The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers

There is a lack of knowledge about psychosocial resources that may sustain post‐resettlement psychological adjustment among unaccompanied minor asylum‐seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population‐based multi‐ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.     

On Attachment to Internal Objects

This paper considers some clinical implications of attachment theory from the perspective of the theory of internal object relationships and the unconscious phantasies that derive from such relationships. The paper focuses on the contributions of Bowlby and his followers, particularly Mary Main, who has developed a language-based methodology to study representational processes in adults and children, bridging the gap between the systematic study of human behavior and clinical psychoanalysis. The theory of inherent role responsiveness in the internal object world—mental representations of self and other in interaction and externalized in complementary role relationships through exchanges of unconscious and conscious messages—is presented as the psychoanalytic complement of Bowlby's theory of internal working models of attachment. Role responsiveness occurs internally as well as externally, so that one can speak of attachment to phantasy objects as well as external objects. Clinical examples illustrate how the therapist, through maintaining a free-floating responsiveness to the patient's enactments, may reconstruct the internal working models of attachment and their origins in the transference. The paperthus illustrates the way in which the origins of phantasy derive from the wished for and feared states related to early experiences of felt security, or lack of it, in relation to the attachment objects, thereby integrating the psychoanalytic theory of phantasy with attachment theory.     

Migration patterns,family functioning,and life satisfaction among migrant children in China: A mediation model

There are three distinct patterns of migration among Chinese migrant children: whole‐family, single‐parent‐first, and both‐parents‐first migration. This study investigated the life satisfaction of children who migrated under the different migration patterns and examined the mediating role of family functioning in the relationship between the children's migration patterns and their life satisfaction. Participants consisted of migrant children (N = 703) from primary and junior middle schools in Chengdu, China. The results showed that (a) migrant children from the whole‐family and single‐parent‐first patterns of migration reported greater life satisfaction than did those from the both‐parents‐first pattern, and (b) family functioning partially mediated the association between migration patterns and life satisfaction. The present study highlights the importance of avoiding separation of children from both parents during migration and the need to develop interventions for migrant children's psychological adaptation by improving their families’ functioning.     

Some thoughts on the concept of the internal parental couple

Some patients are incapable of engaging in a relationship with a partner on a long-term basis. To explain these relationship issues, they invoke reasons that have to do with external reality rather than with their own internal reality. The authors present several clinical examples that have given rise to an initial attempt at theorizing the concept of the internal couple: some patients fail to internalize a positive representation in which they can see themselves as part of a couple. Psychoanalysts tend to think of the father and mother (or their internal representatives) as separate entities, differentiated and complementary, and not in terms of a single object that brings them together as an internal couple. In the author’s view, an internal parental couple is also internalized by the infant under the guise of various internal objects. The internal parental couple thus appears as a complex construction that goes beyond the mere addition of father plus mother. Underneath their neurotic veneer, these patients have severely damaged representations of internal parents and of the internal parental couple. Unable to identify with a stable and procreative internal parental couple, they tend also to attack the psychoanalytic couple. Early distortions in the oedipal sphere may be one cause of the stumbling-block they encounter on the way to introjecting a well-attuned couple-as-object and the idea of parenting.     

Predictors of depressive symptoms among resettled unaccompanied refugee minors

This study investigated the level and predictors of depressive symptoms among unaccompanied refugee minors after resettlement in Norway. Participants (N = 414) were resettled in 26 municipalities from all regions of the country. The average length of resettlement time was 3.4 years. They originated from 33 different countries, mainly Afghanistan (n = 116), Somalia (n = 74), Sri Lanka (n = 41) and Iraq (n = 43). Participants completed a self-report questionnaire administered in groups. Findings show that unaccompanied minors are a high-risk group for mental health problems also after resettlement in a new country. A multilevel model predicting depressive symptoms from individual and contextual demographic factors indicated that, controlling for post-traumatic stress, females had more symptoms than males and Somalis had fewer symptoms than participants from other countries. Variation in symptom levels as a function of gender and ethnic background indicates that some groups may have inherent protective or vulnerability factors that need to be further studied to understand differences in psychosocial adaptation among unaccompanied minors. Further, findings imply that researchers, policy makers and mental health care workers need to expand their attention beyond the first phases of arrival of unaccompanied asylum seeking and refugee minors to the continuing experience of mental health problems after resettlement.     

Ambiguous Loss in Transnational Families’ Adolescents: An Exploratory Study in Ecuador

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members’ experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents’ lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent-child relationships and ongoing parent-child separation. Data analysis identified four themes in participants’ accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents’ lived experiences of parent-child relationships characterized by ambiguity.     

The Social Value of Internal Explanations and the Norm of Internality

Since the 1970s, it has been agreed that ‘internal’ people, who explain what happens to them by internal explanations (their behaviors, their aptitudes, their efforts, their personality, etc.) were more likely to succeed than ‘external’ people, who explain the same outcomes by external explanations such as chance, situational difficulties, the power of others, or fate. The social superiority of internal people is explained in terms of their personality (locus of control). Looking further into the intuitions of American researchers, a French school of thought attempted to show that internal explanations are socially valued. It was suggested that there exists a social judgment norm that could be called the norm of internality and that, perhaps, the success of ‘internal’ people was more specifically due to the fact that social appraisers, whether in school, in organizations, in the courts of justice, prefer this type of person because such people adhere more easily to current social ways of functioning.     

A place within the heart: finding a home with parental objects

For adopted and Looked After children with compromised early experiences, there can be troubling phantasies and anxieties associated with parental objects. These internal object relations can seriously restrict the development of secure intimate relationships with new parental figures. Adoptive parents and foster carers bear the brunt of the associated difficulties. Clinical work with the child, parents/carers, family, or network, may help processes of containment, differentiation, working through, mourning, and integration. This paper is based on thinking derived from clinical work with children who are adopted or Looked After, and with adoptive parental couples, carers, and networks. The primary focus is on how the child needs to find a ‘psychic home’ in the minds of others for their damaged internal parental objects, and the emotional capacities required in adoptive parents to provide this. I describe some of the complexities for adoptive parents and others in providing what is needed to enable the child to experience their internal parental objects in a fuller way. This process can allow the child to introject, identify with, and re-imagine their internal parental objects, and through this develop a more realistic relationship to their adoptive parents and to their birth parents. It promotes trust, freedom, and emotional depth in the relationship with parental figures.     

Validation of the multiple language versions of the Hopkins Symptom Checklist-37 for refugee adolescents

The objective of this study is to provide preliminary psychometric properties of the Hopkins Symptom Checklist-37 (HSCL-37A) for refugee adolescents. The HSCL-37A is a modification of the well-known HSCL-25 and assesses symptoms of internalizing and externalizing problems that have been associated with reactions to trauma. Four independent heterogeneous samples (N=3890) of unaccompanied refugee minors, immigrants, and native Dutch and Belgian adolescents were assessed at school. The confirmative factor analyses, per language version, support the two-factor structure of internalizing and externalizing behavior. The total and subscales show good internal consistency and acceptable test-retest reliability in spite of the heterogeneous sample populations. The construct, content, and criterion validity of the HSCL-37A were also examined and found to be good. The findings of this study suggest that the HSCL-37A is a reliable and valid instrument to be used among culturally diverse refugee adolescents to assess emotional distress and maladaptive behaviors.     

‘Just black sometimes’, part 2: reflections on an adolescent's journey

In this second article about work at a refugee centre for unaccompanied minors in Berlin, the author discusses his encounter with Syrian and Afghani adolescents who were enrolled in the program. Issues around adaptation to a new culture are explored with attention to the dynamics of conformity and marginalization. The questions of what happens to adolescent refugees separated from their families, and how their identity formation is shaped by this burden is explored in relation to the author's meeting with a Syrian adolescent living in Berlin. To illustrate the long reach of a missing father who has been left behind, characters from Virgil's Aeneid are discussed to amplify heroic and spiritual aspects within father‐son relationships. The interplay between needing help and allowing for resilience is explored as an important aspect of refugees’ transitions, while also considering variables such as dependence and independence, foreign and familiar, being with or without family, and adjusting to the present and/whilst relating to the past; tensions between these alternatives can create various psychosocial challenges for adolescent refugees.     

Occupational Identity,Competence, and Environments Among Adults With and Without Attention Deficit Hyperactivity Disorder

Exploring occupational adaptation among adults with attention deficit hyperactivity disorder (ADHD) is essential due to associated occupational difficulties. Occupational Performance History Interview scales—identity, competence, and environments—were compared between 51 adults with and 50 without ADHD who participated in occupations. Internal and external resources supporting occupational participations were represented by the competence and environment scales, respectively. The group with ADHD reported fewer internal and external occupational resources compared to the group without ADHD, despite occupational identity similarities. Study findings suggest that occupational interventions aimed at increasing internal and external occupational resources may support occupational adaptation among adults with ADHD.     

Migration and psychological status of adolescents in Turkey

The aim of this study was to investigate the influence of involuntary migration on an adolescent population that had moved with their families to either one of two culturally different locations in Turkey. One of these groups had moved from a village in Eastern Turkey to a nearby town, while the other had moved a considerable distance to a large city in Western Turkey. Comparison groups included adolescents from both regions who had never migrated. Measures of self-esteem, satisfaction with life, and social support networks were used with 305 adolescents who were between the ages of 12 and 15. Adolescents who had migrated scored lower on self-esteem and life satisfaction, and had fewer people in their social support networks than those who had not. It was also found that those who had migrated tended to be more dependent on peers than family for social support. This was probably the case because school attendance was lower for migrants, particularly for males, and the probability of full time work on the street away from their families was considerably higher.     

Mona Lisa hinter Glas

If one enters a museum nowadays, one is soon confronted with a glass barrier. Mona Lisa is in the Louvre behind bullet-proof glass, Nofretete found her place in the Neues Museum in Berlin in a glass case standing on a spring-mounted fundament. They are art objects, admired, adored, loved, hated and sometimes destroyed. We may be touched by them, but they are not to touch (any more) for us. But the more the art objects recede the more assassination attempts on art are to be observed. What if anything have visits of museums with psychoanalytic sessions in common? Is there anything we can learn from assassination attempts on art or is it right to put them down as incomprehensible acts of seriously disturbed personalities? Art objects just as psychoanalysts have the power to allow aesthetic, e.g. sensual experiences which are able to change the person but in contrast to the notion of beauty linked repeatedly to aesthetics, these changes may also be disturbing. Entering a psychoanalytic practice just as entering a museum creates a tension between the sensual presence of the objects, their seductive potency, their invitation to be assimilated sensually on the one side and the simultaneous sensual deprivation, the imperative of distance and the prohibition of touching. Considering this aspect one seldom hears about attacks on psychoanalysts or on their inventory but it happens. Margaret Little informs about such attacks during her analysis with Winnicott. What is destroyed if a picture is destroyed? Are such assassination attempts attempts to provoke a sensual reaction, confirming the existence and the effectivity of the subject? Searching for answers to this question is a possible substantiation for endless new theories about who might have been the real model for Mona Lisa. This approach tends to see a picture purely as a sign referring to a signifié, perhaps to be protected against the sensual presence of the picture. Accordingly, psychoanalytic theories could also be considered as far as they are really above the ethically necessary imperative of the continuous reflection, to serve as glass plates behind which the analyst can seek shelter but which can also trigger in the patient an enormous desperation and destructiveness.     

What is the Impact of Placement Type on Educational and Health Outcomes of Unaccompanied Refugee Minors? A Systematic Review of the Evidence

Record numbers of unaccompanied refugee minors have been arriving in high-income countries since 2015. Child welfare agencies and non-governmental organisations tasked with providing services have struggled to cope with demands on their services as a result. Despite this, there is little research on how best to meet their needs and in particular what services can mitigate the psychological difficulties they face. As a result, the evidence base for social services for refugee children remains very limited. This paper is a systematic review and meta-analysis of the evidence on the relationship between care placement type and the educational, mental health and physical health outcomes of unaccompanied refugee minors. We searched ten databases and identified 3877 citations which were screened for inclusion. Nine studies were included in the final review, with seven included in the meta-analysis. Eight studies examined the link between accommodation type and mental health outcomes, and two analysed the relationship between accommodation type and education. There were no studies looking at physical health outcomes. Included studies suggest that foster care and placements that are culturally sensitive may be associated with better mental health outcomes. This review highlights the paucity of research on the impact of services provided by child welfare agencies and non-governmental organisations.     

Are parental personality traits a basis for mate selection?

Both psychoanalytic views of attachment and evolutionary theories of imprinting suggest that mates may be preferentially chosen to resemble one’s parents. Using data from a large Dutch study of twins and their families, we tested these hypotheses with regard to personality traits from the Five-Factor Model. Little evidence of parent/spouse similarity was found, although women did tend to select a husband who resembled their parents with regard to Openness to Experience. This effect may be due to the influence of Openness on their social worlds, rather than to their experiences in early childhood.     

Repression and splitting in the psychoanalytic process

The authors examine the concepts of repression and splitting and their interplay during the psychoanalytic process. Initially, repression was introduced by the clinical phenomenon of resistance, leading to the formulation of the association between intrapsychic conflicts and neurotic symptoms. Later, repression was linked to normal development and to personality organization. Splitting, on the other hand, has been defined in quite diverse ways. The two main definitions are of splitting within the ego, and splitting of representations of the self, and of internal and external objects. Repression and splitting are compared developmentally, dynamically, and with respect to their relationship to psychic functioning and energic conditions. Clinical material is presented from the analysis of a patient who presented with borderline personality organization and narcissistic features. During the initial phase of analysis, splitting associated with projection, projective identification and idealization were the main defence mechanisms. As the analysis progressed and the themes of omnipotence and mourning were explored with the simultaneous working through of drive derivatives expressed in the transference, repression gained ground over the more primitive defence mechanisms. The evolution of the case showed a gradual shift from splitting to repression and the association of repression with a more advanced psychic organization. This development reflected the dynamic movement from borderline to hysterical organization in psychoanalytic nosology.     

Validation of psychoanalytic theories: Towards a conceptualization of references

The authors discuss criteria for the validation of psychoanalytic theories and develop a heuristic and normative model of the references needed for this. Their core question in this paper is: can psychoanalytic theories be validated exclusively from within psychoanalytic theory (internal validation), or are references to sources of knowledge other than psychoanalysis also necessary (external validation)? They discuss aspects of the classic truth criteria correspondence and coherence, both from the point of view of contemporary psychoanalysis and of contemporary philosophy of science. The authors present arguments for both external and internal validation. Internal validation has to deal with the problems of subjectivity of observations and circularity of reasoning, external validation with the problem of relevance. They recommend a critical attitude towards psychoanalytic theories, which, by carefully scrutinizing weak points and invalidating observations in the theories, reduces the risk of wishful thinking. The authors conclude by sketching a heuristic model of validation. This model combines correspondence and coherence with internal and external validation into a four‐leaf model for references for the process of validating psychoanalytic theories.     

The impact of words on children with ADHD and DAMP Consequences for psychoanalytic technique

Children with attention-defi cit/hyperactivity disorder (ADHD) and disorder of attention, motility control, and perception (DAMP) are often sensitive to the analyst's interventions. This is not always due to the literal import of the intervention. The children sometimes react as if the words were dangerous concrete objects, which they must physically fend off. The author traces this phenomenon to the child's unstable internal situation. A bad, un-containing internal object is easily awakened and threatens to expel the analyst's words independently of their content. This results in violent clinical situations. Infant research and psychoanalytic work with infants and mothers evince how a complex semiotic process develops between mother and baby. The prerequisite for this process to get started and maintained is a secure external object, which gradually is internalized. Findings from developmental research and clinical infant work are used to illuminate analytic work with children with ADHD and DAMP. Vignettes demonstrate how important it is for the analyst to phrase interpretations after having gauged the state of the analysand's internal object as well as his/her own countertransference. If this is overlooked, the psychoanalytic dialogue easily capsizes. The author provides some technical recommendations on the psychoanalysis of these children. As part of the theoretical discussion he raises the general question of how the representations, which the baby forms in interaction with the mother, and the analysand forms in interaction with the analyst, should be classifi ed. Rather than dividing them into bipartite thing- or word-presentations (Freud), the author suggests C. S. Peirce's tripartite semiotic classifi cation in that the baby forms representations of icons, indices, and symbols.     

A Mixed Bag: The Realities of Psychoanalytic Practice

For a variety of reasons, psychoanalytic training is done in somewhat of a vacuum. It teaches a theory and a way of practicing that does not always translate well to day-to-day private practice work. The clinical realities of psychoanalytic practice prove the psychoanalytic method to be one that provides help to a wider audience than classical psychoanalytic training programs might suggest. The psychoanalytic approach offers the analyst many special opportunities to work with and help a wide variety of patients. Analysts who accept both the limitations as well as the wide application and broad benefits of the psychoanalytic approach may have a more fulfilling experience than their training experiences might foster. At the same time, the analyst's level of therapeutic skill, the patient's diagnosis, and many multiple external factors create different limitations in the practice and outcome of psychoanalytic work. Extensive case material is used to show the broad range of patients who are helped by the psychoanalytic method. The clinical material also shows the less than perfect, but often good enough outcomes of these difficult cases with often severely disturbed patients.     

Exploring Correlates and Predictors of Stress in Parents of Children Who are Deaf: Implications of Perceived Social Support and Mode of Communication

Parenting stress has been linked to negative outcomes for both parents and children, including poor attachment, behavior problems, less positive parent–child interactions, and marital dissatisfaction. Given that parents of special needs children often experience excess stress, they may be susceptible to negative outcomes, thus investigations of protective factors are needed. We explored relationships among parenting stress, social support, mode of communication, and child cochlear implant status in parents rearing a deaf child or child with hearing loss. Findings of our exploratory study indicated that parents of children who use sign language only reported more support, while parents of children who use total communication exhibited less self-reported stress. Also, parents with children who use implants did not differ on any of the measures compared to parents of children without implants. Additional findings suggested that higher levels of perceived social support corresponded with lower stress among parents, however, receipt of supportive behaviors did not correlate significantly with parenting stress. In an overall model, perceived social support and mode of communication were significant predictors of parenting stress. Finally, enacted support predicted significantly life satisfaction in parents. Implications and limitations, as well as suggestions for future research, will also be offered.