A Mother,A Baby,and Two Treatment Approaches: Discussing A Switch Case from CBT and Mentalization Perspectives

ABSTRACT

As the literature on perinatal depression and anxiety grows, there is an increased need for dialogue among theoretical approaches for mother-infant mental health. This article describes a community mental health program incorporating a range of treatment models for pregnant and postpartum women experiencing issues during the transition to parenthood. Perinatal distress can affect parenting practices, from breastfeeding to health care access, creating the need for targeted, practical, and concrete interventions. Interventions that aim to foster secure attachment relationships and mentalization capacities can also help increase maternal sensitivity and attunement and joy in caregiving, and reduce withdrawn/hostile behaviors that may be associated with perinatal distress. The article describes psychotherapy with a mother and her newborn that began from a cognitive-behavioral approach and transitioned to a psychodynamic mentalization-focused treatment. Working principles and examples of two additional components of treatment, a group psychotherapy and research measures, are discussed. The case helps demonstrate how attachment theory can inform treatment and build a bridge between alternative approaches.     

A MEDIATIONAL MODEL RELATING SOCIOTROPY, AMBIVALENCE OVER EMOTIONAL EXPRESSION, AND DISORDERED EATING

Two factors that have been found to predict eating disorders are sociotropy or dependent personality style and ambivalence over emotional expression, but there has been little consideration of the relationship between them and how this relationship may contribute to an understanding of eating disorders. A mediational model is proposed in which high sociotropy leads to greater ambivalence over expressing emotions, which in turn increases vulnerability to eating disorders. Consistent with predictions, among 115 college women, a high level of sociotropy was associated with a high level of ambivalence over emotional expression, which in turn was associated with increased disordered eating. Furthermore, ambivalence over emotional expression significantly mediated the effect of sociotropy on disordered eating, even when controlling for depression level. Findings are considered within a developmental framework, and treatment implications are discussed.     

A Model of Marital Resolution

SUMMARY

This article describes a brief model for exploring reconciliation with couples seeking divorce mediation. The model entails a sequence of individual and conjoint sessions, which are illustrated by a case example. The roles of attachment and ambivalence are presented for the model. Ethical issues related to discussing possible reconciliation with couples considering divorce are discussed and the distinction between mediation and psychotherapy is developed. The article concludes with contraindications and recommendations for the future.     

The Present Status of Group Therapy in United States Correctional Institutions

A time-limited group treatment program focusing on mothers of toddlers with a borderline personality disorder is reported. The project involved two intersecting groups—the toddler group and the mother group. The focus of the work with the children was to promote their social interests and skills to an expanded world beyond the maternal dyad. The focus of the work with the mothers was on their difficulties with emotional separation-individuation and on strengthening their ego functioning, particularly in the area of mothering so that they could participate positively in their child's separation-individuation phase.

Representative group process is presented as it organized around three distinct phases. The initial phase was marked by intense resistance, and ambivalence. During the middle phase, group cohesion developed around shared feelings and issues. The termination phase focused insistently on issues of separation. Conclusions drawn from the project include the utility of a group approach in influencing maternal behavior.     

A Prime Time for Marital/Relational Intervention: A Review of the Transition to Parenthood Literature with Treatment Recommendations

The transition to parenthood is a near universal experience for individuals and families, yet there is a severe lack of applied research and clinical treatment guidelines. Justification for a greater clinical emphasis on this transition is made through a review of the common changes experienced by new parents. Intervention guidelines are offered in the areas of client/participant recruitment, assessment, and clinical areas of focus. Specific topics that should be addressed in treatment include the parents' family-of-origin influences and individual personality characteristics, changes experienced in the couple relationship, and important contextual issues.     

Changes in patterns of Early Mother-Child Interaction: A longitudinal study of the first 18 months of life

ObjectiveThe main objective of the present longitudinal study is to describe the progression of early adult-child interactions between the first and second years of life. Changes identified in interactions are described, focusing on both the qualitative aspects of maternal responses, as well as maternal response latency to the child's behavior using a microanalytical methodology that collected data on maternal and child behavior in real-time without losing sight of the temporal dimension.ParticipantsThis study examined 52 mother-child dyads from intact families that presented no psychological, social, or biological risk factors at 6, 12 and 18 months of age.InstrumentCITMI-R (early mother-child interaction coding system, revised edition) was used to assess early mother-infant interactions during free play sessions between mother and child the.ResultsThe results indicate that some components of maternal sensitivity improve as children progress towards the second year of life, detecting an increase in sensitive maternal behavior and a decrease in intrusive behavior in the evolutive observed period; moreover, regarding latency of maternal response, we observed that mothers of older children give more time for their children to explore, which stimulates autonomy. Finally, the implication of these results for intervention directed to optimizing early adult-child interactions are addressed.     

Restoration of Intimacy and Connection in the Treatment of Couples with Substance Abuse Issues

SUMMARY

Addictions destroy both individuals and in particular their intimate relationships. Couples remain together for many reasons and when one partner has an addiction, the spouse has the fantasy that when the addiction is addressed the couple relationship will return to ‘normal.’ This article focuses on couple issues that have not been addressed in addiction treatment facilities and examines the role of the couple therapist versus the addiction counselor. Techniques and clinical interventions with this population are discussed and illustrated by case examples.     

Rational suicide and the crisis of terminal illness

Abstract

One of the controversial issues facing counselors in the 1990s is whether or not suicide may be considered a rational choice for clients with terminal illness. This article begins by reviewing the definition of rational suicide and the literature and statistics pertaining to suicide and terminal illness. Then various issues related to rational suicide as a treatment option are addressed, including moral and ethical issues.     

Battle of the dinosaurs: The impact of internalized bad paternal and maternal objects in a three-year-old boy

Abstract

This paper begins with a summary of W. Ronald D. Fairbairn's object relations theory, with particular focus on his ideas of how paternal objects are internalized alongside maternal objects. A case is then presented of a three-year-old boy who experienced deprivation and frustration from both his mother and father, thus initiating the internalization of bad paternal and maternal objects. Assessment and implications for treatment are then discussed using Fairbairn's model as an organizing framework for developing goals and interventions, and monitoring treatment progress.     

Depression in South Asian women: Asian women's beliefs on causes and cures

A qualitative, grounded theory approach within a constructivist paradigm is employed to explore perceptions of causes and cures of depression in South Asian women. Ten Asian women suffering from depression and three of their carers were interviewed about their beliefs around the cause of their own and their relative's depression, and the implications of these beliefs for treatment. Findings suggested that understanding their experience of conflicting cultural expectations, distinctions between psychosocial, spiritual, physical health problems and communication problems (general and culture specific) were central to these women's experiences of depression The implications of results for services are discussed and limitations of the study considered in line with criteria developed for constructivist research.     

Living with depression: Coping strategies used by South Asian women,living in the UK,suffering from depression

This brief study employed a qualitative, grounded theory approach within a constructivist paradigm, to explore the coping strategies used by Asian women suffering from depression. Ten Asian women were interviewed about their choice of coping strategies, factors affecting this and how this relates to treatment. The patients were interviewed individually using a brief semi-structured interview. The data were gathered and analysed according to the grounded-theory approach. Findings revealed that coping strategies included religion and prayer, talking, crying and self harm. The strategies were mediated by the individual's perception of the problem as depression, motivating factors and access to help. A distinction is made between general and culture-specific coping strategies and clinical implications for mental health services are also briefly discussed. Limitations of the study were also presented in line with qualitative research guidelines.     

The impact of maternal postnatal depression on men and their ways of fathering: an interpretative phenomenological analysis

Objectives: Postnatal depression affects approximately 15% of women in Western countries. There are conflicting findings about the effects on fathers as well as the extent to which fathers buffer against the negative effects of depression on children. This study sought to understand the ways in which maternal postnatal depression affects men and their ways of fathering.

Design: Narrative interviews were conducted with 14 British fathers (mean age?=?33.9?years) whose (ex)partners had experienced at least one episode of postnatal depression. Interviews explored how their partner’s depression affected them, the partner relationship, their children and their ways of fathering. Data were analysed with interpretative phenomenological analysis.

Results and Conclusions: Men felt that their partner’s depression led to significant physical and/or psychological maternal absence as well as a fracturing of the family unit, which had been an important ideological foundation for men’s fathering. Unequal divisions of labour, unfulfilled expectations, a thwarting of preferred ways of fathering and preoccupation with their partner’s depression took some men away from fathering. Others reported adaptation by accepting the loss of shared parenting and investing in an exclusive father–child relationship. Fathering appears to be particularly affected by the loss of a close adult relationship.     

Evidence for Discontinuity Patterns Across the Stages of Change: A Role for Attitudinal Ambivalence

Cross-sectional analyses of the transtheoretical ("stages of change") model (TTM) can provide valuable information concerning the variables that are likely to shift individuals from one stage to the next. The present study was designed to investigate the roles of theory of planned behaviour (TPB) variables and attitudinal ambivalence across the stages of change. Two samples derived from the general population completed measures of stage, TPB and attitudinal ambivalence with respect to consuming a low-fat diet (n = 148) and eating five portions of fruit and vegetables per day (n = 151). Consistent with previous research, the present study found linear increases in TPB variables across the stages of change. However, as predicted, attitudinal ambivalence showed discontinuity patterns, displaying a quadratic relationship with the stages of change, such that least ambivalence was experienced in the precontemplation and maintenance stages. Discussion of the findings focuses on implications for the development of theory-driven interventions.     

Ambivalence under scrutiny: Returning to the future

Abstract

This Special Issue on the study of ambivalent processes in psychology integrates issues from contemporary evolutionary, cognitive, and cultural psychology with new directions of formal models that are available in qualitative mathematics. Tribute is paid to the pioneer of the study of ambivalence—Else Frenkel-Brunswik. Her work antedates most of our contemporary efforts in this field. Becoming free from the limits of its obsession with numbers in lieu of “measurement”, psychology at our time faces the challenge of investigation of dynamic psychological complexity. Contemporary mathematics—which is qualitative in its nature—provides new opportunities for psychology. New mathematical models—based on topology (Morse functions) and from intuitionistic formal logic (theory of locales)—are shown to provide promising new directions for future research on ambivalence. The emphasis on mathematical tools as enablement devices for psychological theorizing leads psychology to the need to create new kinds of generalized understanding of complex psychological processes.     

Addressing Cultural Factors in Development of System Interventions

SUMMARY

The purpose of this article is to address various issues concerning multicultural interventions at a system level. Diversity is presented through a different conceptual approach and specific implications for school psychological practice are addressed. In this theoretical context an alternative model of school psychological services that was developed in the Greek educational system is presented and a primary intervention program is described as a paradigm of multicultural system/community intervention. Finally, the components of a transnational approach to multicultural system/community interventions that provides the basic procedural guidelines to developing effective, culturally sensitive interventions in the school environment is proposed.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Male Cross-Dressers in Therapy: A Solution-Focused Perspective for Marriage

This paper offers techniques on how to work with male cross-dressers using solution-focused therapy. An overview about issues crossdressers often face is addressed which shows they have many of the same concerns as other clients seeking therapy. Solution-focused therapy is discussed as a way to work with male-cross dressers and their partners. A case study of a male cross-dresser and his wife is presented and possible directions are suggested for marriage and family therapists.     

A randomised controlled trial of a brief online mindfulness-based intervention

ObjectivesThere is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population.MethodOne hundred and four students were randomly allocated to either immediately start a two-week, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period.ResultsIntention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group.ConclusionsThis provides evidence in support of the feasibility and effectiveness of shorter self-guided mindfulness-based interventions. The limitations and implications of this study for clinical practice are discussed.