MOURNING THE LOSS BUILDS THE BOND: PRIMAL COMMUNICATION BETWEEN FOSTER,ADOPTIVE, OR STEPMOTHER AND CHILD

In this article, a particular source for the gifts and agonies of non-biological mothering bonds will be examined, namely the losses both mother and child bring to the new bond-building endeavor. As many women choose non-biological parenting because they are unable to have children of their own, the degree to which they grieve their loss is a factor in their capacity to fully attach with foster, step or adoptive children. On the other side of the connection, many agonies that mothers endure result from the use of projective identification by the child to communicate the devastating feelings due to losses experienced prior to engaging with this new caretaker. The child, too, needs to make peace with these losses, to have them acknowledged so that s/he can move on to new developmental pains and gains. On neither side of the interaction can the attachment process be taken for granted: both mother and child have to work at belonging to one another. Often the feelings which permeate the intersubjective space between mother and newly-claimed child seem like insurmountable obstacles because of their unconscious, primitive or preverbal nature.The mother may be called upon to contain and bear witness to the child's profound distress, which can undermine her confidence as a mother. Similarly the child may be subject to the mother's unconscious fantasies about the child she wished she'd had, and experience the futility of living up to such expectations.This piece is an attempt to delineate the pitfalls, due to not-yet-mourned losses, on the way to mutual recognition on the part of mother and child in non-biological bonds.     

On the vicissitudes of early primary surrogate mothering II: loss of the surrogate mother and arrest of mourning

Among the catastrophic events experienced by infants and young children, one of the most frequent is the loss of an early primary surrogate mother (EPSM). Usually permanent, the loss is often followed by the advent of a new, "replacement" caregiver. One aspect of the emotional environment is unique to this kind of caregiving situation: that parents are often unable to validate the true nature of their child's relationship with the EPSM or, ultimately, the trauma experienced by the child when the EPSM leaves. The marked discrepancy between the parent's and the infant or child's experience of the surrogate mothering leads to an arrest of the child's mourning process, with the potential for serious developmental consequences. Issues related to EPSM loss and its aftermath are examined in the light of two examples. Further exploration of the environment of this kind of caregiving directs attention to the critical need to nurture and protect the attachments of both the infant or child and the parent to the ESPM.     

Being “Psychologically Held”: Separation and Reparation in the Parent-Child Relationship

In the context of child development, this article proposes that “asynchrony,” or brief separation from an attachment figure, is necessary for optimal, emotional growth toward attachment security. Emotional growth is seen as occurring through asynchrony and the repair process that follows. The authors propose to explore the notion of asynychrony in the context of emotional regulation and attachment theory and to relate it to the repair process. Furthermore, the authors plan to understand the possible effects of a lack of asynchrony as well as a loss of the repair process in the context of development. A child's capacity to experience asynchrony changes with development. A caregiver needs to maintain a balance between providing a holding environment and allowing a child to experience asynchrony in a developmentally appropriate way. The authors will address the role of the caregiver in the context of asynchrony and the repair process.     

Family,friend, and neighbour child care providers and maternal well‐being in low‐income systems: An ecological social perspective

Integrating theory from the family ecological systems and social support literatures with findings from child care research, in this study we develop and test a model relating family, friend, and neighbour (FFN) child care provider characteristics to perceived child care quality (provider reports of caregiving behaviours, mother‐provider caregiving relationship) and maternal well‐being (work‐family conflict, depressive symptoms). Results from phone interviews with 187 FFN providers receiving public subsidies indicated that even after controlling for familial status or household income, caregiver perceptions of higher quality care were associated with higher education levels, greater attachment to child care as a job; and lower provider depressive symptoms. After controlling for familial status, data analysed from a subset of 51 mother‐provider pairs, indicated that mothers using care from providers who reported higher quality parent‐caregiver social relationships reported lower work‐family conflict and depressive symptoms. This study suggests mothers who have providers with whom they have good caregiving interactions may experience positive social support and psychological crossover dynamics associated with mother well‐being.     

Youth Mental Illness and the Family: Parents’ Loss and Grief

Parents and family members whose adult child or relative has a mental illness endure significant losses, to which they respond with grief. Such grief may negatively affect family members’ physical and psychological health and also the relationship with their relative. Yet, research in this field is sparse. Very few studies have examined parents’ loss and grief in the context of the patient being a child or teen. It is not clear the extent to which parents’ loss and grief in response to their child or adolescent’s mental illness is similar or different to the accounts of older parents and family members caring for an adult relative with major psychopathology (e.g., Schizophrenia, Bipolar disorder). Parental loss and grief is not often addressed in child and adolescent mental health services’ provision of care; alarmingly, little is known about how best to support parents who access these services. The present study aimed to bridge this knowledge gap and identify the therapeutic needs of this younger parent population. Comprehensive interviews were conducted with 14 parents and one custodial grandparent of a youth aged 18 years or younger who was currently attending a child and adolescent mental health service. An inductive thematic analysis identified six themes; parents’ narrative of finding out, profound and pervasive loss, complex grief, waning support, the challenges of caregiving and a call for assistance. It can be inferred from these results that youth mental illness can constitute a source of loss and grief for parents. Participants’ loss and grief was largely consistent with the experience of families caring for an adult relative with major psychopathology. Opportunities for mental health practitioners to support families’ loss and grief were identified. Further studies are needed to enhance understanding of this complex and, to a large extent, ignored familial experience. Results do underscore the importance of clinicians acknowledging parents’ loss and grief and working directly with this experience over the course of youths’ treatment, perhaps in conjunction with family psychoeducation approaches.     

Parental Loss During Childhood and Outcomes on Adolescents’ Psychological Profiles: A Longitudinal Study

The loss of a parent during childhood is a traumatic experience that can bring about several difficulties in adaptation and psychopathological problems over time during the child’s development. The present study assesses the psychological functioning of a sample of non-referred pre-adolescents and adolescents and considers the impact of the loss of a significant caregiver on their current psychological profiles. Three groups of subjects were considered, as follows: Group A experienced loss between birth and 3 years of age; Group B experienced loss between 3 and 10 years of age; and Group C experienced no loss. The results show that there is a significant decrease in psychopathological risk and improvement in subjects’ scores in the transition from pre-adolescence to mid-late adolescence. Adolescents who have suffered the loss of a caregiver within the first three years of life, however, continue to report higher scores than the other two groups, denoting no improvement in their psychological welfare.     

Attachment and borderline personality disorder

The author outlines his concept of reflective function or mentalization, which is defined as the capacity to think about mental states in oneself and in others. He presents evidence to suggest that the capacity for reflective awareness in a child's caregiver increases the likelihood of the child's secure attachment, which in turn facilitates the development of mentalization in the child. He proposes that a secure attachment relationship offers the child a chance to explore the mind of the caregiver, and in this way to learn about minds; he formulates this model of the birth of the psychological self as a variation on the Cartesian cogito: "My caregiver thinks of me as thinking and therefore I exist as a thinker." This model is then applied to provide insight into some personality-disordered individuals who were victims of childhood abuse. The author proposes (1) that individuals who experience early trauma may defensively inhibit their capacity to mentalize to avoid having to think about their caregiver's wish to harm them; and (2) that some characteristics of severe borderline personality disorder may be rooted in developmental pathology associated with this inhibition. He offers evidence for and some qualifications of this model, and argues that the therapeutic effect of psychoanalysis depends on its capacity to activate patients' ability to evolve an awareness of mental states and thus find meaning in their own and other people's behavior.     

Assessment as Intervention: A Pilot Study of Short-Term Dyadic Treatment

Assessment, as an intervention, is a hallmark of infant mental health that has not been evaluated for treatment effectiveness. A comprehensive assessment framework was standardized as a short-term intervention model and evaluated for treatment effects based on dynamic systems theory of change. The transdisciplinary interaction-based assessment model embeds nondidactic developmental guidance interpretations in the context of eliciting child functional capacities while engaging the caregiver in direct co-observation and reflection to challenge inflexibility in parents’ representations. The findings of this pilot project, with a community sample of Spanish- and English-speaking families, suggest this assessment as intervention model has the potential to promote an active process of change in parents’ representations toward a “disorderly,” or unstable state, possibly both in perceptions of self as caregiver and in representations of the child. Clinically, this disorderly state would be seen as an opportunity that could perpetuate the change process, recognizing disorderliness of representation as an opening, as emerging permeability of representations. Results indicate that this caregiver-clinician collaborative process is associated with caregiver reports of decreased distress, increased empathy for child’s difficulties, and changes in caregiver representations. A subset of families, caregivers who hold immutable views of their children, are less responsive to the developmental guidance approach and may require different or more long-term treatment.     

On Traumatically Skewed Intersubjectivity

ABSTRACT

Beginning with his Interpersonal World of the Infant (1985), Daniel Stern suggested that the infant is driven from birth to connect intersubjectively with his caregivers. By the final three months of the first year of life, as the infant begins to use protodeclarative pointing and jointly attends to the outer world, he also begins to jointly attend with his caregiver to their respective intrapsychic worlds, the mental states of his caregiver and himself. Clinically, analysts observe at this crucial point of development of secondary intersubjectivity mothers who, more often than not, respond only selectively and often unpredictably to their infants. In many instances, this may be motivated out of a mother’s own need for regulation of emotion and arousal as we have shown in our empirical research. This article elaborates on clinical observations that, for the infant or young child to feel his traumatized mother’s affective presence, he must try to enter mother’s state of mind, while simultaneously, mother is seeking to self-regulate in the wake or the revival of trauma-associated memory traces, this at the expense of mutual regulation of emotion and arousal. We call this phenomenon traumatically skewed intersubjectivity. We find that children coconstruct with their traumatized mothers a new, shared traumatic experience by virtue of the toddler’s efforts to share an intersubjective experience with a mother who is acting in response to posttraumatic reexperiencing. The problem is that the infant or young child has no point of reference to decipher the traumatized mother’s social communication. And so, what is enacted leads to a new, shared traumatic event. Both the child’s anxiety and aggression can, in this setting, easily become dysregulated, further triggering mother’s anxiety and avoidance, leading thus to a vicious cycle that contributes to intergenerational transmission of trauma. Clinical examples and implications for psychoanalytically-oriented parent-infant psychotherapy will be discussed.     

Sartre,Developmental Psychology and Burgeoning Self-Awareness: Ricocheting from Being to Nothingness

While the genesis of self-awareness at approximately 18 months old is a dramatic landmark in human development, there is at this stage no explicit awareness on the toddler's part of his/her truly standing apart from others. Only much later does a distinct sense of self shift into focus, and here Sartre provides us with a compelling theory of a first reflective experience of self-awareness. He explains this phenomenon by emphasizing a violent shift in ontological status, one in which the pre-adolescent child is precipitated from functional unity with a primary caregiver to an individuated state involving self-awareness as privative, i.e. where the child becomes aware of existing only in the form of not-being-the-adult. For Sartre this new experience of self is not therefore positive but rather formal or empty; there has in fact been a psychic transition, from being to nothingness. In addition, Sartre also states that all children first explicitly experience themselves in this fashion. These claims find support in the work of developmental psychologist Margaret Mahler. In fact, in spite of the vast developmental discrepancies between toddler and pre-adolescent child, given the appropriate environmental triggers privative subjectivity will be shown to involve a regression to the much earlier rapprochement stage of development described by Mahler.     

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.     

Terminations

Whether the person leaving the group is a group member or a group therapist, the basic dynamics of separation are the same, involving the separation process as well as mourning. Terminations evoke ambivalent feelings of both separation-pain and hope. Group members and the departing person experience a loss, which reminds them of other losses, and the departing person (group member or therapist) may also experience some guilt. Any termination will have an effect on the-group-as-a-whole, as well as on the individual members, and must be dealt with prior to the actual leaving, as well as after the termination.     

Considering the role of early discrimination experiences and the parent–child relationship in the development of disruptive behaviors in adolescence

Discrimination has been shown to be related to diminished psychological adjustment and greater risk for substance use when personally experienced by adolescents and when their caregivers experience discrimination. Our research considers the impact of primary caregiver experiences of racial- and socioeconomic-based discrimination in early (age 3–5 years) and late childhood (age 9½) on adolescent disruptive behaviors (age 14) with a large sample of diverse caregiver–child dyads (N = 634). In addition, we examine the potential protective effects of parent–child relationship quality in early and late childhood in buffering the effects of caregiver discrimination on adolescent disruptive behaviors. We also explore possible gender differences in children's vulnerability to engage in disruptive behaviors in the context of caregiver experiences of discrimination. The findings from this study indicate that at trend level, early childhood experiences of primary caregiver discrimination (ages 3–5) predicted adolescent disruptive behaviors, accounting for the effects of more recent (age 9½) caregiver discrimination. In addition, parent–child relationship quality at age 9½ years was found to buffer the effects of late childhood (age 9½) primary caregiver discrimination on adolescent disruptive behaviors for both male and female youth. The findings highlight the need for prevention and intervention techniques that foster healthy and positive primary caregiver–child relationships.     

The role of transitions to new age groups in the development of institutionalized children

Children in two institutions in St. Petersburg (Russian Federation) experienced ward transitions, one in which caregivers were trained to provide sensitive, responsive caregiving and one that conducted business as usual. A third institution eliminated transitions, received the same training, and implemented a variety of structural and employment changes designed to promote improved caregiver–child interactions and relationships. While the no‐transition comprehensive intervention group of children steadily improved in Battelle Developmental Inventory (LINC Associates, 1988 ) scores across all age intervals, the children in the institution who encouraged some positive caregiver–child interactions improved before and after, but not during, an age period that involved a transition. In contrast, the no‐treatment group displayed no developmental changes across any age period with or without a transition. These results suggest that the common institutional practice of ward transitions to new peers and caregivers is potentially disruptive to infants' and toddlers' general development, but primarily in a context in which some degree of caregiver–child sensitive and responsive interactions are encouraged.     

THE ROLE OF CARDIAC REHABILITATION IN DEALING WITH PSYCHOLOGICAL LOSS AMONG SURVIVORS OF A CARDIAC EVENT

The aim of the current study was to examine the experiences of cardiac rehabilitation (CR) patients within the framework of psychological loss. All participants in this study reported experiencing losses of some nature, some of which were tangible and others less so. However, these do not appear to be strictly independent from each other in that tangible losses, such as loss of income, were underpinned by intangible losses, such as loss of self-esteem. For CR patients, it seems that the losses reported are experienced at more than one level.The first is an externally visible and objectively quantifiable level (for example, loss of occupation) , whereas the second is a more symbolic, phenomenologically based level (for example, loss of purpose as previously defined through one's occupational role). The CR program examined in this study helped patients to effectively deal with these losses and to experience additional developmental gain.     

Caregiver Behaviors and Child Distress in Trauma Narration and Processing Sessions of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective treatment for children impacted by trauma, and non-offending caregivers play an important role in this treatment. This study aims to identify correlates of four caregiver variables that have been identified as predictors of child outcomes in TF-CBT: support, cognitive-emotional processing, avoidance, and blame/criticism. Audio recorded sessions were coded from a community effectiveness trial of TF-CBT that included 71 child-caregiver dyads participating in the trauma narration and processing phase of treatment. Regression analyses were conducted to examine caregiver trauma history and child baseline symptoms (internalizing, externalizing, and posttraumatic stress disorder [PTSD] symptoms) as predictors of caregiver behavior during the trauma processing sessions. Caregivers who reported exposure to more trauma types exhibited more in-session avoidance and also processing during the trauma processing phase of treatment. Child symptoms at baseline did not predict caregiver in-session behaviors. Bivariate correlations were used to investigate concurrent associations between mean levels of in-session caregiver behaviors and in-session child distress (negative emotion, hopelessness, negative behaviors). More caregiver blame/criticism was associated with more in-session child distress on all three measures. Caregiver avoidance was associated with more child negative emotion and hopelessness. Findings may help identify therapeutic targets when working with caregivers to promote change and enhance TF-CBT outcomes.     

Adult Children’s Caregiver Burden and Depression: The Moderating Roles of Parent–Child Relationship Satisfaction and Feedback from Others

The issue of elderly care has generated great interest because today, most of us live in an aging society. It has been found that caring for one’s elderly parents is a stressful experience that is related to negative outcomes. In addition, accompanied with the decline in fertility may make adult children feel heavier caregiver’s burden. Therefore, the current study investigates moderators that may help reduce the caregiver burden. Following the conservation of resources theory (COR), we hypothesized that feedback from others and a good parent–child relationship serve as resources that may help the individual manage the stress associated with caring for his or her elderly parents. To examine our hypotheses, we collected data from 502 adult children who were primary caregivers for their elderly parents. All participants completed the Burden Assessment Scale (BAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Feedback from Others Scale, and the Parent–Child Relationship Satisfaction Scale. Supporting our prediction, we found a positive correlation between the caregiver’s burden and the caregiver’s levels of depression. Furthermore, both moderation effects were significant. Consistent with our hypotheses, the relationship between caregiver burden and his or her level of depression was weaker when participants had high feedback from others or had a better parent–child relationship. Our findings highlight the view that possessing more resources may help the individual manage the stress associated with caring for elderly parents. Implications for issues related to elderly care are discussed.     

Grief and mourning reactions following abortion and miscarriage

Abstract

The loss of an unborn child, like the loss of a child through death, may cause both normal and pathological grief reactions. This paper explores the current research of psychological reactions following induced and spontaneous (miscarriage) abortions. Examples of studies wherein reserachers have, based their understanding of the experience on a loss model are provided. Possible reasons for the apparent inattention to grief reactions following this type of loss are explored. An alternative model based on loss and acknowledging social, political, and interpersonal stigmas is offered. Although these findings do not suggest that abortions should be made unavailable, they demonstrate a need for alertness to possible negative psychological sequelae as well as possible negative physical sequelae.     

A caregiver–child socioemotional and relationship rating scale

This article reports the construction and pilot reliability, validity, and psychometric properties of a new caregiver–child rating scale that emphasizes caregiver–child socioemotional interactions and relationships. While the scale was developed and studied in orphanages for young children, it potentially could be used in nonresidential early care and education settings as well as for parent–child interactions in the home. The intent was to assess a few dimensions that comprehensively cover the range of caregiver–child socioemotional interactions and relationships, by means of a scale that could be administered in a relatively short time period in a variety of situations and would not require extensive coder training, manuals, or materials. Results showed that the scale can be reliably administered even using observation periods as short as 5 min, that inter‐rater reliability was acceptable (based on data from two raters working in two orphanages, and five raters working in another), and that ratings of caregivers were similar across different types of caregiving activities (i.e., feeding, dressing/bathing, free play) and for caregivers attending to children birth to 4 and 4 to 8 years of age. In the orphanage context, factor analyses showed that the scale primarily reflects caregiver–child mutual engagement and relationship with subordinate components of caregiver punitiveness and caregiver‐ versus child‐directed behaviors and intrusiveness.     

Biopsychosocial Factors Associated with Parenting Stress in Pediatric Sickle Cell Disease

Caregivers of children with sickle cell disease (SCD) experience significant physical and emotional hardship with their child’s disease management. Little is known about the potential contributors to parenting stress in pediatric SCD. The present study aimed to identify child and caregiver biopsychosocial factors associated with disease-related parenting stress in pediatric SCD. Participants included 74 caregiver-youth dyads. Parenting stress was associated with increased child pain frequency, more missed school days, and increased healthcare utilization, and inversely correlated with caregiver mental health and social-emotional functioning. Parenting stress also partially explained the relationship between child pain frequency and healthcare utilization after controlling for parent depression and anxiety. Parenting stress may play a unique and critical role in pediatric SCD and underscore the impact parenting stress may have on youth in medical and academic settings. Further research is warranted to determine risk factors and appropriate interventions for parenting stress to improve comprehensive patient care.