Increasing Family Members' Appreciation of Family Caregiving Stress

Participants read a message discussing the duties of a typical family caregiver (for example, a woman taking care of her elderly mother) and the associated psychological, physical, social, and financial stresses. The message was accompanied by an appeal that was either a control or was altruistic (other-oriented: focusing on the mother/caregiver's well-being) or egoistic (self-oriented: focusing on the child of the caregiver's needs and feelings). Participants who received an altruistic appeal were more appreciative of caregiving stresses than were those given an egoistic or a control appeal. Increasing family members' awareness of the stress involved in family caregiving is a first step in encouraging them to personally intervene on behalf of the caregiver.     

Assessing the social behavior of infants: Use of the ADBB Scale and relationship to mother's mood

Infants can show a range of social behavior when interacting with their main caregiver. Previous work has demonstrated that when the caregiver is depressed, the infant may demonstrate withdrawn behavior not only to this person but also to others. This pilot study used a relatively new assessment tool, the Alarme Distress de Bebe Scale (ADBB; Guedeney and Fermanian, 2001), to assess the social behavior of 44 infants during a routine physical checkup. Results indicated that withdrawn infant social behavior to the clinician was related to the mother's report of whether she had felt more irritable, sad, anxious, or depressed since the birth, but not to her current mood as rated by her score on the Edinburgh Postnatal Depression Scale (Cox, Holden & Sagovsky, 1987). The psychometric properties of the ADBB also were explored. The findings are further evidence for the need to screen for mood difficulties in women with infants not just by focusing on a woman's current mood but also her mood since the infant's birth.     

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.     

Compathy or Physical Empathy: Implications for the Caregiver Relationship

In this article a case is made for the importance of a previously overlooked phenomenon, physical empathy orcompathy,defined as the physical manifestation of caregiver distress that occurs in the presence of a patient in physical pain or distress. According to the similarity of a caregiver's response to the original symptoms, there can be four types of compathetic response: identical, initiated, transferred, and converted. Controlling for the compathetic response may involve narrowing one's focus and/or changing caregiver attitudes. Finally, we argue that while the compathetic response may be beneficial to the caregiving relationship, enabling the provision of appropriate and adequate humane treatment and care, the caregiver must at times shield against the compathetic response in order to provide care.     

Longitudinal changes in term and preterm infant night wakings: The role of caregiver anxious-depression

Changes in infant night waking during the first year of life are associated with individual (e.g., prematurity) and family (e.g., caregiver psychopathology) factors. This study examined the association between infant night waking and caregiver anxious-depressive symptoms during the first year of life in preterm and term infants. We considered between-person differences and within-person changes in caregiver anxious-depressive symptoms in relation to changes in infant night waking from 2- to 9-months. Racially (30.0% Black, 60.4% White, 9.5% multiracial/other) and socioeconomically (40.0% below median household income) diverse caregivers (N = 445) of full term (n = 258) and preterm (n = 187) infants were recruited from hospitals and clinics in two midwestern states. Caregivers completed measures of anxious-depression and their infant's night waking at four sampling periods (2-, 4-, 6-, and 9-months). Infant night wakings declined from 2- to 9-months. Between-person differences were observed, such that caregivers with higher average anxious-depressive symptoms or infants born full term reported more night wakings. Within-person effects of caregiver anxious-depressive symptoms were not significant. Caregiver anxious-depression is closely associated with infant night wakings. By considering a caregiver's average severity of anxious-depression, healthcare providers can more effectively plan infant sleep interventions. If caregiver anxious-depressive symptoms are ameliorated, night wakings may also decrease.     

Discussion of care,contribution, and perceived (in)gratitude in the family caregiver and sibling relationship

This qualitative analysis focuses on the discussion of care, division of labor, and perceptions of gratitude and ingratitude between an adult primary caregiver of an elderly parent and his or her sibling(s). Interviews with 20 caregivers addressed the following questions: When do caregivers feel appreciated or unappreciated by siblings? How do siblings communicate that appreciation? How does gratitude influence the experience of caregiving and family relationships during caregiving? Findings revealed that gratitude was manifested through verbal and behavioral expressions, with antithetical communication that left the caregiver feeling unappreciated. Verbal expressions of gratitude included a simple “thank you,” thanks for what the caregiver does, and for who the caregiver is. The inverse of these expressions included neglecting to say “thank you,” failing to identify the extent of the caregiver's work, and communicating criticism. Behavioral expressions took the form of following through on promises, and failing to do so presented as ingratitude.     

The early appearance and intergenerational transmission of maternal traumatic experiences in the context of mother-infant interaction

The paper describes the case of a girl of 8 weeks, referred by her mother because of 'intolerable hysterical attacks' triggering maternal impulses of abuse. Maternal perception of her infant was distorted to the extent that the mother was re-experiencing encounters with her own intrusive and traumatizing mother in the face of her screaming child. She also perceived the infant's motor impulses as physical attacks on herself and expressed intense anxieties about her daughter's future aggressive potential. The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infantile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by employing a rigid scheme of rules and obsessively controlling the father's and grandmother's interaction with the child. The mother feared being overwhelmed by the infant's needs if she were to yield to them in a flexible way. The mother's background of early neglect and trauma is described, in the light of recent literature about the early intergenerational transmission of traumatic experiences, in order to demonstrate possible treatment modalities and the need to consider both protective and risk factors.     

Infants' responses to mothers' imitative behaviors

Several investigators have suggested that young infants' smiles and vocalizations following their mothers' imitative behaviors might reflect infant recognition that the mother's behavior is imitative or at least contingent. This study investigated whether infants smile and vocalize more frequently subsequent to maternal imitative than non-imitative behavior during both spontaneous and imitative face-to-face interactions. Fourteen 3 1/2-month-old infants and their mothers were videotaped in these two face-to-face interaction situations. The infants vocalized more frequently during the imitative situation and infant vocalizations plus simultaneous smiling, and vocalizations occurred more often following maternal imitative than non-imitative behavior. Although these data suggest that infant vocalizations and simultaneous smiles and vocalizations may reflect the infants' recognition of maternal imitative behavior, they do not establish definitively that it is the imitation per se vs. the contingency aspect that is recognized by the infant.     

Discussion of Presentation by Joseph Newirth

Discussing Joseph Newirth's case from a modern Freudian perspective, I explore possible sources of the patient's degraded view of herself, her ambivalent feelings toward men, and her fears of sexuality. I also discuss the course of the treatment, noting that both the patient's progress and the core of her resistance centers on her complex relationship with her analyst. This has been the source of healing and of avoidance of her inner world of imagination and fantasy. I further suggest that active confrontation of the patient's defensive use of her relationship with her analyst would enhance the substantial gains that she has already made.     

Mind the baby: The role of the nanny in infant observation

The influence of nannies and other significant caregivers on a child's psychological and emotional development may be profound and if unrecognized may contribute to psychopathology in adulthood. However, the significance of the nanny has been relatively neglected within the psychoanalytic literature. In this paper I will discuss the impact of early caregivers other than the biological mother on the psychic development of the child, and the role of the nanny within the family dynamics as a figure attracting powerful unconscious phantasies and unwanted projections. These ideas will be illustrated by a detailed account of a year‐long observation of an infant who had a succession of several different nannies in her first three months before her parents employed a more permanent nanny. It is proposed that the baby's emerging attachments to her two primary caregivers, mother and nanny, developed in parallel and influenced each other, with observable impact on her behaviour and developing personality. The paper concludes with a review of the place of infant observation within psychoanalytic training and how the experience of witnessing the earliest infant‐caregiver relationships in an extra‐analytic setting both refines understanding of developmental theory and builds a foundation for psychoanalytic practice.     

Identifications Annealed,Adhesive and Political: Commentary on Paper by Nina Farhi

Farhi's fascinating paper pays tribute to and extends those segments of Milner's clinical work that Milner hesitated to theorize explicitly herself. Seeking to understand the latter, I trace psychoanalytic politics in general and the history of Milner's relationships with Winnicott, Klein, and Riviere in particular to explore how her dutiful compliance to the rigid taxonomy of psychoanalytic power of her time bore on the trajectory of her becoming an analyst with a mind of her own. It is in accounting for how she struggled to disentangle herself from that web, that we discover how Milner was able to creatively refashion her work with her patient Susan, a process by which Susan was greatly impacted.

Following the trail of Farhi's ideas around this process and considering her thoughts around their psychic meanings for both analyst and patient, I explore their clinical implications. I focus on the transferential iterations of these dynamics to consider Farhi's suggestion that an annealed bond needs to be established in the treatment of patients who have, early in life, failed to develop annealed identifications. This opens up questions around how such bonds can malignantly colonize the analyst's mind and psychic reality, raises questions of self-care in the analyst and contributes to prognostically anticipating certain sets of enactments in the course of long-term psychoanalyses.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

On the Existence of Duties to the Self (and Their Significance for Moral Philosophy)

Contemporary philosophers generally ignore the topic of duties to the self. I contend that they are mistaken to do so. The question of whether there are such duties, I argue, is of genuine significance when constructing theories of practical reasoning and moral psychology. In this essay, I show that much of the potential importance of duties to the self stems from what has been called the “second‐personal” character of moral duties—the fact that the performance of a duty is “owed to” someone. But this is problematic, as there is reason to doubt whether a person can genuinely owe to herself the performance of an action. Responding to this worry, I show that temporal divisions within an agent's life enable her to relate to herself second‐personally, in the way required by morality. The upshots, I argue, are that we need an intra‐personal theory of justice that specifies the extent of a person's authority over herself, and that we need to rethink our theories of moral emotions in order to specify how an individual ought to respond to attacks on her interests and autonomy that she herself perpetrates.     

The Impact of Insecure Attachment on Mothering: A New Mother’s Story

This article describes the treatment of a first-time mother and her daughter. The mother’s impoverished primary relationships and the fragility of her early attachments contribute to her challenges with motherhood. Through parent-infant treatment she is gradually developing the capacity to reflect upon her experience and beginning to make discoveries about her attitudes toward herself and others. My work with Leslie has deepened my appreciation for Daniel Stern’s notion of “the motherhood constellation” and for the power of insecure attachment to destabilize the parent and consequently the parent-child relationship. During the treatment, I used the Newborn Behavioral Observations system as an adjunct to therapy to help demonstrate to this distressed new mother her infant’s competencies. Later, I also used the Adult Attachment Interview to enhance her curiosity about her own childhood, and in particular her relationship to her mother and the impact of that relationship on her own mothering.     

Maternal intrusion: Its roots and consequences

Abstract

Behind an intrusive mother’s view of her actual child lies a disproportionate, hidden desire to revive an ideal relationship with a perfect mother. The resulting image of an idealized child then becomes a strategic aspect of the mother’s own identity, representing an idealized figure from her own past. As the mother’s idealization is disturbed by the reality of the child, the mother experiences the situation between herself and the baby as “pathological,” that is, disruptive to her. She then attempts to repair the idealization by resisting any change in the status of her relationship to her child, even as the child grows older. Her rigidity in this regard necessarily excludes a paternal presence that could challenge or change the mother–infant idealized dyad. The mother’s orientation is also contradictory to, and acts as a resistance to, psychoanalytic therapeutic interventions, which aim at any “change.”     

Thinking about and working with depressed mothers in the early months of their infant's life

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the     

My father,Herbert Rosenfeld

Abstract

This is the modified version of the powerpoint that Angela Rosenfeld, the elder daughter of Herbert Rosenfeld (1910–1986) – one of Melanie Klein's most important collaborators – presented in Nuremberg, his native town, on October 5, 2014, upon the invitation of the German Psychoanalytic Society (DPG). In it, Angela Rosenfeld reconstructs not only her father's main life events, but also her personal relationship to him and the family climate in which she grew up. The traumas brought about by Hitler's rise to power in 1933 are partly still reflected in the holes and/or open questions that the author herself became aware of while writing and presenting the paper – and which profoundly touched and moved her audience.     

On Becoming One-Self: Reflections on the Concept of Integration as Seen Through a Case of Dissociative Identity Disorder

This paper explores the concept of “integration” as it relates to the development of self-awareness and the recognition that one exists as a self. It is argued that this awareness relies on a capacity for self-reflection which is intimately tied to the ability to locate oneself in time and in space. Through the presentation of a patient with Dissociative Identity Disorder, the author demonstrates how the development of the patient's consciousness of self progressed through the treatment and particularly, through the relationship between analyst and patient. In the case presented, the patient began treatment unaware of her dissociative structure. She was also unaware of the continuity of time, including the concepts of past, present, and future as they related to herself, and to the fact that she existed in a body that was subject to the basic laws of physics such as being able to be in only one place at one time. Through the development of a self-reflective capacity and a growing familiarity with the various aspects of herself, the patient began to develop a sense of herself as a continuous entity physically, psychologically and spiritually.     

Contacting a 19 month‐old mute autistic girl: A clinical narrative

Conveying that psychoanalysis offers rich opportunities for the very early treatment of autistic spectrum disorders, this clinical communication unfolds the clinical process of a 19 month‐old ‘shell‐type’ encapsulated mute autistic girl. It details how, in a four‐weekly‐sessions schedule, infant Lila evolved within two years from being emotionally out‐of‐contact to the affective aliveness of oedipal involvement. Following Frances Tustin's emphasis on the analyst's ‘quality of attention’ and Justin Call's advice that in baby–mother interaction the infant is the initiator and the mother is the follower, it is described how the analyst must, amid excruciating non‐response, even‐mindedly sustain her attention in order to meet the child half‐way at those infrequent points where flickers of initiative on her side are adumbrated. This helps attain evanescent ‘moments of contact’ which coalesce later into ‘moments of sharing’, eventually leading to acknowledgment of the analyst's humanness and a receptiveness for to‐and‐fro communication. Thus the ‘primal dialogue’ (Spitz) is reawakened and, by experiencing herself in the mirror of the analyst, the child's sense of I‐ness is reinstated. As evinced by the literature, the mainstream stance rests on systematic early interpretation of the transference, which has in our view strongly deterred progress in the psychoanalytic treatment of autistic spectrum disorders.     

Child and Caregiver Dropout in Child Psychotherapy for Trauma

This study focused on the identification of variables collected at baseline assessments that predict children and caregivers who are at risk for dropout from treatment. A sample of 115 children and their caregivers who received evidence-based treatment for traumatic stress was utilized for this study. Multinomial logistic regression analyses indicated that caregiver and child age, the child's externalizing behaviors, and the child and caregiver's acknowledgment of posttraumatic stress symptoms significantly predicted premature dropout from treatment. Clarification of child and caregiver characteristics that increase the risk of dropout allows for the identification of families in need of additional support to stay in treatment.