On psychic elements in a case of autistoid perversion

The paper explores the formation of psychic elements from an epistemological point of view, drawing on the work of Bion to examine a clinical case of autistoid perversion. Distinguishing the qualification of psychic elements from the realization of pre‐conceptions, the paper argues that psychical elements are constituted through a mutually shared experience of presence, and so they should be understood in a paradoxical way – through being‐O and transformations into K. These ideas are explored via a clinical case concerning a patient with an autistoid–perverse organization. The patient had been denied any bodily contact with her parents during her first year of life due to an infection; in later life she exhibited an autistoid coprophilic perversion. During the course of her treatment, as it became possible to break down the autistoid organization, the nameless contents surfaced in a mutually shared experience of presence. The analyst was able to hold on to their meaning, which was unavailable to the patient. The absent analyst, however, turned into the mother who ‘put the child down’ and was experienced by the patient as a suicidal threat. In being‐O, the analyst was able to endure the paradox of being the one who ‘put her down’ in order not to put her down; the paradox of being‐O functioned as a container for the destructive objectal dimension of the state of ‘being put down’.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.     

The use of child drawings to explore the dual↔group analytic field in child analysis

Awareness that the child is part of a complex relational system has ensured that all child analysts agree on the necessity of establishing a therapeutic alliance with the parents. Unconscious conflictual dynamics involve the child analyst and include him, from the time of the initial consultation, in an analytic field that is closer to that of a group than to the bi‐personal set‐up of therapy with adults. Through a clinical example, the author hypothesizes that the child’s drawings and play can be viewed as tools capable of mapping the unconscious emotions present in an analytic field that extends beyond the analyst–child couple. Play and drawings can be used in the relationship with the parents not in an explanatory sense, but as a probe with which to explore the universe of unconscious emotions present in the group field. The images or the story of the play used with this particular modality prove to be an attractive pathway that is effective in facilitating the alpha function of each of the members of the group. Furthermore, in this sense, they create the conditions for an occasion through which the parents can become more aware of their own unconscious emotions that have been entrusted to the child and expressed through his symptomatology. The possibility for the little group of subjects involved in a child analysis for oscillation in a dual–group field permits not only a shared experience of knowledge, but also a shared creativity aimed at knowledge of emotional truth (O).     

How Can I Help You? Dimensional versus Categorical Distinctions in the Assessment for Child Analysis and Child Psychotherapy

ABSTRACT

This paper describes the process of a psychoanalytically-informed or a psychodynamic diagnostic assessment with children, contrasting it with a DSM-like diagnostic process. The importance of understanding and sensitively addressing the experience of parents when they bring their child to a professional for help is highlighted. The promotion of a psychoanalytic atmosphere, the unique contribution of a child analyst or psychodynamic clinician to the general mental health field, is an approach which promotes the development of a therapeutic alliance. This allows both parents and children to express their underlying issues as openly as possible. In addition to the basic assumptions of psychoanalysis (the ubiquity of unconscious mental activity and the impact of the past on the present/the developmental perspective), several factors are crucial to bear in mind: the importance of understanding the nature of the child’s (and the parent’s) emotions, emotion regulation, development of mental representations of self and other, and their conflicts and defense mechanisms. Potential therapeutic approaches are highlighted, including stressing the need to empirically study how decisions are made by a mental health provider when moving from assessment to treatment recommendation.     

Clinical Assessment of Prementalizing Modes of Psychic Functioning in Children and Their Parents in the Context of Trauma

ABSTRACT

As psychoanalytic psychotherapy for children depends on their capacity to mentalize, it is essential to integrate this dimension in their psychological assessment. Mentalization refers to the capacity to identify and comprehend the mental states (feelings, thoughts and intentions) underlying and explaining one’s own behaviors and those of others. This vital ability, which develops during the first five or six years of life in the context of a secure parent-child attachment, is often impaired in children subjected to neglect and maltreatment. Based on rigorous and systematic clinical observations made in youth protection and child psychiatry services, the authors suggest that the children in these settings, along with their parents, frequently present a prementalizing mode of psychic functioning. Further, the authors propose operationalizing the teleological, psychic equivalence, and pretend modes as they might be observed in older children and their parents. To this end, they begin by identifying behaviors, attitudes, and relational patterns potentially linked to each of these modes within a theoretical framework. Next, they describe the characteristics of these children’s narratives, play, and artistic productions. Lastly, three clinical vignettes are used to illustrate how the prementalizing modes are manifested. The results of this clinical assessment can guide the choice of techniques to be used in child psychotherapy.     

The Effects of Mother Participation in Relationship Education on Coparenting,Parenting, and Child Social Competence: Modeling Spillover Effects for Low‐Income Minority Preschool Children

Although suggestions are that benefits of relationship and marriage education (RME) participation extend from the interparental relationship with parenting and child outcomes, few evaluation studies of RME test these assumptions and the relationship among changes in these areas. This quasi‐experimental study focuses on a parallel process growth model that tests a spillover hypothesis of program effects and finds, in a sample of low‐income minority mothers with a child attending a Head Start program, that increases in mother reports of coparenting agreement for RME participants predict decreases in their reports of punitive parenting behaviors. Although improvements in parenting behaviors did not predict increases in teacher reports of children's social competence, improvements in coparenting agreement were associated with increases in children's social competence over time. In addition, comparative tests of outcomes between parents in the program and parents in a comparison group reveal that RME program participants (n = 171) demonstrate significant improvements compared to nonparticipants (n = 143) on coparenting agreement, parenting practices, and teachers' reports of preschool children's social competence over a 1 year period. The findings are offered as a step forward in better understanding the experiences of low‐resource participants in RME. Implications for future research are discussed.     

Mentalization-Based Interventions in Child Psychiatry and Youth Protection Services I: Objectives,Setting, General Principles and Strategies

ABSTRACT

Many of the children who receive services in child psychiatry or are in the care of Youth Protection Services present with complex, multiple and often severe problems. Classic psychodynamic psychotherapy seems to be of little benefit to them. The majority of these children tend to not use symbolic play as a means of expressing their intrapsychic conflicts or relational difficulties and they do not verbally communicate much with clinicians. They are more likely to display an imaginative poverty that translates into boredom, motor discharge, and an inability to use the material put at their disposal for therapeutic purposes. The systematic and rigorous observations of these children in Quebec revealed that the majority of them present with severe mentalizing difficulties. They often show attitudes and behaviors linked to the prementalizing modes of psychic functioning. This article presents a mentalization-based intervention adapted to these children’s difficulties. The objectives, adaptation of the work setting, and general principles underlying this intervention are discussed. In addition, general intervention strategies are also covered. These interventions are considered as preparatory work whose principal purpose is to enable children to benefit later on from psychodynamic psychotherapy. The authors also recommend specific intervention strategies adapted to children’s predominant mode of psychic functioning. The details of these strategies will be shared in a separate article.     

Psychological Consequences of Pregnancy Loss and Infant Death in a Sample of Bereaved Parents

This study aimed to explore a broad range of psychological reactions to trauma in a sample of bereaved parents in order to assess whether the traumatic framework is adequate for describing the entire range of emotional reactions to infant death. A sample of bereaved parents (N = 455) who lost their child through perinatal or postnatal loss were compared to a control group of parents (N = 110) who gave birth to a healthy child. Multivariate regression analysis clearly demonstrated that bereaved parents scored significantly higher on the Depression, Anxiety, Dissociation, Sleep Disturbances, Somatization, Interpersonal Sensitivity, and Aggression subscales of the Trauma Symptom Checklist. Consistent with previous studies, the results showed that for up to 5 years postloss bereaved parents expressed elevated levels of trauma-specific and psychological outcomes, in particular interpersonal sensitivity and aggression.     

Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England,UK: Interviews with members of a family support group

Abstract

Background: Transgender and non-binary children and young people and their parents in England, UK are poorly served across a range of healthcare settings. Whilst UK equalities legislation and international guidance on transgender healthcare pathways protects this group from discrimination and mandates an affirmative approach, services in England are not keeping pace.

Aims: This study aims to draw on the experiences of transgender and non-binary children, young people and their parents in a support group in England in order to investigate their experiences of healthcare provision, and to develop some ideas for improvement.

Method: Data was collected with participants in a family support group which offers a parent helpline service, social groups for children and parents, and training for schools and other organizations. 65 parents and children from 27 families from the family support group attended participatory workshops where they were given a range of briefs: “health,” “family,” “friends,” and “education.” Their participation involved being asked to define their own interview questions and collect data by interviewing each other. Their interview notes constituted the raw data. Data was coded inductively by the author with respondent checking as a second stage.

Results: Results constitute the views of a small group of people, so cannot be generalized. However, they do illustrate some of the issues which may arise. Participants’ experiences elicited five key themes: professionals’ perceived lack of clinical and therapeutic knowledge; mental distress caused by excessive waiting lists; professionals’ stereotyped gender assumptions; direct discrimination within healthcare settings; and a lack of attention to parent and child voice, especially in terms of school-based experiences and where a patient had a diagnosis of autism.     

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.     

Young children's television viewing and the quality of their interactions with parents: A prospective community study

Television is one of the most commonly viewed forms of media by children throughout the world. Excessive television viewing can influence the quality of children's relationships and interactions with their parents. We examined the emotional availability (EA ) of children toward their parents by assessing child responsiveness and child involvement , using a cross‐sectional and longitudinal design. We employed a large and representative community sample of Norwegian 4‐year‐olds (n = 995) who were followed up at 6 years old (n = 795). The results illustrate that, when viewing excessive amounts of television, children are less likely to be involved with their parents in ordinary toy‐play. We argue in favor of the displacement hypothesis, stating that time‐demanding technologies are negatively related to the quality of parent–child relationships because spending more time watching television will leave less time for developing nurturing social relationships.     

The relationship between child-report, parent self-report, and partner report of perceived parental rearing behaviors and anxiety in children and parents

This study investigated the relationship between child anxiety, parental anxiety, and perceived current parental rearing practices, using a multiple informants approach, that is, by aggregating the perception of the child, parent and partner on parental rearing behaviors. Unselected children aged 9–12 (n=75) and both their biological parents filled in the SCARED-C to measure child anxiety, and parents completed the SCARED-A to measure parental anxiety. In addition, child report, parental self-report, and partner report of the rearing dimensions “autonomy-encouragement versus overprotection”, “acceptance versus rejection”, and “psychological control” of both parents was assessed. Results showed that the homogeneity of some rearing dimensions using a single informant was insufficient, but sufficient when using multiple informants. Inter-informant agreement was low (M=0.29). Three-informants' aggregates yielded good generalizability (M=0.54), and the generalizability of six-informants' aggregates (combining both parents) was impressive (M=0.76). Using multiple informants, parental autonomy granting versus overprotection was substantially related to child anxiety (r=−0.41, p<0.001), as well as to parental anxiety (r=−0.45, p<0.001). More precisely, paternal autonomy–overprotection was predominantly related to child anxiety, whereas maternal autonomy–overprotection was predominantly related to maternal anxiety. Acceptance versus rejection and psychological control were only modestly related to child and parental anxiety.     

Evaluation of an Air Force Child Physical Abuse Prevention Project Using the Reliable Change Index

Three hundred and seventy-nine parents at 25 Air Force bases participated in a collaborative child physical abuse prevention project designed by the United States Air Force Family Advocacy Program and Father Flanagan's Boys' Home (Boys Town). These participants were active duty or civilian employee parents and their spouses who completed the Boys Town Common Sense Parenting ® program as part of a comprehensive prevention effort. We hypothesized that participants would report decreased child behavior problems, improved relationships with family members, and reduced risk for child physical abuse after attending parenting sessions. Results supported this hypothesis. The data were also analyzed to determine the frequencies of individual parents who made statistically reliable changes on the dependent measures using Jacobson's Reliable Change Index. Nineteen to 30% of the participants reported significant improvement in the areas assessed. Parents who improved in abuse risk were at a higher level of risk and were less satisfied with family relationships prior to their participation than those who did not change. Implications for prevention of child physical abuse and future directions for research are discussed.     

Parent–Child Joint Reading in Traditional and Electronic Formats

There is little question that parent–child joint reading is related to a number of positive childhood outcomes, such as vocabulary acquisition and school success. With the growth of tablet computers, parents are now able to read to their children using different platforms. This study used a repeated-measures design with parents and their preschool-aged children to test the difference between reading interactions and child comprehension on two platforms: traditional books and electronic iPad books. Results indicated that in the electronic reading condition, parents used more talk about the book format and environment than in the traditional book condition, where they used more evaluative comments about content. Children comprehended significantly more in the traditional book condition than in the electronic book condition. Additional analyses suggested that this finding was related to the increase in distraction talk by parents in the electronic book condition. Results suggest that it is important to consider the specific content of parent–child reading interactions and the increased cognitive load these interactions can place on children, as parent questions about the book format and the environment were related to decreases in child comprehension.     

Maternal and Paternal Perception of Child Vulnerability and Behaviour Problems in Very Preterm Born Children

Preterm born children have more behaviour problems than term born children. Perinatal risks, current child functioning, sociodemographic characteristics, parental psychological distress and parental perceptions of child vulnerability (PCV) have been shown to be risk factors for behaviour problems. However, the role of maternal and paternal PCV is unclear, as these have not been investigated as a risk factor for behaviour problems, with all other risk factors taken into account. Aim of this study is to investigate whether maternal and paternal PCV are independent risk factors for behaviour problems in very preterm (VP) and term born children. The present study is a single centre prospective cohort study. Preterm children (n = 104), born at <30 weeks' gestation and/or birth weight <1000 g, and term children (n = 95) were assessed at age 5. Results showed that risk factors for parent‐rated behaviour problems were low/middle parental education, VP birth, parental stress and, in VP children, maternal PCV. Risk factors for teacher‐rated behaviour problems were low/middle parental education, foreign parental country of birth, intrauterine growth restriction and objective child vulnerabilities. It can be concluded that maternal PCV is a risk factor for parent‐rated behaviour problems in VP children. When VP children are presented with behavioural problems, clinicians ought to be aware of the possibility that parents might still perceive their child as vulnerable. The neonatal history of the child, the way parents experienced that period, their perceptions of the child and possible consequences of these perceptions could be subjects for conversation during visits at follow‐up clinics. Copyright © 2015 John Wiley & Sons, Ltd.     

Unconscious choice: the dissociation of creative animus among writers and psychotherapists

The paper argues that writers and psychotherapists are drawn to their work through the desire to remedy an unconscious sense of lack brought about by early relational trauma. Often, because of its origins in psychic pain, the connection between these individuals' beginnings and their profession remains largely dissociated. The theme is developed with reference to the idea of the wounded healer taken up by Jung. It is proposed that the original wound is also the crack that lets the light in: a dissociated tough spirit that can be channelled into discriminating countertransference and strong writing. This paper is implicitly arguing against an objective or neutral analytic stance, and for the therapeutic and creative value of acquaintance with negative affect.     

Murder: A psychotherapeutic investigation

This paper suggests that it is theoretically necessary and clinically useful to make a distinction between two types of psychic encapsulation within the broader literature. The proposed distinction, as it relates to these psychic structural manifestations, is illustrated here as applied to anorexia. The author suggests that psychic encapsulation is commonly encountered in work with anorexics, and that each type seems to imply a somewhat different therapeutic course. The distinction is made between anorexic patients who appear to display evidence of autistic/autistoid encapsulation as opposed to those who seem to manifest non-autistoid/later traumatic encapsulation – termed secondary adjunctive encapsulation in this paper. Defensive encapsulations are associated with pathological organisations of the personality – both within and beyond these structures, they exert an organising power over central mental processes. Psychic encapsulation and pathological organisations are defensive structural developments – the result of psychic trauma. Clinical material from three cases is presented to illustrate the arguments.     

Development of the self-system: How children perceive their own and others' ideas about themselves

The purpose of this article is to present a model for the development of the self-system in which six concepts within and related to the self-system are distinguished as follows: Four intraindividual self-concepts involving the real and the ideal self-concepts, the perceived real concepts of others about the self, and the perceived ideal concepts or expectancies of others about the self and two environmental concepts involving the actual ideas of others about the child and the others' ideal concepts of or expectancies toward the child. The development and interrelationships among these concepts were studied with 204 children from six age groups (i.e., 6-, 8-, 10-, 12-, 14- and 16-year-olds) with respect to their fit. The intraindividual self-concepts of the children were assessed by means of a Repertory Grid procedure presented to the children. The environmental concepts were obtained by interviewing both parents. The results suggest that although adolescents believe that they do not fulfill their parents expectations, their parents are reasonably satisfied with the extent to which their children have met their ideal expectations.