The internal world of the juvenile sex offender

This paper explores the consequences of the therapist's two successive pregnancies on a female patient. The second pregnancy was felt to be particularly difficult and disturbing. One of the central reasons was that after the patient's birth, the mother had a disabled child, followed by a stillbirth and soon after that the father left to marry another woman. Using Freud's concept of deferred action I will argue that my second pregnancy revised these earlier traumatic experiences.

The patient seemed to have incorporated and identified with a damaged maternal object that at the time of the original trauma was left husbandless, depressed and suffering from panic attacks. Although the therapist's healthy pregnancies seemed to reassure temporarily, it was difficult for the patient to hold onto a view of a helpful and productive therapist, one separate from this damaged internal mother. This was particularly so during and after the second pregnancy, where there was a marked absence of an idea of a third object, a father or a husband, who could help the patient deal with this pregnancy, her only escape was to retreat and act out.

The acting out was in part identification with a fleeing father and in part a defence against the absence of such a third object, so that it was used as a way of avoiding claustrophobic feelings of being trapped with the damaged mother. Her feelings of triumph then produced much guilt, and impeded reparation.

Another important issue that two successive pregnancies bring, are feelings of guilt in the therapist for exposing the patient to two major disruptions. In this patient's case it exacerbated the internal reality of a damaged maternal figure.     

“Yeah that Made a Big Difference!”: The Importance of the Relationship between Health Professionals and Fathers Who Have a Child with Down Syndrome

Evidence suggests that medical services do not reflect the increased involvement of fathers in childcare, a discrepancy that can often lead to feelings of exclusion and inequality. Fathers who have a child with Down syndrome may encounter many different health professionals during their child’s life, therefore it is important to consider this relationship, and investigate the factors that influence their experiences. This is particularly important because the limited research focusing on fathers suggest that those who have a child with Down syndrome can experience increased stress levels and lasting feelings of loss and grief. It is therefore important to address their relationships with health professionals, as these may be a significant resource to prevent these feelings. This study used interpretative phenomenological analysis (IPA) to explore the experiences of seven fathers who have a child with Down syndrome, focusing on their interactions with health professionals. The analysis showed that the major factors associated with negative experiences were feelings of exclusion, receiving overly negative information about the condition and a perceived lack of on-going support. Positive experiences were associated with being made to feel like an equal parent, being given direct/clear information and being congratulated on the birth of their child. These results provide an insight into what fathers expect in terms of their own and their child’s care and highlight that health professionals have an important and extensive role in influencing fathers’ experiences of Down syndrome.     

Therapeutic action in psychoanalytic therapy with toddlers and parents

Psychotherapy with toddlers and parents can focus on promoting attachment, facilitating development and improving interactions. Some techniques provide guidance to the parents, whereas others interpret to them their unconscious fantasies or ‘ghosts’ contributing to the child’s disorder. A recent paper introduced a psychoanalytically oriented technique, which emphasised the therapist’s interaction with the child in the presence of the parent(s). The child was addressed about his/her unconscious motivations in the session and the feelings towards the therapist. Also, the parent’s transference onto the therapist was seen as a vehicle that might further the therapeutic process and was accordingly addressed. The present paper analyses the therapeutic action in such treatments. Whereas work with the parents resembles that of ordinary psychodynamic therapy, therapeutic action is more difficult to conceptualise regarding the toddler, whose understanding of verbal interpretations and the therapist’s dialogues with the parent is more limited than that of an adult. However, a clinical vignette demonstrates a toddler’s precise and swift reactions to communications from mother or therapist. The paper investigates evidence from neuroscience and psychological research as to which communicative channels – beyond words – toddlers might perceive and comprehend. In addition, it is claimed that the countertransference is key to explaining how the therapist understands such communication.     

Unmarried, nonresident fathers' involvement with their infants: a risk and resilience perspective.

The authors used a subsample of fathers (n = 652) who participated during the 1-year follow-up of the Fragile Families and Child Wellbeing study to assess the influence of risk and resilience factors on unmarried, nonresident fathers' involvement with their infants. They examined the additive, multiplicative, and moderating models of risk and resilience in relation to paternal involvement. Fathers' relationship to the child's mother was conceptualized as a risk or resilience factor. Fathers in acquaintance relationships with the mother and fathers who scored higher on the additive risk index were less involved in child care. Fathers who scored higher on the additive resilience index were more involved in child care. There was a multiplicative effect of relationship status and the risk index on fathers' involvement. The findings point to the importance of programs that address risk and resilience conditions affecting nonresident fathers in interaction with the quality of relationships they have with their children's birth mother.     

The drama of the gifted child and the psycho-analyst's narcissistic disturbance.

In order to develop a true self, the child needs, in the first weeks and months of his life, his mother's appropriate emotional response, mirroring and respect. These narcissistic aspects have to be distinguished from the drive wishes. Only the mother's appropriate responses make it possible for the child to experience his feelings as belonging to his own self. If the child does not get the right narcissistic response, he will continue to search for narcissistic supplies for the rest of his life. The most suitable objects for this will be his own children initially, who are completely at his disposal. Specially gifted children who are sensitive, alert and have many 'antennae', will quickly learn to adapt to the narcissistic needs of their parents. Their behaviour will then give the mother all the mirroring, consideration and admiration which she had missed as a child herself. The result will be that, in spite of excellent performance, the child's own true self cannot develop. All this leads to narcissistic vulnerability and to new attempts in the adult to find at last an available 'mother' in his own child, partner, or, if he has become a psycho-analyst, in his patient. In the transference this type of analysand first experiences narcissistic rage before deep mourning is possible. This process of mourning enables him finally to accept his own deprivation as a child, to give up the unconscious idealizations and with them the hope of finding such a 'mother'. This leads regularly to the liberation of the life forces and allows creativity to develop. Only after this has been achieved is the analysis of drive conflicts possible and becomes emotionally effective.     

Motherhood Is Not a Given Thing: Experiences and Constructed Meanings of Biological and Nonbiological Lesbian Mothers

This study was designed to examine the subjective experiences of Israeli lesbian mothers. We explored the constructed meanings that both biological and nonbiological mothers relate to their motherhood experience. Eight lesbian couples who were parenting together and who had 1, 2, or 3 children were interviewed. Our data suggest that the birth of the first child to lesbian couples marks a turning point in the lives of each partner, as well as in the lives of the couples, by creating for the first time a significant distinction between the partners. It was found that lesbian mothers tend to organize their experiences into 3 circles of “being”: personal, couple, and communal (e.g., familial and social) aspects. Three themes contribute to the theoretical understanding of lesbian motherhood. First, although lesbian couples are known to value the sense of equality in their relationships, the birth of a child by one of the partners is an event that creates 2 different statuses of motherhood: a biological mother and a nonbiological mother. Second, the legal aspects of lesbian motherhood become a part of everyday life for the lesbian family and shape the partners’ relationship. Third, being both a lesbian and a mother highlights the fundamental dialectic between marginality and mainstream conformity in the life experiences of lesbian mothers in Israeli society.     

Concurrent treatment of mother and child in resolution of multigenerational separation and individuation difficulties

This case serves as a paradigm of concurrent treatment of a mother and child, where the central problem was one of separation-individuation. The nature of the child's presenting symptom of night terrors, the overinvolvement of the mother and the child, and the tendency of the child to withdraw from the outside world, all pointed to a child at risk for the more symptomatic development of school refusal and greater psychopathology. Since the treatment took place within a full service community mental health clinic, it was possible to provide psychiatric evaluation and consultation of both mother and child and the use of two therapists working collaboratively. With this method of treatment, the unfolding of both mother's and child's separation-individuation processes could be identified and utilized. Since she was an electively mute child who refused to come into the treatment room, another therapeutic tool became the use of the younger brother as a facilitator.     

A clinical contribution to the etiology of lesbianism

Lesbianism may be viewed as an attempt to rectify malfunctioning in the original mother/daughter dyad. This paper discusses how failure of the girl child to establish female identification is preceded by failure to individuate, causing regression to an earlier symbiotic stage, resulting in feelings and desire for merging. It is this failure in development, regression to the symbiotic stage and wish to merge which may be a crucial component in the lesbian personality. The course of treatment of a young woman, who was not sure whether she was lesbian or not, is described with focus on her request for a hypnotic session, which was done by another therapist.     

Perceived stress and adjustment in religious Jewish families with a child who is disabled.

We investigated 82 religious Israeli families who had a disabled child, many of whom had experienced economic strains, lack of community support, feelings of stigma, and lack of time. Results showed that families reporting a stronger impact associated with the care of the disabled member were smaller, faced more daily strains and hardships, had a boy with a disability, and a mother who was older. About 50% were rated by a school professional as coping and adjusting effectively. Many mothers and fathers maintained close contact with their own parents, frequently discussed the child's problems, and sought advice from health care professionals and from their spiritual leader. Most families needed financial assistance. Many would have benefited from relief services, parent training programs, and a stronger social support network.     

Co-creating change within a child protection system: integrating art therapy with family therapy practice

This paper considers family art therapy intervention using a partnership developed between an art therapist and a family therapist within a child protection system. The aim of this co-working relationship is to bring together skills that can amplify the child's voice within the family, using art as a means of extending the family story. The use of metaphor adds to the repertoire of skills available when working with families, and offers a particular form of communication in which children can more easily engage. By co-working, we also bring together our personal and professional stories, creating multiple ideas and ways of seeing and taking account of differences in the life experiences of individual families.     

“Sometimes I Feel Like a Motherless Child,a Long Way from Home”: Complex Adolescent Identity Formation in a Transcultural Adoption

During adolescence, concerns about identity come to the fore. Questions such as “Who am I?” and “Who am I in relation to other people?” present unusual difficulty for the adopted child, who must navigate the complex developmental task of including two sets of parents (and possibly several cultures) within his representational world. Adopted children must also integrate the knowledge that they were born to one set of parents but are being raised by another. When the child's physical characteristics are different from the adoptive parents, this further complicates identity issues. Even when children have developed a safe and secure attachment to the adoptive parents, knowing that they were born into this world by a mother who then gave them away can evoke feelings of being utterly alone, bereft, and unloved. When adopted children enter adolescence, these feelings can loom large and powerful, derailing the development of their sense of identity. Presented here is the case of an adolescent in a transracial adoption in which the boy left his adoptive mother's home in a cataclysmic crisis, feeling alone and motherless, to run to his adoptive father, who suffered from major depression. The mother, too, felt bereft, and the therapist initially felt unable to help.     

The merman: recovering from early abuse and loss

This paper explores once-weekly psychotherapy with a 10-year-old boy who had been physically abused and spent six years in various foster-homes before being placed with his birth father and family. This case has many parallels with the experience of late adopted children who may struggle to think about and emotionally digest the experiences of their early lives, while also facing the challenge of joining a new family. This boy's longing for, resentment of and identification with his birth mother were actively communicated through drawings and re-enactments. His expectation of an object as unpredictable and unreliable made it difficult for him to apprehend different experiences with his family and in therapy. Exploring the nature of his internal objects and gradually enabling him to bring feeling and thought into closer proximity provided one way of giving meaning to experiences he could not remember or understand. Technical difficulties in working with a child who actively flaunted the boundaries of the sessions are considered, as is the importance of a containing network surrounding the child.     

Parental Anxiety Disorders, Child Anxiety Disorders, and the Perceived Parent–Child Relationship in an Australian High-Risk Sample

This study was designed to explore the role of perceived parenting behavior in the relationship between parent and offspring anxiety disorders in a high-risk sample of adolescents. We examined the relationship between parental and child anxiety disorders and tested whether perceived parenting behavior acted as a mediator between these variables. Analyses were performed on a high-risk sample of 816 fifteen-year-olds drawn from a birth cohort in Queensland, Australia. Parental depression and income were covaried. Maternal anxiety disorder significantly predicted the presence of anxiety disorders in children; the association between paternal anxiety disorder and child anxiety disorder was not significant. There was no evidence that perceived parenting played a mediating role in the association between mother and child anxiety disorders. These results replicate earlier studies' findings of elevated rates of anxiety disorders among the offspring of anxious parents, but only when the child's mother is the anxious parent.     

Pete the diesel: Psychotherapy with a severely disturbed five-year-old boy

The psychic significance of the figure of the grandmother in psychodynamic psychotherapy has received scant attention. This paper develops the concept of the ‘grandmaternal transference’ in parent–infant psychotherapy and explores its identification, its possible functions and its therapeutic significance. The grandmaternal transference has special relevance to parent–infant psychotherapy since the grandmother often represents both the mother’s mother and the child’s grandmother and offers a unique third position between mother and child. Three clinical vignettes illustrate how the grandmaternal transference may operate in this third position. In the first vignette, the therapist becomes in the transference a containing grandmother thereby facilitating maternal containment. In the second case, the therapist may be experienced as a differentiating grandmother able to help mother and infant with separation and individuation. In the third one, the therapist is transferentially experienced as a paternal grandmother who acts as a pseudo-father able to embody the paternal function. In each of these positions, the transference and countertransference – whether positive or negative – require that the therapist responds to rather than enacts the grandmaternal role. The three configurations of the grandmaternal transference have different clinical manifestations and offer different therapeutic ports of entry.     

Countertransference,enactment and sexual abuse

This paper examines the development of a therapeutic relationship with a sexually abused latency girl who, in the course of her two years of four times weekly psychotherapy, was placed in two different foster-homes. It is argued that the child's re-enactment of the abuse in the consulting room allowed her to move from a seductive relationship with the therapist to one characterized by basic trust. This was paralleled by her development of a capacity to think and to tolerate affect states. The use of an imaginary twin by the child and the use of powerful countertransference feelings in the therapist are seen as the main therapeutic tools in the treatment. The premature termination of the treatment – due to the therapist's departure – enabled the child to articulate for the first time her feelings, in the transference, about the trauma and the traumatizing agent. The child's progressing moves in the therapy are also presented.     

Social punishment in the modification of a pre-school child's "autistic-like" behavior with a mother as therapist

The mother of a 3-yr-old girl who showed "autistic-like" behavior was cued via an FM wireless microphone systematically to approve and disapprove of her child's behavior. After baselines were taken on two categories of problem behavior (Pre-Academic and Social Behavior), the social contingencies were applied successively to each category. The Pre-Academic task was quickly established in the child when the mother applied these social contingencies. This result was replicated with requests for social interaction. In the final phase, cueing was withdrawn from both situations and the mother was able to maintain the child's improved behavior. An analysis of the mother's behavior suggested that her increased use of social punishment for inappropriate behavior was the key factor in the child's increasing responsiveness. Follow-up seven months later indicated that the improvements maintained.     

Maternal factors and experiences associated with observed parenting behavior in mothers attending a residential parenting program

Parents experiencing early parenting difficulties often seek support through parenting programs. Characteristics of mothers seeking parenting support and information at an early parenting center in Victoria, Australia and the relationships between these factors and parenting behavior were explored using an observational measure of parent–child interaction. Participants were 43 mothers and children attending a 5‐day residential parenting program at the Queen Elizabeth Centre. Maternal and sociodemographic data as well as an observational mother–child interaction task from the Nursing Child Assessment Satellite Training Parent Child Interaction Teaching scale were completed and scored on the first day of the program. Certain maternal factors and experiences were associated with observed parenting behavior. Poorer maternal sleeping quality, unplanned pregnancy and preterm birth were all associated with less optimal parenting behavior in certain domains. Findings are discussed with reference to the impact of past experiences around pregnancy and birth as well as the current context and well‐being of mothers attending early parenting centers.     

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.