State of mind assessments

This paper describes state of mind assessments as undertaken by child psychotherapists. It considers the similarities and differences with an assessment for an ongoing child psychotherapy treatment intervention and is described here as a ‘package’ that is offered to the family, child and young person and also the referring colleague. It is suggested that the consultative aspect has more weight in a state of mind assessment. The stages of the assessment are outlined and include the initial consultation with the referring colleague, a meeting with parents, three sessions with a child or young person and feeding back to parents with further consultation to the referring colleague. The meaning of the request at any particular time is explored and influences the stance and the approach to the assessment by the therapist. A summary of a case example illustrates the different stages outlined here. The thinking and approach described may be particularly useful to trainees and those starting out as child psychotherapists in child and adolescent mental health services.     

Grandiosity,trauma and self

Distortions and inversions of Kohut's phase of grandiosity play a major role in multi-generational patterns of child-abuse and neglect. Such families are considered ‘upside down’ in their organization: parents enact unmet needs for mirroring and grandiose assertion, while the child experiences anxiety and endures a split between defensive compliance and a turbulent, trauma-ridden inner life. Within the space of this lonely inner life, the child fixates on atavistic power fantasies and dreams of possessing or controlling its objects. Hence, distortions of power and grandiosity replicate themselves from one generation to the next. The therapeutic play of children from upside down families typically passes through four phases: 1) re-enactment of trauma vignettes; 2) restoration of appropriate grandiose and mirroring themes; 3)restoration of rudimentary empathic abilities and empathy longing; 4) the search for an appropriate parenting object. Psycho-analytically based play therapy is effective when combined with other interventions to stabilize the child's milieu.     

Conflicting interests and the creation of a “third space”; reply to commentary

This paper addresses how to be an available and responsive therapist to a controlling and narcissistically vulnerable young girl. It presents an overview of the treatment relationship and specific vignettes from sessions. The paper describes an impasse that posed a quandary: how to find a balance between staying in control of the treatment while being responsive to the kind of object the child needs the therapist to be—being empathic without being intrusive—and meeting her aggression without getting into a power struggle. The author discusses how asserting her subjectivity by playfully role-playing aspects of the patient, by spontaneously using humor, and by surviving her destructiveness allows the treatment to move forward. Trial and error, reflection on practice, and informed intuition contributed to the author's understanding of the child and of the transference. Various theoretical perspectives influenced the work.     

Rules? Role Model? Relationship? The Impact of Parents on Their Children’s Problematic Mobile Phone Involvement

Parents can influence their children’s problematic mobile phone involvement (PMPI) by engaging in parental mediation activities, such as restrictions or co-use, by being a role model, and by their general and domain-unspecific parenting style that facilitates more or less attachment security of the child. This study tested the associations between these different routes of influence—parental mediation of the mobile phone, parental PMPI, and secure child-parent attachment—with children’s PMPI. Data was acquired from a quota-sample survey with 500 children, between 8 and 14 years of age, and one of their parents. Results point to the importance of open and empathic parent-child-communication, as well as a positive relationship quality, and demonstrate the detrimental effects of parents’ own PMPI on children’s PMPI.     

Examination of the Eyberg Child Behavior Inventory Discrepancy Hypothesis

ABSTRACT

This study examined the Eyberg Child Behavior Inventory (ECBI) discrepancy hypothesis, which asserts that a discrepancy in score elevations on the ECBI Intensity and Problem Scales is related to problematic parenting styles. The Intensity Scale measures the frequency of child disruptive behavior, and the Problem Scale measures parent perception of their child's behavior as problematic. In a sample of 216 female caregivers of 3-to7-year-old children, the magnitude of discrepancy between T scores on the two ECBI scales was found to predict parental tolerance for child misbehavior. A one-standard-deviation difference in ECBI T scores identified (a) parents intolerant of their child's misbehavior when the Problem score was highest and (b) overly permissive parents when the Intensity score was highest.     

Managing boundaries under pressure: A qualitative study of therapists’ experiences of sexual attraction in therapy

Aim: To identify therapists’ views on sexual boundaries and the strategies they employ to manage them in therapeutic practice. Method: In‐depth qualitative interviews were conducted with a sample of 13 accredited, experienced practitioners of psychotherapy or counselling. A grounded theory approach, informed by principles from Free Association Narrative methodology, was employed, in which team members used debriefing sessions for extending depth of understanding of the interviews. Findings: There is consensus about boundaries at the extremes, but variability about fantasy, flirtation and touch. A core process was generated from accounts of successful management of sexual attraction. We identified four problematic ways of reacting to boundary pressure, each with potential to harm clients and therapy. Discussion: A participant‐observer stance was conceptualised as essential for managing threats to boundaries, consistent with the empathic stance. Minor boundary crossings were viewed by interviewees as both potential precursors of more serious transgressions, and as opportunities for understanding the client's difficulties. Implications for practice: These span training, accrediting organisations, supervision and therapy practice.     

Teaching beginning group therapists to incorporate a patient's empathic capacity in treatment planning

The author suggests that a focus on a patient's empathic capacity helps the supervision and teaching of beginning group therapists. The paper describes a promising working model to present in class or in supervision for assessing the level of empathic ability manifested by a prospective or current group member. In addition, ways of using this data for treatment planning are described and illustrated by a case example.     

Reaching Latino Families Through Pediatric Primary Care: Outcomes of the CANNE Parent Training Program

The lack of culturally adapted parenting programs for Latinos contributes to low engagement in effective parenting programs. Criando a Nuestros Niños Hacio el Éxito (CANNE), a culturally adapted program, improves family dynamics by decreasing problematic child behavior and helping parents manage stress. CANNE was delivered with 12 Latino parents of children (age 3–7). Increased attendance and participation resulted in less child behavior problems and parenting stress from preintervention to postintervention. A culturally relevant adaptation of an evidence-based parenting program improved engagement, child behavioral outcomes, and parenting stress. Implications of mental health services in primary care facilities for Latino families are addressed.     

Counseling Parents of Handicapped Children: An Empathic Approach

Counseling is often perceived as a process one reluctantly goes through when life's problems become too overwhelming to handle alone. One such situation frequently occurs when parents become aware that they have a handicapped child. Prescott and Hulnick hold that essentially all of life's experience, including parenting a handicapped child, can be perceived as an opportunity for personal growth. Given this orientation, the truly empathic counselor assists parents in learning the skills and attitudes needed to deal effectively with their child and to learn to transform their own pain into caring and love.     

Parent and child causal attributions during clinical interviews

Attributions made by children and their parents for the cause of the child's clinical problem were monitored during assessment interviews. Results support previously observed differences obtained through questionnaires, with parents making more attributions than their children to characteristics of the child. This pattern was affected by variations in interview format. Parents and children differed in the locus of their attributions when interviewed individually, but these differences were not present when families were interviewed with both parents and children present. Implications for the methodology of attribution research with child-clinical populations are highlighted.     

Some thoughts on the creation of the child psychotherapist's role in a major teaching hospital

Twenty-three children, aged four to eight years, who had been exposed to violent attacks, were videotaped in individual 40-minute play sessions. These play narratives were recorded by a student researcher trained in narrative analysis and play therapy. She then sorted these play vignettes into three patterns of post-traumatic play, defined in the Children's Play Therapy Instrument/Adaptation for Trauma Research (CPTI/ATR). The three patterns were re-enactment with soothing; re-enactment without soothing; and overwhelming re-enactment. Each pattern was analysed further by the student researcher and the two authors of the scale to specify in detail the qualitative features of each pattern. Factors leading to resilience are identified and the contribution of play activity to repair is discussed.     

The effectiveness of therapeutic assessment with an adult client: a single-case study using a time-series design

This article presents the therapeutic assessment (TA; Finn, 2007) of a traumatized young woman named Claire. Claire reported feeling debilitated by academic demands and the expectations of her parents, and was finding it nearly impossible to progress in her studies. She was also finding it difficult to develop and sustain intimate relationships. The emotional aspects of close relationships were extremely difficult for her and she routinely blamed herself for her struggles in this arena. The assessor utilized the TA model for adults, with the exception of not including an optional intervention session. The steps of TA, particularly the extended inquiry and the discussion of test findings along the way, cultivated a supportive and empathic atmosphere with Claire. By employing the single-case time-series experimental design used in previous TA studies (e.g., Smith, Handler, & Nash, 2010; Smith, Wolf, Handler, & Nash, 2009), the authors demonstrated that Claire experienced statistically significant improvement correlated with the onset of TA. Results indicated that participation in TA coincided with a positive shift in the trajectory of her reported symptoms and with recognizing the affection she held for others in her life. This case illustrates the successful application of case-based time-series methodology in the evaluation of an adult TA. The potential implications for future study are discussed.     

Filial Therapy With Incarcerated Fathers: Effects on Parental Acceptance of Child,Parental Stress,and Child Adjustment

The rationale for filial therapy is explored and the effectiveness of a 10-week filial therapy parent training group for incarcerated parents is described. Results of the analysis of covariance revealed that incarcerated fathers in the experimental group scored significantly higher after training than incarcerated fathers in the control group on both their attitude of acceptance and their empathic behavior toward their children. They also scored significantly lower than the control group fathers on level of stress related to parenting and identified child problem behaviors. In addition, t-test results showed that the self-concepts of the children of fathers in the experimental group increased significantly as a result of interactions with their fathers in structured filial play sessions.     

Emotional empathy and associated individual differences

Emotional empathic tendency is defined as an individual’s characteristic inclination to respond with emotions similar to those of others who are present. Within a three-dimensional framework for describing temperament, more empathic persons were found to be more arousable, and secondarily, more pleasant. Greater skin conductance and heart-rate responses of more empathic persons to emotional stimuli confirmed their greater arousability. Also, more empathic individuals were more emotional, evidenced by their greater tendency to weep. Males were found consistently to be less empathic than females. Compared with parents of low-empathy subjects, those of high-empathy subjects were found to spend more time with their children, display more affection for them, and to be verbally more explicit about feelings. Also, more emphatic mothers were more tolerant of infant cries and were less prone to engage in child abuse. High-empathy, compared with low-empathy, subjects engaged more in altruistic behaviors, were less aggressive, more affiliative, rated positive social traits as more important, scored higher on measures of moral judgment, and volunteered more to help others. A modified Emotional Empathic Tendency Scale (EETS) for children correlated negatively with teacher ratings of child aggressiveness.     

Coping in Families with a Retarded Child

The impact of a retarded child on a family has previously been described by individual family members' reports. This study of 40 families, 10 in each of four critical periods during the life of the retarded child, utilized videotaped interviews with whole families, with subsequent clinical observation and analysis based on the Beavers family assessment model. Healthy and problematic adaptations are delineated, with specific attention to systems concepts such as family structure and power, member individuation, feeling expression, and values. The report includes data analysis and a summary of pattern differences in family functioning.     

Bereavement and triangular relationships in a case of a child suffering from anorexia

This paper describes the mother–child assessment of a five-year-old girl suffering from anorexia since weaning, which was carried out in an Italian NHS neuropsychiatric child and adolescent unit. The author aims to show how she was able to link the little girl’s refusal of food to a death in the maternal family, which occurred soon after her birth. As well as this post-traumatic formulation, the author links the child’s anorexia to two related aspects of the family dynamics: avoidance of the awareness of death and the inability to manage triangular relationships, due to important intrusion and exclusion anxieties. Using extracts from the sessions, the author shows how the little girl was able to begin to work through the death phantasy which was previously inaccessible to her and her family. The concept of the death phantasy is defined and explored and possible analogies between this case and what is observed in some anorexic adolescent girls and their families are described.     

Support gaps in parent‐emerging adult dyads: The role of support quality

This study used a support gap approach to examine parental support to college‐going emerging adults. Based on data from 156 parent–child dyads, this study investigated whether discrepancies between the amounts of support that children received from parents and what they desired would be associated with both persons’ perceived support quality and individual and relational well‐being. Using polynomial regressions with response surface modeling, analyses demonstrated that, generally, support deficits (i.e., receiving less support than desired) were associated with poorer outcomes. However, support surpluses (i.e., receiving more support than desired) were not necessarily problematic, and children and parents exhibited different viewpoints regarding support surpluses. In addition, child‐reported support quality mediated several associations between support gaps and relationship satisfaction reported by both persons.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.