Therapeutic Assessment With Children: Intervening With Parents “Behind the Mirror”

All the steps in the model of therapeutic assessment used with children (TA–C) are designed to involve and impact the child's parents. However, a distinctive process that parallels and accompanies the testing sessions with the child might be the most significant in helping parents shift their story of their child and family. In this process, parents are invited to observe their child's testing sessions (in an adjacent room through a live video feed, through a 1-way mirror, or in the corner of the testing room) and process the experience with the assessor (either simultaneously in the case of the 2-assessor model or after the fact in the 1-assessor model). We discuss the development and evolution of what we have come to call the “behind the mirror” method. We describe the therapeutic intent of the method and delineate 13 techniques utilized to enlist parents as active collaborators. We illustrate each technique using the case study of a 10-year-old boy where the 2-assessor model and live video feed method were used. We also provide research findings from the case study that address the parents’ experience of the assessment and their changed view of their child.     

Family sessions as part of child psychological assessment: goals, techniques, clinical utility, and therapeutic value

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.     

Training assessors in Therapeutic Assessment

This article focuses on the use of the comprehensive Therapeutic Assessment training model (Finn, 2007) with a child and his mother. The mother observed the child's testing sessions and was actively involved in a family intervention session as a way of translating assessment results into practice. One psychologist administered the psychological tests with the child, and 2 other clinicians worked with the mother throughout the process. We offer ideas about learning and training in the context of our case in Therapeutic Assessment. We investigate the parallel process between the way in which parents learn about their child's perspective and the way in which clinicians learn about the family's perspective. We discuss our discoveries in the context of planning case interventions. We explore the impact of trauma and ways of holding and containing this difficult work within our community and with each other.     

Family Sessions as Part of Child Psychological Assessment: Goals,Techniques, Clinical Utility,and Therapeutic Value

Including a family session in a child assessment can significantly advance the assessor's and parents' understanding of the child's problems and enhance the likelihood that parents will follow through on recommendations after the assessment. A family session allows the assessor to observe the child in the family context, test systemic hypotheses, better understand the meaning of individual test results, and try out possible interventions. A family session may also help parents see systemic aspects of their child's problems, help the child feel less blamed, foster positive experiences among family members, and offer the family a glimpse of family therapy. We describe methods and techniques for structuring family sessions and offer guidance on preparing for and conducting such sessions depending on one's case conceptualization. Detailed case examples illustrate each technique and demonstrate the immediate and subsequent impact of family sessions as well as their therapeutic value. We also address common clinical and pragmatic issues.     

“Why Won't My Parents Help Me?”: Therapeutic Assessment of a Child and Her Family

We present a case study of a child's psychological assessment using the methods of Therapeutic Assessment (TA). The case illustrates how TA can help assessors understand the process and structure of a family by highlighting how maladaptive family processes and interactions impact a child's development. It also illustrates how TA with a child can serve as a family intervention. In this case, it became apparent that the child's social difficulties were significant, not minor as initially reported by the parents, and were rooted in an insecure attachment, underlying depression, an idiosyncratic view of the world, and longing for attention, all of which were hidden or expressed in grandiose, expansive, and off-putting behaviors. In addition, the familial hierarchy was inverted; the parents felt ineffective and the child felt too powerful, leading to enhanced anxiety for the child. Intervention throughout, punctuated by the family session and feedback sessions, allowed the parents to develop a new “story” about their child and for the child to experience a new sense of safety. Following the TA, the parents and child indicated high satisfaction, enhanced family functioning, and decreased child symptomatology. Subsequent family therapy sessions allowed the family to further implement the interventions introduced in the TA.     

Discrimination of moving video images of self by pigeons (<Emphasis Type="Italic">Columba livia</Emphasis>)

The ability to recognize self has been known to be limited to some animal species, but previous research has focused almost exclusively on the animal's reaction to a mirror. Recent studies suggest that the temporal contingency between a subject's action and the corresponding visual scene reflected in a mirror plays an important role in self-recognition. To assess the roles of visual-proprioceptive contiguity in self-recognition, we explored whether pigeons are able to discriminate videos of themselves with various temporal properties. We trained five pigeons to respond to live video images of themselves (live self-movies) and not to video filmed during previous training sessions (pre-recorded self-movies). Pigeons learned to peck trial-unique live self-movies more frequently than pre-recorded self-movies. We conducted two generalization tests after pigeons learned to discriminate between the two conditions. First, discrimination acquired during training sessions was transferred to a test session involving live self-movies and new pre-recorded self-movies. Second, the same pigeons were tested in extinction procedure using delayed live self-movies and new pre-recorded self-movies. Although pigeons responded to delayed presentations of live self-movies more frequently than to new pre-recorded self-movies, the relative response rate to delayed presentation of live self-movies gradually decreased as the temporal discrepancy between pigeons' own behavior and the corresponding video increased. These results indicate that pigeons' discrimination of self-movies with various temporal properties was based on the temporal contiguity between their behavior and its visual feedback. The methodology used in the present experiment is an important step toward improving the experimental analysis of self-recognition in non-human animals.     

Families and children with hearing loss: grief and coping

Parental coping with the diagnosis of their child's hearing impairment has not received a great deal of research attention, despite the evident importance of it. Parental coping has been changing with the inception of newborn screening as we move from a parent-initiated model of diagnosis to an institution-initiated model. Coping now begins without any preparation, and without any time for parents to "enjoy" their child as "normal." The grief models, based on the death experience, usually employed to describe parental reactions to the diagnosis may also be inappropriate. Death grief is terminable whereas parental grief is chronic. There is not sufficient research on the long-term effects of chronic grief and how that impacts on parent-child bonding. There is evidence that our screening endeavors have far outstripped our habilitation efforts, leaving parents with a diagnosis but without support. This gap must be closed.     

Characteristics and Effects of the Co-parenting Alliance between Incarcerated Parents and Child Caregivers

We examined co-parenting alliance based on information provided by 57 incarcerated parents and their corresponding child caregivers who took part in the Messages Project, in which incarcerated parents video recorded greetings to children that were then mailed home. We assessed perceptions of co-parenting alliance, measured by the Parenting Alliance Measure, and levels of child contact from both parents and caregivers. We also observed expressions of positive and negative attitudes that prisoners expressed regarding the home caregiver during the video recording. Incarcerated parents reported more frequent phone contact with children and more frequent letter-writing to children than did home caregivers. Incarcerated parents likewise reported higher levels of co-parenting alliance with the home caregiver in comparison to the assessment of co-parenting alliance reported by the home caregiver. Among children observing the video recorded message, a more positive co-parenting alliance between their parent and home caregiver was associated with increased positive mood. More frequent displays of negative attitudes toward caregivers during the recordings were associated with more negative mood indicators among children. Results suggest the importance of a strong co-parenting alliance between incarcerated parents and home caregivers, but imply that incarcerated parents may have a more optimistic view of their connection home than is the case for collaborating caregivers.     

Recognizing the role of parents in developmental outcomes: a systems approach to evaluating the child with developmental disabilities

When developmental concerns arise in children, a clinical assessment focuses on the child's developmental profile to achieve three goals (1) determine diagnosis, (2) develop interventions, and (3) evaluate progress. Parents often have needs during this time that are not addressed by professionals because of the exclusive focus on the child during the evaluation. In this article, we suggest that clinicians take a "systems" approach to the assessment process by recognizing how the well being of family members can impact a child with a developmental disability. We review systems theory and its conceptualization of individual functioning and discuss how parental well-being differs according to child diagnosis. Finally we suggest a systems-based model to use during the assessment process.     

Intersubjectively oriented,time-limited psychotherapy with children: how does the therapist evaluate the therapeutic process and what are the therapist’s tasks?

Based on the therapist’s evaluations of three therapies, this research aims to study the therapeutic process in intersubjectively oriented, time-limited psychotherapy with children. A primary objective is to further develop the therapy method. The study comprises therapies with children 6–11 years of age, who had experienced difficult family situations. Each child received 12 therapy sessions. The number of therapy sessions with children and parents was agreed upon beforehand, and the therapeutic objectives were approved by the parents. Each of the therapy processes were evaluated by the therapist by answering three questions and filling in three forms after each therapy session. The forms were: The Feeling Word Checklist; an alliance form for the child; and a process form. The therapeutic alliance and the behaviour of the therapist during the therapy sessions are discussed on the basis of the total material. The following main tasks for the child therapist emerged: structuring the therapy sessions; following the child’s initiatives; participating and cooperating with the child; exploring the child’s expressions; and understanding and regulating emotions.     

Les représentations mentales de l’enfant chez les parents : situation,illustrations et réflexions sur les catalyseurs de changements en évaluation thérapeutique de l’enfant

Therapeutic assessment of the child (TA-C) is a model of psychological assessment that allows for collaborative work with parents and child on their reasons for consultation, a collaboration that breaks away from a traditional double separation (parent/assessor, and assessor/therapist) in child assessment. This paper, grounded in a contemporary psychodynamic viewpoint, presents clinical illustrations to support a conceptualization of change processes in TA-C. It is argued that, in order to revitalize empathy in parents, work focusing on the parents’ mental representation of their child is central. We propose a hierarchy of assessment/therapeutic goals that allows for a better distinction between TA-C and standard assessment in work with children.     

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.     

父母早期受虐与子女对立违抗症状的关系:亲子虐待和儿童愤怒管理的作用

本研究探讨了父母的早期受虐经历与子女的对立违抗症状的关系,通过构建一个有调节的中介模型,考察了亲子虐待的中介效应和儿童愤怒管理对该效应的调节作用。采用问卷法对359名来自北京市、山东省和云南省的14所小学一至五年级的儿童及其父母进行调查,研究工具包括儿童对立违抗症状评估表、童年期创伤问卷、儿童愤怒管理量表。结果发现：（1）男孩的ODD症状得分显著高于女孩;男孩受到的躯体虐待、情感忽视和躯体忽视显著多于女孩（2）在控制了儿童性别后,父母在童年期的受虐经历仍可显著正向预测其成年期的家庭中子女的ODD症状;（3）亲子虐待在父母受虐和子女ODD症状之间起完全中介作用,即父母受虐通过亲子虐待间接影响子女ODD症状;（4）父母受虐通过亲子虐待影响子女ODD症状的中介效应后半路径受到子女个体水平愤怒失调（AD）的调节,具体来说,当AD水平较高时,亲子虐待对ODD症状的影响更大;但愤怒应对（AC）和愤怒抑制（AI）对中介效应无显著调节作用。     

Parental Responsibility and the Morality of Selective Abortion

It is now a common opinion in Western countries that a child's impairment would probably place an unexpected burden on her parents, a burden that the parents have not committed themselves to dealing with. Therefore, selective abortion is in general a morally justified option for the parents. I argue that this view is based on biased information about the quality of life of individuals with impairments and their families. Also, a conscious decision to procreate should bring about conscious assent to assuming obligations as a parent. This implies a duty of caring for any kind of child. Consequently, if the child's condition is not such that it would make its life not worth living, and if the parents live in an environment where they are able to provide their child and themselves an adequate well-being, they do not have a morally sufficient reason to terminate the pregnancy on the grounds of fetal abnormality.     

Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent–infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent–infant dyads may illuminate important aspects of the method itself as well as the therapists’ role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent–infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent–infant dyads where child protective issues arise, where caregivers’ insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists’ role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.     

Self-recognition: a study of a population without mirrors

The study of the influence of familiarity with mirrors on children's capacity to identify their reflected images permitted differentiation between two problems that confront the child in the mirror situation: (a) the identity of the image and (b) the capacity to relate mirror space to real space. Sixty children, 6 to 26 months old, without previous experience with mirrors, were observed systematically while discovering their mirror image and a reflected object. Their behavior was compared to a control group with habitual mirror familiarity. The results suggest that (a) self-recognition in the mirror is independent of the child's familiarity with reflecting surfaces and (b) the capacity to relate mirror to real space seems to be strongly influenced by previous experience with mirrors.     

Ethnic Differences in Parental Perceptions of Genetic Testing for Deaf Infants

As genetic testing becomes an integral part of the evaluation of deaf infants and children, it is important to understand parental views on genetic testing. The purpose of this study is to examine parental reasons for, and beliefs about, genetic testing for deafness in early-identified infants, and to determine if they differ as a function of ethnicity. We present baseline data collected from 56 Caucasian, 59 Hispanic, and 24 Asian parents of deaf children participating in a longitudinal, prospective study on genetic testing for connexin-related deafness. The overall finding is that reasons for, and beliefs about, genetic testing for deafness varied as a function of ethnicity. Virtually all parents sought genetic testing to understand why their child is deaf. However, Asian and/or Hispanic parents were more likely than Caucasian parents to view family planning, helping with their child's medical care, and helping the family as other important reasons for testing, and were more likely than Caucasian parents to perceive genetic testing to be useful for these purposes. Asian and Hispanic parents were more likely than Caucasian parents to perceive genetic testing in harmful terms. Genetic testing fulfills a cognitive need for parents to understand why their child is deaf, yet differences in responses suggest that Asian and Hispanic parents may seek testing for other purposes. Understanding different perspectives on genetic testing for deafness will enhance genetic counselors' cultural competence and facilitate the pre-test genetic counseling session.     

The Child Immigrant

This article uses a developmental perspective to look at the effects of immigration on the young child. Factors influencing the way in which the immigrant family negotiates the ongoing process of settling into the new country are considered. It is argued that the ability of parents to provide an adequate holding environment to protect the young child from too much loss or dislocation is probably the most critical factor in determining whether the child's internal world will be enriched or impoverished by the immigration experience. It is emphasized that immigration is an ongoing process for the entire family. Some clinical material is presented to illustrate how the child's engagement in the process of separation-individuation both shapes and is shaped by, the immigration experience.     

How Can I Help You? Dimensional versus Categorical Distinctions in the Assessment for Child Analysis and Child Psychotherapy

ABSTRACT

This paper describes the process of a psychoanalytically-informed or a psychodynamic diagnostic assessment with children, contrasting it with a DSM-like diagnostic process. The importance of understanding and sensitively addressing the experience of parents when they bring their child to a professional for help is highlighted. The promotion of a psychoanalytic atmosphere, the unique contribution of a child analyst or psychodynamic clinician to the general mental health field, is an approach which promotes the development of a therapeutic alliance. This allows both parents and children to express their underlying issues as openly as possible. In addition to the basic assumptions of psychoanalysis (the ubiquity of unconscious mental activity and the impact of the past on the present/the developmental perspective), several factors are crucial to bear in mind: the importance of understanding the nature of the child’s (and the parent’s) emotions, emotion regulation, development of mental representations of self and other, and their conflicts and defense mechanisms. Potential therapeutic approaches are highlighted, including stressing the need to empirically study how decisions are made by a mental health provider when moving from assessment to treatment recommendation.