A cognitive-linguistic intervention model for mother-infant Pairs: Birth-to-three

There is a challenge to develop an educational technology which promotes cognitive and linguistic competency among children of the poor. Researchers who have studied early interactions between mother and child and service deliverers who have implemented parenting programs recognize the link between cognitive and language development. The focus of this paper is a curriculum model which includes both areas of development. The interactive behaviors of mother and child during three successive stages of the child's development (0–9 months, 9–18 months, and 18–36 months) from the matrix of the cognitive-linguistic intervention model.     

Successful intervention with multi-problem mothers: Effects on the mother-infant relationship

A two-step model of intervention for multi-problem mothers was proposed. In order to improve mother-child interaction and later developmental outcomes, the first step is for the practitioner to help the mother change her external competencies (adult social skills) and internal perceptions (support, depression). These changes make the second step possible—the mother then can learn to foster her own child's development. The model was tested in a study of 95 multi-problem women who participated in a nursing intervention program from mid-pregnancy through the child's first birthday. The results supported the two-step model. Improvements in the mothers' external competencies were related to completion of intervention goals. These external improvements also were related to more optimal patterns of mother-child interaction during teaching and feeding episodes at 1 year. Furthermore, an especially insecure type of attachment relationship was found more frequently among the infants of mothers in the group that did not improve. Changes in internal perceptions were unrelated to intervention or interaction measures. These unexpected results suggest that the mother's internal improvements may have a more delayed or a less direct effect upon the child.     

Psychoanalysis, psychoanalytic science, and psychoanalytic research--1986

The present standing of psychoanalysis as a science and the vitality of psychoanalytic research effort are reviewed. The two are interdependent, since the possibilities for empirical research rest on the necessary assumption that psychoanalysis is indeed enough a science to be susceptible to knowledge advance by the (research) methods of science. Concerning our status as a science, I review attacks on our scientific credentials (both from within our ranks and without) by the logical positivists, by the hermeneuticists (a rubric comprising a variety of hermeneutic, phenomenological, exclusively subjectivistic, and/or linguistically based conceptualizations of our field), and the most recent by the philosopher of science, Adolf Grünbaum. I try to demonstrate what I feel to be the failure of each of these assaults, and why I feel there is no reason to see psychoanalysis as anything other than a scientific psychology and, therefore, in theory amenable to empirical research approaches. I then review the history and the current status of these systematic research efforts in psychoanalysis, and the reasons why these have been far less in scope and in accomplishment than has been possible or than has been needed. Here I have focused especially on research involving technique and our theory of change and cure--i.e., research on the analytic process; on what changes take place (outcome) and how those changes come about or are brought about (process).     

Ladies in waiting: a group intervention for families coping with deployed soldiers

It is widely recognized that military service during wartime can take a toll on a soldier's psychological health. Recent work has revealed effects on the families left behind as well, as reflected, for example, in an increase in child abuse and neglect in these families. My interest in studying the transgenerational transmission of trauma led me to offer the National Guard a pro bono group therapy for women whose husbands had been deployed overseas. A slightly unorthodox approach paved the way not only to group treatment but, ultimately, individual treatment for these women and their children. My hope is that this work can serve as a model for other therapists who share my interest in treating the intergenerational transmission of trauma by implementing group and mother-child psychotherapy.     

Neonatal imitation, gaze aversion, and mother-infant interaction

A relationship between elicited imitation in neonates and social interaction has been proposed by several investigators. The present work examines if such a relationship can be found when studying neonatal imitation, gaze aversion, and mother-infant interaction. Thirty-two infants were observed at 2 to 3 days, 3 weeks, and 3 months of age. Imitation of tongue protrusion and mouth opening was assessed in all three observations. In addition, a face-to-face interaction between mother and child was included when the child reached 3 months of age. The most striking result was a negative relationship between the infants' brief gaze aversion observed at 3 months of age while interacting with their mothers and the infants' imitative reactions at 2 to 3 days, 3 weeks, and 3 months of age. Behaviorally, these patterns indicate that high-imitating infants tend to display fewer episodes of brief gaze aversion when interacting with their mothers.     

From principles to principals: The new direction in medical ethics

Many alternatives or supplements to principalism seek to reconnect medical ethics with the thoughts, feelings, and motivations of the persons directly involved in ethically troublesome situations. This shift of attention, from deeds to doers, from principles to principals, acknowledges the importance of the moral agents involved in the situation — particular practitioners, patients, and families. Taking into account the subjective, lived experience of moral decision-making parallels recent efforts in the teaching of medicine to give the patient's subjectivity — his or her personal experience of being sick or disabled — epistemological parity with scientific medicine's objective, biomedically-oriented view of the person's sickness or disability.Moreover, the shift from principalism to principals signals a growing realization that ethical problems in the profession of medicine are inseparable from its practice. Philosophers and other humanists working in medicine should resist the temptation to institutionalize a professional role as solver of ethical problems, clarifier of values, or mediator of disputes and work instead to help practitioners practice medicine reflectively.     

Watching My Weight: Self-Weighing, Body Surveillance, and Body Dissatisfaction

Understanding of the benefits of self-weighing are currently mixed, particularly with respect to women??s psychological health. Applying Objectification theory (Fredrickson and Roberts 1997), we explored the role of body surveillance as a mechanism in the link between self-weighing, a common weight management technique, and body dissatisfaction. The study was cross-sectional and the sample included primarily Caucasian, US college students from the Northeast (N?=?145). Participants completed measures of self-weighing, body surveillance, and body dissatisfaction. We predicted that body surveillance would mediate the positive relation between self-weighing and body dissatisfaction. Results supported our prediction; however additional work is necessary to clarify the potential negative effects of self-weighing on women??s body image.     

Dramatology in life,disorder, and psychoanalytic therapy: A further contribution to interpersonal psychoanalysis

Abstract

Action and interaction, and emotion and thought as the inner wellsprings of action, play a central role in the lives of individuals, families, and society, spanning the continuum between everyday life and disorder. Until now, the narrative tradition has been the main methodology for portraying and formulating human action and interaction, and little has been written about the dramatic approach to life, disorder, and therapy. Since the essence of drama is action, dialogue, character, and emotion, it is time to give drama its due. The author proposes a methodological concept – dramatology – analogous to narratology, to highlight the dramatic method of investigating action and interaction in life, disorder, and therapy. Breuer and Freud presented both aspects of dramatology: dramatization in dream and fantasy, and dramatization in act, focusing on the person. This approach was elaborated by psychoanalysts with an interpersonal orientation, focusing on the person and speech as action. Dramatology is applied to exploring ongoing patient–therapist interactions as reality and as transference. Analyzing unconscious and latent dramatization in dream, fantasy, and enactment with free association is enhanced by utilizing clarification and confrontation, focusing on the manifest and mutually observable expressive form and style of actions and enactments, defenses and resistances, and the discharge and meaning of emotions. Dramatology puts forward a new paradigm for psychiatry, psychotherapy, and psychoanalysis.     

Intervention to improve mother-infant interaction and infant development

Thirty-three infants at risk for developmental delay were videotaped interacting with their mothers. Maternal position during interaction (facing, beside, or behind the infant) was strongly related to the frequency of maternal interactional behavior and to indices of infant communication and cognitive development. Intervention to teach mothers to use the facing position showed that improvement in position was related to increases in both maternal interactional behavior and infant development. Because the mother's position is easily assessed, understood, and changed by a mother, it is potentially useful to early intervention programs, particularly those serving at risk populations.     

Acting,feeling and thinking: psychoanalytic psychotherapy with Tracey

This paper consists of a case study and commentary which formed a part of the inaugural lecture in a series entitled ‘Working with Psychosomatic Issues’*. The audience consisted of psychoanalytic, body psychotherapy and integrative practitioners. The presentation was divided into three parts, (1) an outline of philosophical themes that inform perspectives on health, illness and psychosomatic phenomena, (2) the case study reproduced below and (3) a summary of Winnicott's work (1960, 1966, 1988) on ‘the indwelling of the psyche in the soma’. The case study describes work with a young woman who harms herself through self-hitting and, in addition, expresses other physical manifestations of psychological distress. The core approach of the practitioner is psychoanalytic. The work is informed also by postmodern sensibilities and phenomenological themes.     

Poetic closure, psychoanalytic termination, and death

Our pull to grasp narrative structures--including beginnings and especially endings--applies not only to the intentional craft of fictions, but to life as lived, as it is in psychoanalytic termination. Remarkable parallels, for instance, exist between thematic closure in poems and the conscious and unconscious signals of closure that develop in pretermination and accelerate in termination proper. A case illustrates this point: the slow crescendo of cues begins months before the first "pretermination dream." It is the patient's emerging awareness of greater health and freer functioning that likely gives rise to these phenomena, yet this awareness is often warded off because of the grave task of ending that it implies. Literature and psychoanalysis share concerns with how an ending is borne. Fictive closure and apocalyptic narratives allude to or imply finality (i.e., death), and lesser "endings" in daily life may not escape the specter of that linkage. But Kermode asserts that "ending" confers significance on an entire narrative and may thereby console us. Coltart links the realities of mortality and psychoanalytic termination, yet falls short of consolation. Clues to the role of beginnings (in final matters) and how they may help emerge from considering Basho's last days and poems. Nonetheless, the power of narrative has its limits in helping us bear the burden of a real ending, as of an analysis. Joining present to future, as through normal hope, or joining present to past through normal nostalgia, works toward a "bearing of the burden"--but only within the context of health achieved through the analysis.     

Coregulation in mother-infant dyads: links to infants' cardiac vagal tone

This investigation explored links between mother-infant coregulated communication patterns and infants' emerging parasympathetic regulatory processes (cardiac vagal tone). Participants included 56 first-time mothers and their 6-mo.-old infants (31 girls, 25 boys). A 4-min. baseline EKG was gathered from the infant and an ensuing 15-min. mother-infant dyadic free-play episode was videotaped and coded using Fogel's 1994 Regional Coding System. This system was developed to describe variations in coregulated features of communication among dyads, ranging from symmetrical patterns to disruptive patterns of coregulation. Analysis suggests a positive link between infants' cardiac vagal tone and more symmetrical features of coregulated communication patterns in mother-infant dyads. Cardiac vagal tone was also negatively correlated with unilateral features of coregulation communication systems. These findings point toward the potential relation between emerging physiological regulatory abilities of infants and the more relational regulatory processes in mother-infant dyads.