King Tiger and the roaring tummies: a novel way of helping young children and their families change*

Therapy with young children and their families poses special challenges for the therapist. In particular, it is important for the therapist to meet the child at his or her ‘view’ of the world. King Tiger is a special helper who can assist the therapist in this task. Once the idea or existence of King Tiger has been introduced to the child and family in therapy, the therapist can commence writing letters and stories to the child on King Tiger's behalf. These written interventions can affect the entire family. The paper will examine some of the useful and creative techniques that can be incorporated into King Tiger therapy. A case example will illustrate how King Tiger can work as a co-therapist.     

FAMILY CONFLICT MODERATES EARLY PARENT–CHILD BEHAVIORAL TRANSACTIONS

The reciprocal transactions that shape early parent–child relationships are influenced by contextual stress, such as family conflict. Although family conflict is a salient stressor to the family system, few studies have considered how parent–child transactions vary according to exposure to family conflict. The present study examined how family conflict alters early parent–child behavioral transactions. We utilized three waves of data from a multisite longitudinal study of low‐income families (N = 2, 876), child age 14 months, 24 months, and 36 months, to identify behavioral transactions of positive and negative maternal (supportiveness, negative regard) and child (engagement, negativity) behaviors. Results indicated that family conflict at 14 months diminished the positive association between maternal supportiveness and child engagement, and amplified the inverse association between maternal negativity and child engagement. Family conflict at 14 months also was associated with increased stability of child negativity and subsequent increased maternal negative regard at 36 months, in part via increases in 24‐month child negativity. In sum, family conflict occurring early in childhood predicted and moderated behavioral transactions between young children and their mothers.     

Conflicting internalizations: Effect on development of trainees' professional role

Training in psychoanalytic psychotherapy stimulates both trainee regression and development-enhancing intemalization of supervisors. The internalization processes of introjection, identification and ego-integration influence both trainees' personal development and development of a professional role. Since both supervisors and the personal therapist are introjected and identified with, the possibility of trainee-perceived conflict arises. Where the identifications seem incompatible, trainees will tend to reject the supervision if it is overly dogmatic. If their personal therapy is conflictual, trainees will apply ego-ideal and superego structures to their personal therapy experience and reject their personal therapist. The reasons for this choice suggest the possible value of supervisor-personal therapist collaboration and a supervisory stance of identification with the learning process itself.     

One and One and One is Minus Three: Therapeutic Consultations in Child and Adolescent Mental Health Services with Separated and Conflicted Parents

Many children and young people attend mental health services where the conflict and dynamics between their separated parents contribute to their mental health difficulties. Without intervention in the conflicted co-parenting relationship, the child’s mental health may not improve. This article discusses the issues from the position of both children and their parents and describes some psychoanalytic thinking that can be applied in this work. This includes the development of triangular space and a third position in which the relationship itself is seen as a separate third and the understanding of grievance as a state of mind and a psychic retreat. The therapist’s countertransference offers insight into the experience of the child.     

The Jerusalem TeleRehabilitation System, a new low-cost, haptic rehabilitation approach.

Survivors of brain injury or stroke can improve movement ability with intensive, supervised practice. Since the hours of supervised therapy with a physical or occupational therapist are limited, telerehabilitation will enable patients to greatly expand the hours that they practice therapeutic exercises. The Jerusalem TeleRehabilitation System (JTRS) consists of patient and therapist systems plus a central server and database connected via the internet. The system can work in two modes: (1) a cooperative mode in which the therapist and patient are online at the same time, and (2) a stand-alone mode in which the patient uses the system on his own. In both cases, the system will monitor the status and progress of the patient and various parameters of his movement abilities, and prepare reports for the patient and for the therapist. From the clinic, the therapist will be able to change the screen seen by the patient and change the level and types of tasks, as needed. Compared to existing systems, our system will have the following advantages: (1) inexpensive and easy to use; (2) remote monitoring and control of the patient's computer by the therapist in the clinic; (3) more detailed analysis of patient status and progress; (4) a "smart" system which self-adapts to the patient's capabilities in real time, increasing or decreasing the difficulty of the exercise as needed; and (5) a central, international database which, by gathering data on many patients over time, will provide the basis for "smart" therapy and will also facilitate coordinated multicenter research studies.     

The Divorce Process and Child Adaptation Trajectory Typology (DPCATT) Model: The Shaping Role of Predivorce and Postdivorce Interparental Conflict

Divorce has been conceptualized as a process. Research has extensively demonstrated that it is pre/postdivorce family environment factors that primarily account for the variability in children’s adaptation over parental divorce process rather than the legal divorce per se. Amongst various factors, interparental conflict has been consistently identified as a prominent one. Surprisingly, a single source is still lacking that comprehensively synthesizes the extant findings. This review fills this gap by integrating the numerous findings across studies into a more coherent Divorce Process and Child Adaptation Trajectory Typology (DPCATT) Model to illustrate that pre/postdivorce interparental conflict plays crucial roles in shaping child adaptation trajectories across parental divorce process. This review also summarizes the mechanisms (e.g., child cognitive and emotional processes, coparenting, parent–child relations) via which pre/postdivorce interparental conflict determines these trajectories and the factors (e.g., child gender and age, child coping, grandparental support) that interact with pre/postdivorce interparental conflict to further complicate these trajectories. In addition, echoing the call of moving beyond the monolithic conceptualization of pre/postdivorce interparental conflict, we also review studies on the differential implications of different aspects (e.g., frequency versus intensity) and types (e.g., overt versus covert) of interparental conflict for child adjustment. Last, limitations of prior studies and avenues for future research are discussed. The proposed framework may serve as a common knowledge base for researchers to compare/interpret results, detect cutting edges of the fields, and design new studies. The specificity, complexity, nuance, and diversity inherent within our proposed model await to be more fully revealed.

     

A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.     

Conflict resolution and social understanding in six to twelve year old boys

Three different aspects of children's social competency were studied, i.e. social methods, (via their suggested solution to given conflict situations), social understanding (via their explanations of the solution given) and role-taking capacity. 75 boys—ages 6, 8 and 12 years—were interviewed concerning different conflict situations, six of which involved a child/child interaction and six a child/adult interaction. A separate role-taking task was also used. Developmental differences in social methods were found only in situations involving adults, where older children to a greater extent chose altruistic methods for solving the conflict. As regards social understanding, developmental changes were found and correspond to results reported by previous researchers. Role-taking capacity was found to increase with age. Role-taking as measured here was not related to social understanding. Social method and social understanding were significantly related to each other in some of the situations, mainly in those involving only children. The results indicate that different norms prevail for solving conflicts with adults versus with peers, and that the role-taking aspect is but one of several involved in the development of social understanding.     

Therapy with greek families living in Australia

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasize the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict will be given.Originally published inThe Australian Journal of Family Therapy, Vol. 1, No. 2 (January 1980) pp. 62–68. Reprinted here with permission. Title slightly changed from original.     

Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children

Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered video-tape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.     

The Role of Family Functioning in Bipolar Disorder in Families

Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.     

Management of religious issues in family therapy

Social scientists have long emphasized the reciprocal relationship between family and religion in society. Yet the family therapy literature is virtually devoid of consideration of religious variables in family life and function. Four major psychosocial aspects of religion in family life are discussed: sacralization, coalitions with the supernatural, religious conflict as a projection of family conflict, and family conflict as a projection of religious conflict. Clinical issues presented include: family therapy in religious and secular contexts, family religious expectations and transference, therapist religious countertransferences, religious identification in family therapy, and family therapy in different degrees of congruence or difference in religious orientation between the family and the therapist. The family therapist must learn how to correctly interpret and appropriately respond to religious issues as they appear in family life and family therapy.     

Intersubjectively oriented,time-limited psychotherapy with children: how does the therapist evaluate the therapeutic process and what are the therapist’s tasks?

Based on the therapist’s evaluations of three therapies, this research aims to study the therapeutic process in intersubjectively oriented, time-limited psychotherapy with children. A primary objective is to further develop the therapy method. The study comprises therapies with children 6–11 years of age, who had experienced difficult family situations. Each child received 12 therapy sessions. The number of therapy sessions with children and parents was agreed upon beforehand, and the therapeutic objectives were approved by the parents. Each of the therapy processes were evaluated by the therapist by answering three questions and filling in three forms after each therapy session. The forms were: The Feeling Word Checklist; an alliance form for the child; and a process form. The therapeutic alliance and the behaviour of the therapist during the therapy sessions are discussed on the basis of the total material. The following main tasks for the child therapist emerged: structuring the therapy sessions; following the child’s initiatives; participating and cooperating with the child; exploring the child’s expressions; and understanding and regulating emotions.     

父母冲突、亲子关系与青少年抑郁的关系:独生与非独生的调节作用

以452名青少年及其父母为被试,采用问卷法考察亲子关系在父母冲突与青少年抑郁关系间的中介作用,以及独生与非独生对上述中介作用的调节作用。结果发现：（1）独生家庭的母子关系和父子关系显著优于非独生家庭;独生与非独生家庭的父母冲突没有显著差异;（2）父母冲突正向预测青少年抑郁,母子亲密与母子冲突在父母冲突与青少年抑郁间发挥着中介作用,父子亲密与父子冲突的中介作用不显著;（3）母子亲密在父母冲突预测青少年抑郁中的中介作用在独生子女与非独生子女上没有差异,母子冲突的中介作用仅在独生子女上显著。研究结果显示,对于独生子女家庭而言,母亲应尤其注意将父母冲突所带来的消极情感消化在夫妻系统内部。     

Discussing the therapeutic setting in child and adolescent psychoanalytic psychotherapy

The aim of this paper is to contribute to a debate on the particular characteristics of the therapeutic setting in child and adolescent psychoanalytic psychotherapy and its differences from the setting in adult therapy. In our opinion, there is a fundamental difference between these two, as in child and adolescent psychotherapy two distinct aspects co-exist and in some areas, overlap. In this paper, we attempt to delineate these two aspects, following Green’s division of the analytical setting into the active matrix and the casing. We propose that in child and adolescent psychotherapy the therapeutic contract, the active matrix, concerning the necessary conditions for making a therapy psychoanalytic – namely, the therapist’s free-floating attention and the patient’s free associations – is agreed between the therapist and the child/adolescent. We argue that in contrast, the contract regarding the casing – the timings of sessions, the fees and so on – is agreed primarily with the parents or carers of the child/adolescent. Ruptures and possible modifications in both the matrix and the casing of the setting are discussed through the presentation of clinical material.     

Interparental conflict and adolescent problem behavior: an examination of mechanisms

The purpose of the present study was to examine several competing hypotheses which have been utilized to explain the negative relationship between interparental conflict and child/adolescent problems. These mechanisms of operation have included modelling, genetic transmission, disrupted parenting, the role of perceptual/appraisal processes of the conflict, and an inhibition hypothesis. One hundred and forty-two young adolescents and their mothers served as subjects. Eighty were from intact families and 62 from recently divorced families. Data were collected from the perspective of the adolescent, mother, behavioral observer, and social studies teacher. The results indicated that intact and divorced samples had to be considered separately as different pathways contributed to adolescent behavior problems in the two samples. For externalizing problems, a direct path between interparental conflict and problem behavior existed for the divorced sample whereas an indirect path through the adolescent's perceptions of the conflict existed for the intact sample. The different context in which the interparental conflict occurred for the two samples was offered as an explanation of this difference. For internalizing problems a significant direct path existed between conflict and problem behavior for both samples; however, the indirect paths through the adolescent's perceptions and through poor parenting skills contributed only for the divorced sample. The results suggest that various mechanisms appear to operate in influencing how interparental conflict influences behavior problems of young adolescents. Both the type of problem examined and the marital status of the parents appear important in determining the relative impact of the mechanisms. Implications for the behavior therapist are noted.     

Applying developmental previewing to the principles of family therapy

This paper discusses the application of principles of infant psychiatry to the diagnosis and treatment of multigenerational family conflict. Using a technique referred to as previewing, the therapist can focus on the interpersonal meaning that the infant's development precipitates in the family and determine how the parents' relationships with the infant replicate their relationships with their own families of origin. The therapist may then use these insights for overcoming conflict and for acclimating parents to new developmental skills in an optimal manner. Specific suggestions for how parents may promote more adaptive patterns of interaction with the infant using previewing are offered.     

A Task Analysis of Client Re-engagement: Therapeutic De-escalation of High-Conflict Coparents

Parents who are engaged in protracted conflict following a divorce are often referred to coparenting therapy. Episodes of intense conflict are common during these therapy sessions and often result in coparents disengaging from the therapist while they engage in escalating conflict with each other, potentially disrupting their progress in therapy. The purpose of this study was to identify how therapists successfully re-engage clients in the session. To understand this process, 24 disengagement events (12 successful and 12 unsuccessful) from 13 cases were analyzed using a task analytic approach. The sample included coparent dyads referred by the judicial system to a high-conflict coparenting therapy program. Task analysis was used to create a model of how re-engagement unfolds in treatment. The empirical model that resulted has five phases: (1) disengagement from the therapeutic process, (2) disruption of the conflict, (3) de-escalating the most escalated coparent, (4) de-escalating the other coparent, and (5) therapist buffered re-engagement. Successful episodes of re-engagement tended to have therapists who remained active throughout the conflict episode, used structuring interventions aimed at disrupting and then regulating the most escalated partner, blocked attempts to re-engage in conflict, and then repeated this process with the less escalated partner. Additional interventions that promote therapeutic re-engagement are described for each phase, and implications for clinicians and researchers are discussed.     

Therapist memory and reverie: implications for the clinical setting

In this work, the author considers reveries to be ‘dream-like-memories’. In the course of a session they appear as proto-memory – the therapist’s early traumatic object relations that are recorded in the unconscious at an almost bodily level (a type of unthought known) and which are resurrected between therapist and patient when a similar traumatic subject arises between them. The therapist’s reveries are recollections in the form of dream-like allusions to his past experience. A clinical vignette from the psychotherapy of a child whose father suffered from PTSD (following a wartime experience in Afghanistan and Iraq) is discussed. Dissociative dynamics were repeated in the therapeutic relationship, in the form of an obsessive game intending to preserve the state in which there was no need to remember what had been unconsciously transmitted to the child: his father’s wartime experience. The projection of the primary elements which had been silenced evoked in the therapist allusions to his unconscious identification with his ancestor’s post-traumatic experiences. These allusions helped in overcoming the dissociated state. The role of memory in child psychotherapists’ receptivity of trauma is revisited.