sleeping disturbances, disturbances of attachment/exploration, disturbances of autonomy/control). In addition, the systematic collection of data serve to investigate the etiology, clinical course, and possible treatments of regulatory problems in infancy. The program is based on a systemic model of early developmental psychopathology. Diagnostic procedures include a semistructured clinical interview, a developmental neuropediatric examination; behavioral diaries; questionnaires on infant temperament, the mother's psychological condition, marital satisfaction, and social support; and videotaped mother–infant interactions in age-related contexts. As is evident from the data analysis, regulatory disturbances in infancy may be associated with (1) maladaptive regulatory patterns in several domains (e.g., excessive crying and disturbed sleep-wake organization), (2) high maternal distress and multiple psychosocial risk factors, and (3) considerable distress of the early mother/parent–infant relationship and communication. Interaction-centered infant–parent psychotherapy is an interdisciplinary, multidimensional therapeutic approach for families with regulatory disturbed infants. It targets upon dysfunctional patterns of mother/parent–infant communication. Particular emphasis is put on restoring the parents' intuitive capacities. The approach has proved to be effective within short time periods and aims at preventing later developmental problems. © 1998 Michigan Association for Infant Mental Health     

Decreasing Infant Mortality as a Global Demographic Change: A Challenge to Psychology

Decreasing infant mortality is taken up as a demographic phenomenon which constitutes one aspect of a broader conceptualization of “Global Change”. At the root of the global environmental problems faced today is the population issue. With sharp increases in the rates of infant and child survival, the question of what happens to those who survive assumes greater importance. With new policy shifts focusing on early childhood care and development, psychologists' expertise is now being called upon. Psychological knowledge is required especially in the cross-culturally valid conceptualization and assessment of human development. When made applicable to large numbers of children and parents, such knowledge can be used for detection and screening of risk cases and for establishing the environmental factors promoting psychosocial development.     

Sibling attachment: The development of a new infant-based measure (SPPIR)

This paper describes a new infant-based measure for assessing infant attachment to a sibling during a modified strange situation procedure. Research has demonstrated that young siblings often form a special relationship and that they prefer to interact with one another rather than with an unfamiliar peer. Also it has been shown that older siblings can respond appropriately to the distress of an infant. Research on relationships has moved from frequency counts of discrete behaviours towards more global measures of the ways in which behaviour is organized. These have tended to focus upon the older child as caregiver or the influence of the mother-child relationship on child-child interaction during the strange situation. The main findings of previous studies are presented. This paper describes a new method for measuring sibling attachment. Advantages of the new scoring system over previous procedures are that it utilizes ethological attachment theory, it is infant-based, it allows for a variety of infant reactions to reunion with the older sibling, and it focuses on overall patterns of behaviour rather than tallies of frequences.     

The infant's physical attractiveness: Its effect on bonding and attachment

The results of a project concerned with studying infants' physical attractiveness are reviewed. Information on what makes an infant cute and what the effects of infant cuteness are, is provided. These findings and hypotheses derived from them are then discussed in relation to the bonding and attachment phenomena. It is suggested that adults' initial reactions to the appearance of any infant are similar to what occurs during bonding, whereas differential reactions to infants varying in appearance are similar to the variability observed in the construction of an attachment relationship. Adults' reactions to atypical appearance are also discussed.