The measurement of shared care and its effects in a sample of non-working mothers with young children

Interview data from a sample of non-working mothers of young children indicated that most of them left their child with one or two other caretakers on a regular basis. Children averaged about five hours per week with non-maternal caretakers. Most mothers rated children as being always well settled with these caretakers. Those caretakers with whom children were noted as not always well settled tended to be those who spent little time jointly with the mother and the child, and this tendency was stronger if in addition they were solely responsible for the child less than once a month. Interview data were also compared with diary data kept over a complete week. This suggested that interview data tended to underestimate the amount of waking time children spent in non-maternal care, but was reasonably accurate regarding the number and identity of non-maternal caretakers.     

Prevention of child sexual abuse. Myth or reality

Programs to prevent child sexual abuse have proliferated as a result of increased public awareness and professional documentation of its incidence. We describe the content and format of these prevention programs in general and examine selected programs for effectiveness. Although there is limited evidence for an increase in knowledge for program participants, most evaluations suffer from basic design problems and present few results indicative of either primary prevention or detection. Overall, we argue that self-protection against sexual abuse is a very complex process for any child and that few, if any, prevention programs are comprehensive enough to have a meaningful impact on this process. Finally, we discuss several untested assumptions that guide these programs. We conclude that it is unclear whether prevention programs are working or even that they are more beneficial than harmful.     

Unprompted Between Subject Generalization of Home Safety Skills

In this study, an eight-year-old boy received home safety skills training from his mother and demonstrated clear improvements in several aspects of home safety. His five-year-old brother never received formal training from an adult, but was allowed to observe training and received unprompted teaching from his older brother. He, too, showed large improvements in several aspects of home safety skills training. The importance and utility of peer training is described and methods of enhancing this procedure are discussed.     

A Case Study of the Coping Power Program for Angry and Aggressive Youth

This paper illustrates the application of the Coping Power program with an 11-year-old boy and his father. Coping Power is a manualized preventive intervention for school-age children at-risk for disruptive and delinquent behavior. Cognitive-behavioral techniques are taught in separate child and parent groups to improve children’s social and emotional competencies. This case study highlights the core content of the Coping Power child and parent intervention components, the contextual social cognitive risk factors that the program targets, and the empirical support for the program’s effectiveness.     

Information and attitudes about HIV/AIDS in Portuguese adolescents: state of art and changes in a four year period

The incidence of infection with HIV/AIDS among the heterosexual population has been increasing in young adults. The goal of this research was to deepen knowledge of preventive sexual behavior in Portuguese adolescents, including knowledge and attitudes about HIV/AIDS, and assessing whether they changed from 2002 to 2006. Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in School-aged Children (HBSC), a collaborative WHO study. The study provides national representative data of 7093 Portuguese adolescents, randomly chosen from those attending 8th and 10th grade of high school. Results showed there was an increase in the age of first sexual intercourse and a decrease in the number of teenagers who reported having had sexual intercourse, also in the level of information regarding HIV/AIDS transmission/prevention and in positive attitudes towards people with HIV/AIDS. In general, adolescents have good knowledge about how to protect themselves from becoming infected. However, comparing to 2002, there was a reduction of knowledge and consequent increase in the doubts regarding HIV/AIDS. Given the incipient state of sex education in 2006, the results cannot be attributed to sex education, but they will be relevant for comparison with the 2010 HBSC results.     

Childhood Sexual Abuse and the Perpetration of Violence: The Moderating Role of Gender

This study sought to increase specificity in our knowledge of links among child sexual abuse (CSA), aggression, and physical intimate partner violence (IPV) perpetration by criminal offenders, with particular interest in gender. Participants were 202 men and 72 women (N = 274), who were recruited from an urban pretrial supervision program. Women reported higher rates of CSA than men. After controlling for relevant covariates, CSA was associated with general aggression and severe IPV. We found a gender by CSA interaction; CSA was associated with aggression and severe IPV for women, but not men. Findings provide preliminary evidence that CSA impacts aggression and IPV perpetration differently for female offenders compared to male offenders and gender-specific treatment might be warranted in pretrial settings.     

Surviving Destruction and Finding Connection: Play Therapy with an 11 Year Old Boy

ABSTRACT

How do child therapists manage the most difficult and emotionally intense moments in play or maintain safety with our most emotionally challenging patients. This extended case presentation presents material from a play therapy treatment with an school aged old boy. The treatment shows how the therapist struggled to maintain boundaries and safety, while maintaining space for the patient to share his most disturbing self-states in order to help the patient find connection with the therapist and developmental advancement.     

Parenting Wisely: Parent Training via CD-ROM with an Australian Sample

The effectiveness of a parenting program was examined with an Australian sample regarding improved parent knowledge, parental sense of competence, and child behavior. One hundred and sixteen parents and their children were randomly assigned to three conditions: a two-session group based intervention, a two-session self-administered individual intervention, or to a waitlist control group. Across both treatment modalities results reveal a significant increase in parental satisfaction, efficacy, and a reduction in child problem behavior. Improvements were maintained at 3-months follow-up. Results indicate the individual self-administered format enhanced treatment gains relative to the group format.     

The making of an abuser

This paper investigates how it is that a child has become an abuser, and by what means that process may be deconstructed. We know that abusers generally have a childhood history of abuse, though not necessarily sexual. Since not all children who have been traumatised repeat those patterns, and inflict abuse on others, then something must have happened for these particular children in response to their abuse. The author elaborates the view that there is no such thing, to paraphrase Winnicott, as ‘an abused child’ – no such child, that is, separate from the world of the relationships that formed him. He draws on the conceptualisation by Bentovim of an interlocking set of roles described as a ‘trauma organised system’; this notion reflects the fact that the child is a product not just of his specifically traumatic experiences but of a milieu in which power and control is exerted by someone who has typically succeeded in neutralising any caring function in a family in order to bring about the exploitation of a child. Clinical material is presented from the intensive psychotherapy of a nine-year-old boy, who happened also to be a refugee, for whom abusive family dynamics dominated his internal world. He was found to have identified with the abuser, his own father, in order to escape the pain of his victim self and was threatening to act this out in the treatment, making the therapist into a victim. Management of the treatment setting by the inclusion of a benign parental figure enabled the acting out to be contained. Symbolisation of the child’s inner conflicts became possible through play. As the abuser self was contained so the child’s victim experiences could be processed. The conclusion is drawn that engaging therapeutically with the residues of trauma from the beginning of treatment is essential in working with young people who have abused.     

Of sex roles and strollers: Female and male attention to toddlers at the zoo

Research supports the conclusion that adults interact differently with children of different sexes. Laboratory and home studies indicate that fathers/adult males are the primary agents of sex typing and that mothers/adult females are the primary caretakers, especially regarding the managerial aspects of child care. Little attention, however, has been directed at the public display of these differences and their covariance. Observations were made of 6414 visitors to the Sacramento zoo, with 524 adult females, 524 adult males, and 524 toddler triumvirates targeted for specific analyses of adult-child interactions and caretaking behaviors. Males were significantly more likely to carry female toddlers than male toddlers, while females made no such distinction. Adult females were more likely than adult males to push the child's stroller. Related research on the father's role in sex-typing behavior and the role of the division of child care between parents in the maintenance and reproduction of gender roles is discussed.This research was supported by a University of California at Davis Faculty Research Grant to the second author. We thank R. J. Mitchell for his contributions, both in and out of his stroller.     

Sacramental psychology: Treating intimacy failure in catholic priests

The treatment of intimacy failure in Roman Catholic priests in an outpatient program designed to treat sexual misconduct is discussed here. Three case vignettes highlight a particular feature of an intimacy deficit that sets the stage for the priests' sexual acting out. Intimacy, hypocrisy, and self-deception and the Catholic sacramental world view are discussed to shed light on the treatment of sexual addiction in the clergy. Tapping into a priest's beliefs regarding the divine power arising from his own ordination creates a nexus of healing where psychotherapy and spiritual direction join forces to produce a kind of “sacramental psychology.” This material was originally offered as part of a Grand Rounds presentation at St. Vincent's Hospital and Medical Center in New York City.     

Working with and ‘seeing through’ the sexual transference in the psychotherapy of an adolescent boy

This paper explores the challenges and developmental opportunities of working with the sexual transference in psychotherapy with adolescents. Psychoanalytic contributions investigating the nature of adolescent sexuality and the developmental move from a narcissistic organisation to a capacity to form intimate relationships are reviewed, and the question of what happens when there is a lack of containment in infancy is addressed. The way in which unintegrated sexual impulses and phantasies can invade the therapeutic relationship is further discussed through the account of the weekly psychotherapy of a 16-year-old boy who formed a powerful sexual transference to his female therapist. The paper highlights how working through the sexual transference enabled this young man to face his developmental paralysis and begin to use the therapy as an opportunity for psychic growth.     

THE EFFECTS OF A CHILD'S SELF-EVALUATION PROGRAM ON COMPLIANCE WITH PARENTAL INSTRUCTIONS IN THE HOME

A self-evaluation program was implemented with a kindergarten-aged boy in the home to increase compliance with parent instructions and decrease inappropriate verbal behavior. The self-evaluation package included the child's assessing the appropriateness of his behavior in 5-min intervals, receiving chips for positive self-evaluations, and exchanging chips for a reward following experimental sessions. In a reversal design, analyses were conducted of the effectiveness of the self-evaluation program, the requisite conditions for effective child behavior change with a self-evaluation approach, and the parent's efficiency in using the self-evaluation package. The self-evaluation procedures typically resulted in increased compliant behavior and decreased inappropriate behavior, although the effects generally weakened with time. Behavioral gains were greater and better maintained when the self-evaluation procedures were preceded by a phase of external evaluation via the mother than by baseline, suggesting that self-evaluation procedures may serve more to maintain the effects of external evaluation rather than to induce their own changes. The parent generally was efficient in implementing the procedures. Research and clinical implications for using self-evaluation procedures in a home setting are discussed.     

Parent education home visitation program: adolescent and nonadolescent mother comparison after six months of intervention

This study examined the effect of an intervention over a 6-month period to improve first time mothers knowledge about parenting and safety in the home. The sample included 61 mothers who completed a baseline and follow-up survey. Mothers were first time adolescent (38) and nonadolescent (22) mothers recruited from rural county health departments for participation in a voluntary home visitation intervention program. Four hypotheses were tested that associated home visitation with greater parenting skill and child development knowledge and safety. Adolescent mothers were expected to make greater gains but to lag behind nonadolescent mothers in child development knowledge, parenting skills knowledge, household safety, and use of community resources. The sample included 32% with a high school degree and 12% African American. 83% were in school. 85% lived at or below the US federal poverty level. Parent Educators provided weekly in-home education based on a manual and individualized curriculum. Parenting skills knowledge was measured by the Adolescent-Adult Parenting Inventory (Bavolek, 1984). Home safety was measured by Culp's Home Safety Checklist. Educators recorded use of 13 community services. Analysis of variance revealed that infant knowledge increased to the same level among all mothers regardless of adolescents' lesser knowledge at baseline. Parenting skill knowledge of child roles increased for both ages, but older mothers scored higher. Parenting skill knowledge of alternatives to corporal punishment increased similarly for both ages. No age or interactive effects were related to improvement in safety or use of community services.     

Psychosocial Factors in Child Safety Restraint Use1

Within the past 3 years, a majority of states have passed laws requiring children riding in automobiles to be properly restrained in safety devices. Several studies indicate that such laws have only a modest effect on the number of children being properly protected. To determine factors associated with safety restraint use a telephone interview survey was conducted with 211 residents of a state that has had a child safety restraint law in effect for two years. Several hypotheses derived from the Health Belief Model were tested. The model was generally supported, but will require some revision to explain a routine and repetitive behavior such as safety seat use. While strong general resistance to government intervention in family behavior was found, this did not translate into resistance of safety seat laws.     

Treatment of traumagenic beliefs among sexually abused girls and their mothers: An evaluation study

The objective of this study was to evaluate and compare the efficacy of two short-term individual therapy interventions for sexually abused girls and their nonoffending female caretakers. Thirty-two girls, ages 8 to 13, and their caretakers from primarily low-income, African-American families were randomly assigned to a theoretically based, structured experimental treatment program or to a relatively unstructured comparison intervention. Measures of child outcome were completed before and after the treatment program by each parent and child, and by a clinician blind to treatment condition. Pre- and postmeasures of maternal outcome were completed by the caretaker and a clinician not involved in the treatment. Both treatment programs yielded decreases in children's posttraumatic stress disorder symptoms and traumagenic beliefs reflecting self-blame and powerlessness, and increases in children's overall psychosocial functioning. The experimental intervention was more effective than the comparison program in increasing abuse-related caretaker support of the child and in decreasing caretaker self-blame and expectations of undue negative impact of the abuse on the child. Clinical impfications of these findings include the development of interventions targeting sexually abused children's traumagenic beliefs and nonoffending parents' support of their victimized children.This research was supported by the Emory Medical Care Foundation and the Children's Trust Fund of Georgia. Preliminary findings were presented at the Society for Research in Child Development, New Orleans, March 1993.The authors thank the clinic families, volunteer therapists, and project staff members whose work together made this research possible. Core project staff members other than the authors include Milonne Ambroise, Mary Lynn Dell, Sherry Dey, Beth Dreelin, Jenny Gould, Katherine January, Suzann Lawry, Marie Simmons, and Lisseth Rojas.     

The Emergence of Eric: Co-Therapy in the Treatment of a Family with a Disabled Child

This paper focuses on the problem of socialization of the disabled child within his family. For the family of the disabled child, socialization is doubly challenging; the family must teach its child not only how to be human, but also how to be disabled in the larger society. Often families of disabled children need help in enhancing their child's participation in family life — a critical aspect of socialization. One highly effective means of assisting families in this task is the use of family therapy. A case study is included to illustrate the use of family interviewing with a congenitally blind adolescent boy. Two therapists — a rehabilitation counselor (who is blind) from a state agency serving blind children^a and a social worker from a child guidance agency^b— collaborated in working with the family, which included a mother, father, their congenitally blind thirteen-year-old boy, and his two sighted brothers. The authors conclude that the child's family is the most potentially powerful resource for the successful habilitation of the disabled child into larger society and postulate family treatment as an effective means of attaining this end.     

Luminosity and the Safety of Knowledge

Abstract: In his recent Knowledge and its Limits, Timothy Williamson argues that no non‐trivial mental state is such that being in that state suffices for one to be in a position to know that one is in it. In short, there are no “luminous” mental states. His argument depends on a “safety” requirement on knowledge, that one's confident belief could not easily have been wrong if it is to count as knowledge. We argue that the safety requirement is ambiguous; on one interpretation it is obviously true but useless to his argument, and on the other interpretation it is false.     

Between listening and expression

This paper sets out to conceptualize what goes on in the analyst's mind as he listens—and expresses something—to the patient. Bion's ideas of approaching the patient's O, without memory and desire, are discussed. An alternate, more permissive, attitude to desire is suggested. This is based on the idea that containment, instead of denoting a dyadic interaction between mother and child, is a process which links the child to a begetting couple, thus a triad. Containing the patient corresponds, in the unconscious, to thinking about a sexual couple in a mutually beneficent interaction. Since the patient's anxiety, in his unconscious, parallels a frightening primal scene, containment is viewed as a continuous translation of a primitive primal scene into a mature act of love. A specific kind of genital desire is thus necessary for containment. This finds expression in the analyst's resonance with the patient. Clinical material from an analysis with a 7-year old boy is provided.     

Knowledge gained by mothers enrolled in a home visitation program

This study examined whether new mothers would gain knowledge of child development after participating in a home visitation program for six months, and whether there would be differences between adolescent mothers and older mothers. Forty-seven mothers were administered the Knowledge Inventory of Development and Behavior: Infancy to School-age (KIDS) after the birth of their babies and six months later. Results indicated an overall increase in total knowledge of child development for mothers (of all ages) participating in a home visitation program. KIDS subscale scores indicated a significant increase in new mothers' knowledge about both infant and school-age development. There was no significant difference between the adolescent and older mothers in knowledge of infant development.