A Review of “Mind to Mind: Infant Research,Neuroscience, and Psychoanalysis”

Abstract

This article examines current research pertaining to the relationship between a mother and her children, and how this relationship may affect sibling interactions. Issues such as temperament, gender, and the age gap between children are also explored to ascertain their impact on the sibling relationship.

The displacement of the first-born child and the ensuing sense of loss and anger he may experience as a result of this is explored. The mother's second pregnancy is also discussed in regard to the impact of unresolved issues relating to her own sibling relations. The mother's interactions with each child, her role as a model for identification, and marital relations are discussed in light of their impact on sibling relations.

The evolution of a positive attachment between siblings is explored. Rivalrous behavior between siblings is also discussed, particularly in association to the mother's treatment of her own children and the manner in which the mother deals with her own aggression.     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.     

The Play Relationship and the Therapeutic Alliance

Abstract

This article examines the function of play in normal development and within the treatment relationship in both child and adult psychotherapy. Noting its developmental function and the natural role that play has as a mode of communication with children, the author emphasizes the centrality of play in the construction of the therapeutic alliance. The therapeutic alliance is characterized here as a libidinal attachment, a new object relationship through which developmental experiences involving play may be revivified and, ultimately, may lead to the forging of more enduring and successful adaptations. Two detailed clinical vignettes furnish illustrations of the ways in which play themes and scenarios develop in therapy, and how their association to the therapeutic alliance and transference relationship may be understood and interpreted.     

Intertraumatic Dissociative Attachment

SUMMARY

This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years.

This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.     

The associations between adult attachment,posttraumatic symptoms,and posttraumatic growth

Background and Objectives: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. Design: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. Methods: The sample comprised 393 university staff and students (Range_Age= 18–49, 85% females) who completed online measures. Results: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. Conclusions: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.     

Operational Sequence in Group Therapy with Young Offenders

Abstract

Attachment has increasingly been identified as central to therapy process and outcome. Attachment theory proposes that an individual’s prior interactions with attachment figures develop into templates that will guide the way they form connections and perceive their relationships with others. This study examined clients’ ratings of their relationship with the therapist as well as their ratings of group climate at multiple discrete points during treatment. These variables were examined in relation to attachment classification prior to therapy. Participants were 62 women attending the Women Recovering from Abuse Program (WRAP), a primarily group-based day-treatment program for childhood interpersonal trauma, at Women’s College Hospital in Toronto, Ontario, Canada. Results demonstrated that clients’ perceptions of relationships in group therapy varied as a function of attachment classification.     

Psychodynamic Group Therapy with Hispanic Migrants: Interpersonal,Relational Constructs in Treating Complex Trauma,Dissociation, and Enactments

ABSTRACT

This article introduces an interpersonal, relational approach to group therapy for Hispanic migrants with significant histories of violence, abuse, multiple losses, and recurrent trauma. Psychodynamic group psychotherapy may help to address trauma symptoms, insecure/disorganized attachment, grief, and isolation with newly arrived migrants. How the relational paradigm in group psychotherapy is contributing to current theories of complex trauma and dissociation is reviewed. Using this modality conveys the importance of examining trauma-driven enactments, dissociation and symbolization involving the members of the group, the group-as-a-whole, and the group leader. Clinical examples and group therapy interventions used to address powerful dissociative enactments are discussed.     

A Child With Autism Spectrum Disorder Teaches Siblings to Skateboard: Effects on Sibling Skills and Family Social Behavior

Abstract

Children with autism spectrum disorder (ASD) may have few common activities with their siblings who do not have ASD, and this can limit their opportunities for social play. In this study, we used a multiple-baseline across skills design to assess the effects of a boy with ASD following an activity schedule to teach his favorite activity of skateboarding to his two siblings who do not have ASD. Family social behavior was also measured before and after sibling training. After training by the boy with ASD, both of the siblings’ skateboarding skills improved, and measures of family social behavior also increased. Results suggest that sibling relationships may benefit when a child with ASD teaches siblings to play.     

Resilience Processes in Context

Abstract

This article considers resilience as a multiplicity of psychological characteristics that are shaped by the ecological interplay of relational, social, and cultural contexts. Bronfenbrenner's (1979) person-process-context model of human development is examined in terms of its implications for research and for both micro- and macro-level interventions. Attention is given to “the first context” and to the role of early attachment in the cultivation of resilient functioning. Attachment theory and research are reviewed. Themes are extracted from this research to suggest how psychotherapy with trauma survivors can mobilize the resilient capacities of trauma survivors and function as a reparative context. Implications of an ecological perspective and attachment theory and research for national and community-level interventions are considered.     

Seduction,date rape,and aborted surrender

Abstract

This paper clarifies the dual-layered nature of the “demon lover complex,” with its background of both pre-Oedipal trauma and Oedipal-level desire. It draws on an object relations understanding of the unconscious and dissociated addiction to an internal demon object that has derivations in the personalities of the actual parents, and in the internalization of these parents. The dramatic case of early trauma compounded by adult date rape trauma serves to illustrate how a “developmental mourning process” in treatment can resolve such trauma. It also illustrates how reparation with the mother that partially heals pre-Oedipal trauma cannot immunize anyone against Oedipal-level attractions to a “demon lover” father, as represented in a displacement, resulting in victimized behavior, and in an aborted surrender to heterosexual desire. However, this victimization can be resolved, as seen in the clinical illustration, when the psychoanalyst has an understanding of the mourning process in developmental terms, working with a natural interaction between mourning and transference evolutions in treatment. The case also demonstrates the transitional object role of the psychoanalyst who is involved with the healing of pre-Oedipal trauma through mourning.     

Early trauma,negative affect,and anxious attachment: the role of metacognition

Background and Objectives: Metacognition is linked to the etiology and maintenance of negative emotions and psychological disorder in the Self-Regulatory Executive Function Model. Although there is significant evidence supporting the model, little is currently known about the situational factors for developing dysfunctional metacognitions. The current study explored the hypothesis that early aversive experiences might be important and also tested if metacognitions could mediate the relationship between such experiences and psychological symptoms. Design and Methods: Three hundred and fifty non-clinical adults completed a retrospective early trauma measure, as well as measures of current metacognitive beliefs, negative affect, and anxious attachment. Results: Early emotional abuse positively and significantly correlated with several metacognitive belief dimensions but other forms of early trauma did not. Metacognition fully mediated the relationship between emotional abuse and negative affect. Anxious attachment was also positively and significantly associated with metacognitive beliefs and specific relationships remained after controlling for early emotional abuse and current negative affect. Conclusions: Findings are consistent with the ideas that: (i) early negative experiences, and emotional abuse in particular, could be a factor in the formation of problematic metacognitions and (ii) these metacognitions may be important in determining the effects of abuse on subsequent psychological symptoms.     

A framework for the study of filial imprinting and the development of attachment

Filial imprinting is the process through which early attachment behavior becomes restricted to the mother and siblings. In the present paper it will be shown that the processes underlying imprinting in chicks (Gallus gallus) can be fruitfully analyzed by referring to the same mechanisms as are generally assumed to play a role in perceptual and associative learning. This can be achieved within a framework formulated to study the development of behavior in general. This offers the opportunity to apply the same general framework to the study of filial imprinting and the further development of attachment. The involvement of perceptual and associative processes in imprinting is discussed in some detail, while the broader implications of the present approach are indicated only briefly.     

Aspects of Safe Attachment in the Recovery from Trauma

Abstract

The attachment capacities of trauma survivors were hypothesized to be positively related to their recovery from traumatic event(s). Recovery from psychological trauma is conceptualized as consisting of multiple criteria, and proceeding through a series of stages. The safe attachment dimension of the Multidimensional Trauma Recovery and Resiliency (MTRR) scale was examined through factor analyses, resulting in four factors or subscales. One hundred and twenty-six participants were rated according to recovery status and on the MTRR scale by clinicians from various clinical settings. Recovery status was positively correlated with the overall Safe Attachment dimension and with each of the four separate subscales. Implications for psychotherapeutic goals are discussed.     

Introduction to the Special Theme Issue on Health Disparities,Trauma, Disruptive and Criminal Behaviors and the Adolescent Brain: Conference Collaborators,Major Developments in Conference Planning,and Overview of the Articles

ABSTRACT

The November 21, 2015, conference Health Disparities, Trauma, Disruptive and Criminal Behaviors and the Adolescent Brain, examined the national problem of youth incarceration by exploring research on the adolescent brain, trauma, poverty, racism, health disparities and mental health treatment. This special theme issue of the Journal of Infant, Child and Adolescent Psychotherapy provides an opportunity for selected authors to contribute original articles that capture their contributions to the conference event. The purpose of this article is to provide an introduction to this special theme issue. This article provides an overview of the following: the roots of the conference, including the role of numerous collaborators; specific major developments that contributed to the evolution of the conference focus; and a brief overview of the actual articles that have been selected for inclusion in the theme issue.     

Siblings’ appearance-related commentary,body dissatisfaction,and risky eating behaviors in young women

IntroductionNegative feedback on appearance is a risk factor for the development of problems related to one's body image.ObjectiveThe present research aimed to analyze the relationship among siblings’ positive and negative appearance-related feedback, dissatisfaction with one's body and risky eating behaviors among young women. The mediational role of body-related social comparison has been investigated.MethodTwo hundred and eight young women living in Italy, with a mean age of 23.15 years, filled in a questionnaire containing the Italian version of the Verbal Commentary on Physical Appearance Scale – Siblings, the Physical Appearance Comparison Scale, the Body Shape Questionnaire-14, and the Eating Disorder Examination-Questionnaire.ResultsDissatisfaction with one's body shows a significant link with risky eating behaviors. Weight and shape-related positive comments made by siblings were significantly and negatively related to social comparison, which in turn was associated with women's dissatisfaction with their body image. Negative comments were directly linked to body dissatisfaction; the mediation role of social comparison with respect to negative comments was not confirmed.ConclusionsThese findings underline the significant role of siblings in the development of females’ body image. Programs aimed to prevent or reduce body dissatisfaction and risky eating behavior could be implemented; these programs should be concerned with not only negative feedback on appearance but also positive comments because of their relevant role.     

Emotionally Focused Family Therapy and Play Therapy Techniques

Emotionally Focused Family Therapy provides a framework for understanding children's behaviors in terms of attachment needs of comfort and support. However, when working with young children, play therapy is often developmentally preferred over “talk therapy.” By integrating play therapy techniques within an Emotionally Focused Family Therapy theoretical framework, therapists can help parents understand and meet their child's needs for affection and comfort. This article will discuss how play therapy techniques can be integrated with an Emotionally Focused Family Therapy theoretical framework for work with young children and their families.     

Witch-mother is which? The potential role of the analyst in facilitating authentic motherhood

Abstract

This paper explores challenges in the treatment of women suffering from disturbances in maternal identification. A review of the psychoanalytic and developmental literature focuses on the frequent finding of early-onset mother–daughter relational disturbance involving maternal narcissistic fragility and exaggerated dependency needs, intergenerational trauma, and related psychopathology including mutual affect dysregulation. A case example of a young woman with a severe anxiety disorder is presented and discussed to illustrate the challenges to the traditional psychoanalytic technique. This patient avoided pregnancy into her late thirties and entered analysis with feelings of inauthenticity, characterological masochism, and a “secret mission” to unmask the witch recurring in her dreams. Through an elaborate working-through of negative maternal transference, the analyst and patient saw through the birth of the patient’s authentic self, a new approach to her career, her relationships with men, and her anticipation of the birth of a child by the sixth year of treatment. The author posits that psychoanalytic technique benefits from contemporary, attachment, and trauma research that supports the analyst’s playing a more active role in approaching, co-regulating, tolerating, and integrating avoided affects and memory traces that are associated with early-onset relational disturbances worsened by the effects of violence, maltreatment, and loss.     

The Influence of Individual Attachment Styles on Group Members’ Experience of Therapist Transitions

Abstract

Attachment theory has recently been applied to clinical practice in an effort to improve understanding and treatment of the maladaptive relational patterns clients bring to therapy. While most of this research has focused on individual therapy, interest in the application of attachment theory to group psychotherapy is growing. This paper will explore the impact of clients’ attachment styles on their experiences of co-therapist transition in an ongoing psychodynamic therapy group. This discussion will elucidate how knowledge of attachment theory and an understanding of clients’ individual attachment styles can be useful in predicting responses to therapist-initiated terminations and transitions.     

A Case Study: A Discussion of Depression,Ambivalence, Attachment,and Culture Portrayed in the Therapeutic Environment

ABSTRACT

This paper uses object relations theory to conceptualize and manage the complexities of a home-based case that was followed for a period of six months. It discusses maternal depression in relation to the caregiver role, self-harm, and self-determination. The client's ambivalence issues are addressed, with particular emphasis on transference and countertransference issues in the relationship and the use of transitional space and objects. Also discussed is the effect of maternal depression and ambivalence on mother-infant attachment, with the introduction of interaction-guidance as a treatment modality. An examination of cultural differences and the concomitant ethical implications that arose in the treatment process is provided. Finally, therapeutic implications and reflexivity are addressed.