The role of the body as the medium in child psychotherapy: snapshots of therapy with an 11-year-old,severely abused,multiply placed girl

In Victoria, Australia, children with a history of abuse and severe attachment difficulties, and who have experienced multiple carers and placements, have been traditionally viewed by mental health services as unsuitable for psychoanalytic psychotherapy. A number of factors, including the lack of integrated, long-term case planning; unstable residential placement; and the belief that psychotherapeutic treatment will be of an extended duration, have influenced the decision not to provide individual psychotherapy for these children. Currently, the movement within mental health services is towards responsive and briefer treatment models. The child psychotherapist is challenged to re-think theory, technique and practice. This paper identifies contextual constraints that have led to these children being precluded from accessing psychotherapy. An alternative model of intervention is discussed and illustrated with clinical material. The contributions of Alvarez, Trevarthen, Schore and other writers are drawn on to underpin the clinical work. This model involves a change in technique and role and the use of a time-limited intervention. Intrinsic to the model is the understanding of the child's psycho-biological experience of trauma and disrupted attachment. The child's experiences are conveyed in the pre-verbal, gestural domain to enable history to be given voice.     

In The Theater of Confusion: Mourning and Its Consequences for a Four-Year-Old Child

Abstract

Hyrck M. Inner Objects and the Christian Images of God. Int Forum Psychoanal 1997;6:41-43. Stockholm, ISSN 0803-706X.

Religion can be viewed very differently by different individuals. For some people it forms the basis of emotional safety while others regard it as the main obstacle to true humanity. One reason for this wide variance of opinion lies in the different ways that God can be perceived even within the same religious tradition. He can, for example, appear as a cosmic sadist torturing men eternally or as the vicariously suffering Christ sharing and containing the evils of mankins.

These and other images of God are analyzed by a systematic psychoanalytic instrument constructed upon the object relations theory. It describes five inner objects created by different partial drives or aspects of these drives. The inner objects are regarded as unconscious phantasies in the Kleinian sense. Five corresponding analoguous emotional images of God are abstracted from the Christian tradition.     

The personal life of the behavior analyst

The human species faces crises of critical proportions. Excessive population, global warming, and the anticipated descent from peak fossil-fuel extraction promise to change our future in far-reaching ways. Operant conditioning prepares the individual for a world similar to the selecting past, but our world is changing more rapidly than our adaptation. As individuals, we cannot make substantial changes in the world at large because we do not control enough reinforcers, but we can turn to the sources of our personal behavior and manipulate them. We will need help. Better organized social networks and the self-management techniques they support can promote immediate changes in consumption at home, work, and moving about in our personal worlds. Surprisingly, consuming less can lead to more satisfying and happier lives, but a better understanding of reinforcement contingencies is necessary. We can recover the strengthening effects of personal daily accomplishments that are eroded when conditioned generalized reinforcers intervene. When we get our own personal lives in order we can reduce our carbon footprints, restore the connections between our behavior and its strengthening effects, and become models worthy of imitation.     

The role of traumagenic dynamics on the psychological adjustment of survivors of child sexual abuse

The aim of this study was to analyse the consequences of child sexual abuse (CSA) on the psychological adjustment of survivors, as well as to determine the role of the feelings provoked by the abuse, following Finkelhor and Browne's traumagenic dynamics model (1985), on the adjustment of CSA victims. The sample of the study comprised 182 survivors of CSA, and another 182 participants selected as a comparison group. Results showed that CSA survivors, in contrast with the group of non-victims of CSA, had significantly higher scores on state anxiety, trait anxiety and depression, and lower on self-esteem. With regard to the role of traumagenic dynamics, feelings of powerlessness, self-blame, traumatic sexualization and, to a lesser extent, betrayal, predicted the scores of the CSA survivors in the four psychological adjustment variables assessed. To summarize, the results confirm the relation between CSA and the development of psychological problems in adulthood, explaining the survivors' feelings to a substantial extent the variability of adjustment.     

The Efficacy of Systemic Therapy for Childhood and Adolescent Externalizing Disorders: A Systematic Review of 47 RCT

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on “family‐based treatment” rather than on the theoretic orientation “systemic therapy.” We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems‐oriented therapy in various forms (family, individual, group, multi‐family group therapy) with child or adolescent index patients (0–17 years) suffering from mental disorders were identified by data base searches and cross‐references. Inclusion criteria were as follows: index patient diagnosed with a DSM‐ or ICD‐listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow‐up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow‐up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.     

Individual differences in effects of child care quality: The role of child affective self-regulation and gender

The current study investigated whether the relation between child care quality and children's socio-emotional behavior depended on children's affective self-regulation skills and gender. Participants were 545 children (M_age = 27 months) from 60 center-based child care centers in the Netherlands. Multi-level analyses showed that children with low affective self-regulation skills or who were male demonstrated less teacher-rated social competence when exposed to relatively low quality child care. In addition, children with low affective self-regulation skills also showed more social competence in the case of relatively high quality child care, suggesting mechanisms of differential susceptibility. No main effects of child care quality or interactions were found for teacher- and parent-rated externalizing behavior. These findings emphasize the importance of considering children's affective self-regulation skills and gender in understanding the effects of child care quality. High quality child care can be a means to strengthen children's social development.     

The use of the analyst as an autistic shape

In this paper I describe through detailed clinical material the challenges posed by patients who employ entangled autistic defenses. I discuss the complicated nature of treating a patient who employed entangled autistic defenses and utilized my voice in an effort to preserve an undifferentiated state of dual unity. My patient's pursuit of dual unity took a very concrete form in her attempt to mitigate the terror of separateness. This concreteness was expressed via the patient's urgent request that I read letters she wrote to me between sessions. This type of autistic defense placed great strain on my ability to think analytically and I also became increasingly concrete in my response to the patient. Crucial to the analyst's regaining a space in which to think and a sense of separateness is the ability to contact the ground floor of her separate bodily experience. This is just the beginning step in the analyst separating herself from the powerful press to join the patient in a state of dual unity. Interpretation in action (Ogden, 1994) was an effective way to convey the importance of creating and tolerating internal space in myself and begin to create internal space in the patient. Previously such space had been closed down in order to manage primitive fears of annihilation. When a patient is absorbed in an entangling autistic retreat words do not reach the patient on a symbolic level but rather are experienced primarily as an assault on the need for dual unity with the analyst. The patient's need to be wrapped in a sensation based world of dual unity is preferable to a world of spoken words that carry the danger of delineating psychic separateness. In essence there is no self to speak words, only a whirl of an amorphous sensation self lacking definition. I believe with certain kinds of patients it may be necessary to first lose and then work to regain one's analytic mind, as I have powerfully described in the case of Linda. Linda's profound loss of connection to the ground floor of her experience could only begin to be addressed when I worked to extricate myself from ‘our magic carpet ride’ of dual unity, contacting the reality of my bodily experience, and begin to tolerate the terror I felt regarding my separateness from Linda. I also describe the confusing vacillation between entangled and encapsulated defenses in patients like Linda as previously identified by Cohen and Jay (1996). Ultimately, this kind of slow difficult analytic work began to help Linda develop a capacity to think and provided an alternative to the deadened world of her autistic protections.     

The impact of a child bike seat and trailer on the objective overtaking behaviour of motorized vehicles passing cyclists

IntroductionThe lateral clearance distance of a motorized vehicle while overtaking a cyclist is a key indicator of safety. This lateral clearance distance has never been measured for cyclists transporting a child. Therefore the aim of this study was to investigate the behaviour of motorized vehicles in overtaking cyclists with and without a child on the same bicycle.MethodsThe lateral clearance distance of the overtaking manoeuvres of motorized vehicles was measured using an instrumented bicycle when performing 19 cycling trips on one single road with two different types of cycling infrastructure (a bike lane and shared lane marking) in the Brussels Capital Region (Belgium). Mixed effect regression was used to examine the effect of cycling condition (cyclist without a child [control], cyclist with a child bike seat and cyclist with a child bike trailer) and secondary independent variables (i.e. cycling infrastructure, peak traffic hours and traffic density) on the lateral clearance distance.ResultsThe mean lateral clearance distance in ‘cyclists without child’ was significantly smaller (117.3 cm) than in ‘cyclists with child’ (128.8 cm) (95%CI [7.2;15.9]). Looking at ‘morning peak traffic hours’ (i.e. 7:00 to 9:00 a.m.) a cyclist with child bike seat was overtaken at greater lateral clearance distances than a cyclist with a child bike trailer or a cyclist without child (p=0.041). Furthermore, the percentage of passing manoeuvres under 100 cm was significantly higher in ‘cyclist without child’ (35.3%) in comparison to ‘cyclist with child bike seat’ (21.8%) and ‘cyclist with child bike trailer’ (21.8%) (Chi2=29.19, p<0.001). No significant differences were found between a shared lane marking and bike lane.ConclusionDrivers of motorized vehicles do adapt their overtaking manoeuvre when they overtake cyclists transporting a child, keeping greater and therefore safer lateral clearance distances. In morning peak traffic hours and/or crowded circumstances the child bike seat can be considered as the safest way to transport a child in terms of lateral clearance distance. In general, with 25.3% overtaking manoeuvres under 100cm, police should monitor compliance with the traffic rules with regard to cyclists, and motorists should be more aware of the overtaking traffic rules.     

The Experiential Liberation Strategy of the Existential-Integrative Model of Therapy

This article summarizes the experiential liberation strategy of the existential-integrative (EI) model of therapy. The existential-integrative model of therapy provides one way to understand and coordinate a variety of intervention modes within an overarching ontological or experiential context. I will (1) define the experiential liberation strategy—such as its emphasis on the capacities to constrict, expand, and center psychophysiological capacities; (2) describe its salient features—such as the four stances that promote experiential liberation: presence, invoking the actual, vivifying and confronting resistance, and the cultivation of meaning and awe; and (3) illustrate the relevance of the strategy to case vignettes drawn from actual practice.

The affective experience of the analyst in the extra-analytic moment

This exploration of the extra-analytic moment focuses on the analyst’s affective experience of encountering her patient outside the boundaries of the consulting room. Two complex interactions are presented in which the analyst is challenged to confront known and unknown aspects of herself and negotiate her next move. The authors discuss the value of examining oneself beyond the traditional boundaries, and highlight the potential for personal and professional growth in moments when the analyst’s fallibility and humanity are unwittingly revealed. In allowing the unpredictable to become less of an unwanted event and more of an opportunity to express that which makes us human, our analytic work is enriched.Janet Rivkin Zuckerman, Ph.D., is Visiting Instructor at the Westchester Center for the Study of Psychoanalysis and Psychotherapy, Adjunct Clinical Supervisor at the Derner Institute, Adelphi University, and Ferkauf Graduate School, Yeshiva University, and Faculty Member and Supervisor at The Center for Preventive Psychiatry, White Plains, New York.Lisa Horelick, Psy.D., is Faculty Member and Supervisor at the Suffolk Institute for Psychotherapy and Psychoanalysis, Adjunct Clinical Supervisor at the Ferkauf Graduate School, Yeshiva University, and Supervisor at the Postdoctoral Program in Psychoanalysis and Psychotherapy, Derner Institute, Adelphi University, New York.     

The reality of the other: Dreaming of the analyst1

The author discusses the obstacles to symbolization encountered when the analyst appears in the first dream of an analysis: the reality of the other is represented through the seeming recognition of the person of the analyst, who is portrayed in undisguised form. The interpretation of this first dream gives rise to reflections on the meaning of the other’s reality in analysis: precisely this realistic representation indicates that the function of the other in the construction of the psychic world has been abolished. An analogous phenomenon is observed in the countertransference, as the analyst’s mental processes are occluded by an exclusively self‐generated interpretation of the patient’s psychic world. For the analyst too, the reality of the other proves not to play a significant part in the construction of her interpretation. A ‘turning‐point’ dream after five years bears witness to the power of the transforming function performed by the other throughout the analysis, by way of the representation of characters who stand for the necessary presence of a third party in the construction of a personal psychic reality. The author examines the mutual denial of the other’s otherness, as expressed by the vicissitudes of the transference and countertransference between analyst and patient, otherness being experienced as a disturbance of self‐sufficient narcissistic functioning. The paper ends with an analysis of the transformations that took place in the analytic relationship.     

Investigating the neurodevelopmental mediators of aggression in children with a history of child maltreatment:An exploratory field study

Maltreatment of children is a chronic community problem that increases the risk of future aggression. Despite several decades of research highlighting this relationship, few studies have explored the potential neuropsychological deficits that are likely to mediate it. This exploratory study aimed to examine how child maltreatment may be associated with aggression via impairment in the developing prefrontal-limbic-autonomic pathways that are implicated in neuropsychological models of aggression. Furthermore, it aimed to investigate the relationship between child maltreatment and both reactive and proactive aggression subtypes. To investigate this non-invasively in an at-risk population, children with a documented protective care history (n = 20) and a community control group (n = 30), aged between 6 and 12 years, were compared on measures of cardiovascular functioning, affect regulation and cognitive functioning aligned with this neuropsychological model. Whilst no group differences were found on cardiovascular functioning (i.e., resting heart rate, heart rate reactivity, heart rate variability), the protective care group performed significantly worse on measures of affect regulation and cognitive functioning (i.e., global intelligence, executive functioning, smell identification and social cognition). The relationship between child maltreatment and aggression was mediated by executive dysfunction and affect dysregulation but not global IQ, social cognition or olfactory identification. The results suggest that interventions targeting aggression in maltreated children will benefit from clinical assessment and psychological strategies that address the executive dysfunction and affect dysregulation that has been associated with this clinical outcome.     

The relationship between quantity,type, and timing of external childcare and child problem behaviour in Switzerland

This study aimed to investigate the relationship between external childcare and child problem behaviour at age 7 in a culturally diverse urban sample from Switzerland. We used data from the Zurich Project on the Social Development of Children and Youths (z-proso). Findings suggested that the quantity of group-based childcare (but not individual childcare) was related to aggression, ADHD, non-aggressive externalizing behaviour, and anxiety and depression at age 7. Analyses on timing of childcare suggested that the accumulation of childcare over the life course, and not so much childcare in the first years of life, was associated with child problem behaviour. In addition, childcare at age 5 to 7 had a unique relationship with problem behaviour over and above quantity of group-based childcare received in other age periods.     

The writing of clinical papers: the analyst as illusionist

Rather than begin by defining what we mean when we call a paper 'clinical', I would like to reflect on how such a piece of work originates, how, through the interplay between the written and the spoken word, it becomes clinical and good enough for a professional journal.
In the following, I shall pay particular attention to recent publications from the editorial side, that is, those by Wharton, one of the three editors of The Journal of Analytical Psychology , and by Tuckett, editor of The International Journal of Psycho-Analysis . I shall plead that there should not only be one kind of clinical paper, namely the type that for political reasons seems to be the one that is most wanted at the present time and the aim of which is to put psychoanalysis on more secure foundations than it currently is.     

Prospective relations between maternal autonomy support and child executive functioning: investigating the mediating role of child language ability

Although emerging evidence suggests that parental behavior is related to the development of child executive functioning (EF), the mechanisms through which parenting affects child EF have yet to be investigated. The goal of this study was to examine the potential mediating role of child language in the prospective relation between maternal autonomy support and child EF. A total of 53 mother–infant dyads took part in three home visits at 15 months, 2 years, and 3 years, allowing for the assessment of maternal autonomy support (T1), child expressive vocabulary (T2), and child EF (T3). The results suggested that child language played a mediating role in the relation between maternal autonomy support and child performance on EF tasks entailing a strong impulse control component above and beyond child previous EF and family socioeconomic status (SES). In contrast, no such mediating role of language was found with EF tasks tapping mostly into working memory and set shifting. Thus, this study highlights one pathway through which parenting can affect child executive control.     

The measure of a nation: The USDA and the rise of survey methodology

Survey research has played a major role in American social science. An outgrowth of efforts by the United States Department of Agriculture in the 1930s, the Division of Program Surveys (DPS) played an important role in the development of survey methodology. The DPS was headed by the ambitious and entrepreneurial Rensis Likert, populated by young and talented social scientists getting their first practical experience, and fed by the needs of the US government fighting World War II. The DPS innovations included open-ended interviewing and area probability sampling methodology as illustrated in the War Bond studies and the Master Sample of Agriculture. This paper examines the creation of the DPS, its work, and its legacy.     

Every Child Still Matters: interdisciplinary approaches to the spirituality of the child

Abstract

Ten years ago, I was a researcher with the Evaluation of Children’s Trusts which examined a key aspect of U.K. government policy, Every Child Matters. Every Child Matters was partly a response to Lord Laming’s 2003 report into the murder of 8-year old Victoria Climbié, which concluded that children’s services needed to be better integrated to avoid such tragedies in the future. Children’s Trusts were regional hubs, set-up across England to facilitate integrated professional practice; but Every Child Matters was bigger than this because it set out a policy vision for rethinking the child as a whole person. At the time, I was struck by the absence of any reference to spirituality in this new holistic view of the child, and this led me to write an article which was published in 2006 entitled, ‘Every Child Matters and children’s spiritual rights: does the new holistic approach to children’s care address children’s spiritual well-being?’.

This article was originally a keynote talk at the 2016 International Conference on Children’s Spirituality with the theme Spirituality and the whole child: interdisciplinary approaches, and this provided the opportunity both to see where we are now with integrated working for children and young people more generally, and to focus our attention on interdisciplinary approaches to children’s spirituality and the whole child in particular. The article begins by summarising some of the current thinking spirituality, the whole child and interdisciplinary working. The article then goes on to consider a long-standing concern of mine, and one which was highlighted in my 2006 article, which is what we intend to mean – collectively, as academics and professional practitioners concerned with children’s (and adults’) spirituality – when we use the term ‘spirituality’ in the professional context. In my view, it is time to stop stating that spirituality is hard to define, and come to an agreement about what we mean when we use it. Interdisciplinary approaches to children’s (and adults’) spirituality, and holistic approaches to the child (and adult), will not be successful unless there is a clear, shared agreement about what we mean, and the article ends with suggestions for ways forward.     

The Boulder Model in Academia: Struggling to Integrate the Science and Practice of Psychology

For many professionals, the Boulder model captures the ideals of clinical psychology. Unfortunately, it can be extremely difficult to integrate science and practice in many work settings. The present paper provides several recommendations for encouraging the scientist-practitioner model in academia. Faculty can strive to integrate teaching, research, and clinical services in weekly activities. First, it is important for the professional to retain a strong and clear focus on clinical psychology, without straying into allied fields. Second, it is essential for anyone who works in academia to learn to juggle many different activities that demand the professional’s time. Third, it is important to maintain a consistent focus on specific areas of interest in order to cultivate them into domains of expertise. Fourth, it is helpful to appreciate the synergism whereby work in one area can enhance the other domains. Fifth, it is helpful to integrate several activities into one multi-purpose task. Finally, it can be useful to view professional involvement in many different activities that could help to advance the field.