Successful treatment of the mother-infant relationship in a mother suffering from severe postpartum depression

This paper discusses the treatment of severe postpartum depression in home-based infant-parent psychotherapy. Severe postpartum depression is examined as a psychiatric disorder in which childbirth is a necessary but insufficient cause. Home-based treatment that involved both mother and infant permitted a more comprehensive approach. By facilitating assessment of the risks to the infant from the mother's impairment by direct observation of the mother-infant relationship, infant-parent psychotherapy helped to avoid an unnecessary hospitalization of the mother in the case example. Instead, treatment helped to build on the ego strengths of the mother in order to stabilize precarious defenses and to support her bonding with her baby.     

A METHOD FOR INTEGRATING AN AUTISTIC CHILD INTO A NORMAL PUBLIC-SCHOOL CLASSROOM1

This study investigated the feasibility of using behavioral techniques to integrate an autistic child into a normal public-school class with one teacher and 20 to 30 normal children. The results showed: (1) that during treatment by a therapist in the classroom, the child's appropriate verbal and social behaviors increased, and autistic mannerisms decreased; and (2) training teachers in behavioral techniques was apparently sufficient to maintain the child's appropriate school behaviors throughout kindergarten and the first grade.     

ON THE CONSEQUENCES OF TELEVISION-RELATED PARENT-CHILD INTERACTION

This is a theoretical examination of certain ways in which a child's development may be affected by parent-child interactions in which the content of television programming appears as an explicit referent, i. e., as the topic of a verbal exchange, as the premise for a game, and so forth. The discussion deals with four areas of development, viz.: (1) the child's interpretational skills with regard to the television medium; (2) the child's repertory of cognitive categories regarding the real world; (3) the child's behavioral repertory, including both verbal and nonverbal items; and (4) the child's social relationships. The paper concludes with a discussion of certain methodological issues involved in the empirical examination of these matters.     

The relationship of mother–child interaction and the child's development of symbolic play

The extent to which the mother–child interactive relationship either promotes or limits a child's ability to see options or choices in the environment was investigated. It was predicted that this quality of interaction provided primarily by the mother would relate to the child's cognitive development as reflected in his or her level of symbolic play. The level and frequency of symbolic and nonsymbolic play in 30 children, ages 12 to 47 months, were coded and mothers' options‐promoting and options‐limiting behaviors were identified. Children, across this range of ages, whose mothers created an options‐promoting social context were observed engaging in more symbolic play. Nonsymbolic play, however, was not found to be significantly influenced by the mother's interactive style. A child's symbolic play marks a dynamic developmental achievement for the child, and appears to be related to the social context created by the mother's interactive style. ©2003 Michigan Association for Infant Mental Health.     

On becoming a child: Reverie in the psychotherapy of children

My aim in this paper is to examine the role of reverie in facilitating the development of the child‐subject, that is, the child's continuous motion towards subjectivity. I begin by briefly reviewing the concept of reverie and proceed with an examination of elements I believe are fundamental and common to both reverie and child psychotherapy, that is, primary thought processes and primitive impulses. I then describe and demonstrate the atmosphere created by these elements using three examples from the psychotherapy of 8 year‐old Jonathan. Next, I discuss an intersubjective parallel of Bion's reverie and a developmentally oriented version of Ogden's reverie, focusing on its relation to processes of destruction and recognition. I argue that reverie provides the recognition of the child's struggle for his own birth and growth as a subject, that is, of his child‐subject. Finally, I refer to the presence of reverie from the primary preoccupation of mother and father till the child's reverie of himself, his day‐dreaming.     

Primal splitting as a basis for emotional and cognitive development in children

This article discusses the importance of good primal splitting as the basis for the child's emotional and cognitive development. A theoretical introduction analyses the possible pathologies of primal splitting, as they were first pointed out by Melanie Klein and then by some post-Kleinian authors, in particular Donald Meltzer. This is followed by some excerpts from the clinical material of the first year of the psychoanalytic psychotherapy of a three-year-old child suffering from eating problems. Starting from the child's play activity, the author tries to identify the splitting problems that underlie the child's view of the world, and to address these with him. The article shows how at times it can be useful to speak also to the child's intelligence, combining the usual analytic work (containment of anxiety and analysis of transference) with the analysis of the child's distortions and cognitive misconceptions. The article also suggests that faulty primal splitting tends to be transmitted from one generation to the next.     

Attachment and preschool children's understanding of maternal versus non‐maternal psychological states

There is growing evidence that insecurely attached children are less advanced in their social understanding than their secure counterparts. However, attachment may also predict how individual children use their social understanding across different relationships. For instance, the insecure child's social‐cognitive difficulties may be more pronounced when the psychological states of an attachment figure are being considered. In the current study, forty‐eight 4‐ to 5‐year‐old children were asked about their mothers' emotions and false beliefs, as well as those of non‐attachment figures. The Separation Anxiety Test (SAT) was administered to assess children's attachment representations. Children's SAT scores predicted their overall performance on the false belief and causes of emotion tasks, even after controlling for age and verbal ability. More interestingly, however, children with high scores on the Avoidance dimension of the SAT experienced greater difficulty understanding maternal false beliefs relative to those of an unfamiliar adult female. Thus, although attachment insecurity may hinder social‐cognitive development in general, the findings suggest that there are more specific effects as well. Attachment representations that are characterized by high levels of avoidance appear to interfere with children's ability to fully engage their social‐cognitive skills when reasoning about maternal mental states.     

A teacher‐centered exploration of the relevance of social factors to theory of mind development

Many accounts of children's Theory of Mind (ToM) development favor a cognitive explanation, for example, in terms of mental representational improvements at or before 4 years. Here, we investigated whether social factors as rated by a child's teacher, are related to ToM development. We tested 82 children of 3–6 years on each of four ToM tasks, and their class teacher completed a social questionnaire about each child's playing behavior, sharing, talkativeness, confidence, aggressiveness and outgoingness. A measure of task memory and the child's gender were also recorded. Here, children generally passed ToM tasks after 5 years‐old, but no one gender performed reliably better than the other. Teacher‐rated confidence and playing behavior were correlated to ToM. But in a regression analysis, these were replaced by teacher‐rated talkativeness; with age and memory given primacy in both sets of analyses. It is concluded that maturation and cognitive factors may well have primacy but social factors, facilitated during early primary education, must also be given a role in ToM development.     

Relation‐based intervention with at‐risk mothers: Outcome in the second year of life

It has been shown that the UCLA home visiting/mother–infant group intervention made a significant positive impact during the child's first 2 years of life on two indices of the mother's support and on three areas of mother–child and child development: (1) The mother's responsiveness to the needs of her child and the related development of his or her security of attachment; (2) the mother's encouragement of her child's autonomy and the related development of his or her autonomy; and (3) the mother's encouragement of her child's task involvement and the related development of his or her task orientation. By child age 2 years, the mothers experiencing the intervention, in comparison with those that did not, also used verbally persuasive as opposed to coercive intrusive methods of control and their children responded more positively to these controls. Mothers who did not experience the help of the intervention had significantly more difficulty controlling their child if it was a boy as opposed to a girl. They used the least appropriate methods of control, and the boys responded more negatively to these controls. The nature of the development of the mother's use of appropriate controls and the child's response to that control was elucidated by determining on the total sample where 12‐month antecedents influenced the indices of control either independently of or in interaction with the intervention status. The child's endurance in the test situation was an independent predictor of mother‐appropriate control and the child's positive response to that control, while the absence of maternal intrusiveness further enhanced the impact of the intervention on that control. ©2001 Michigan Association for Infant Mental Health.     

Relationships,Environment, and the Brain: How Emerging Research is Changing What We Know about the Impact of Families on Human Development

Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at‐risk child to prevent or minimize the onset of mental illness including providing partnerships with at‐risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.     

The Effects of Coping-Modelling Problem Solving and Contingency Management Procedures on the Positive and Negative Interactions of Learning Disabled and Attention Deficit Disordered Children with an Autistic Peer

Two learning disabled and two learning-disabled attention deficit hyperactivity disordered boys participated in-group problem solving sessions to improve interactions with the attitudes toward a socially rejected autistic classmate. In class positive interactions and negative interactions served as individual baselines within a multiple baseline design with replications across the four students. Problem solving sessions increased positive interaction between each of the students and their autistic peer. Negative interactions, in contrast, did not decrease. Introduction of an interdependent classroom DRO subsequently reduced negative interactions. Weekly questionnaires revealed a positive shift in the residually autistic child's sociometric status. The number of interactions this student initiated with three peers and his responsiveness to those interactions initiated by two also increased.     

Working Through Physical Disability in Psychoanalytic Psychotherapy With an Adolescent Boy

The narcissistic injury that may be caused by physical disability in infancy and the possible familial traumatization may block the integration of the infant's body and self-image, and can consequently hinder the child's identity formation. This article presents how an adolescent boy with cerebral palsy in short-term psychoanalytic psychotherapy works through the mental impact of his physical disability using a story. Transference and countertransference reactions are discussed. The positive impact of short-term psychoanalytic psychotherapy highlights the importance of caring for the mental health of children with physical impairments.     

Assessing and Facilitating Children's Cognitive Development: Developmental Counseling and Therapy in a Case of Child Abuse

This article presents practical implications for assessing a child's cognitive development and then facilitating developmental growth. The concepts of developmental counseling and therapy (Ivey, 1986, 1990) are presented as a systematic framework to integrate neo-Piagetian developmental theory into the interview. Specific techniques may be used for assessing cognitive development, expanding horizontal and vertical development, designing systematic questioning sequences, and planning overall treatment. An example of treatment of a case of child abuse illustrates the concepts in action.     

A psychoanalytic approach to language delay: When autistic isn't necessarily autism

This paper describes family work with four children from different ethnic backgrounds presenting with autistic features in the context of delayed or deviant language development and, in one case, elective mutism. It begins by describing how psychoanalytic approaches to language development have tended to see the process as underpinned by symbol formation as a compensation for loss of the object. This is contrasted with an approach which, following Bion, emphasizes language development as an aspect of a broad process concerned with enabling emotional experience to become thought. I also emphasize the significance of the survival and development of the self in achieving separation. In the case studies, the paper highlights the degree of trauma in the parents' backgrounds, which had impeded them from containing their children's developmental anxieties. The parents' telling their stories was both valuable to them and enabled them to become more emotionally available to their children. In all cases the work promoted language development and autistic features disappeared or waned considerably after relatively brief intervention. The conclusions discuss the relevance of these findings to the autistic child population, and the value of child psychotherapy to differential diagnosis within the autistic spectrum.     

Intrapsychic and family dynamics in perinatal sibling loss

The effects of perinatal death on surviving and subsequent siblings have been virtually unexplored. Perinatal sibling death is considered an event with impact determined by the interaction of the child's emotiond and cognitive responses with the reactions, distortions, and communications of the parents. The potentially maladaptive aftermath of perinatal sibling death is illustrated by clinical case reports that integrate intrapsychic and family perspectives. In each case, the individual's disturbed response to perinatal sibling death complements parental inability to: (1) resolve their loss; (2) communicate accurate information about the death to their child; and (3) assist their child in dealing with his/her feelings about death.     

Light and color in a void: The analysis of a special needs child

This clinical report comes from the five year, four day a week analysis of a male child. What is special is that this treatment is of a child with marked mental retardation. I have retained this nomenclature because that is how Ricardo's parents described his mental capacity. What they meant was that he was greatly impaired in his cognition and this could be seen in Ricardo's severe cognitive, social, behavioral, and relational improprieties. I have privileged the function of psychoanalytic understanding and the role of transference to bring about modifications in this child's internal world. And I have considered the patient's psychotic mental state to be in need of psychoanalytic treatment not withstanding his psychosis's connection to his cognitive handicap. I have also added information I have received after the analysis, information that demonstrates continued integration coming from the analytic process. Owing to Ricardo's limited mental capacities, this article advances clinical information that is not often found in analyses of children. There are possibly many other children like him who nonetheless would benefit from dynamic psychoanalytic understanding. On the other hand, I shall not discuss this matter theoretically, even though some theoretic considerations are necessary. Clinical practice and the transferential relation are this report's principal material.     

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.     

A Goodness-of-Fit Approach to Informed Consent for Pediatric Intervention Research

As children and adolescents receive increased research attention, ethical issues related to obtaining informed consent for pediatric intervention research have come into greater focus. In this article, we conceptualize parent permission and child assent within a goodness-of-fit framework that encourages investigators to create consent procedures “fitted” to the research context, the child's cognitive and emotional maturity, and the family system. Drawing on relevant literature and a hypothetical case example, we highlight four factors investigators may consider when constructing consent procedures that best reflect participants' rights, concerns, and well-being: (a) the child's current assent capacity and the likely impact of study information on the child's mental and physical development, (b) parents' understanding of their child's treatment needs and distinctions between treatment and clinical trials research, (c) the family's history of shared decision making, and (d) the child's strivings for autonomy within the context of their parents' duty to make decisions in the child's best interest.     

Countertransference,enactment and sexual abuse

This paper examines the development of a therapeutic relationship with a sexually abused latency girl who, in the course of her two years of four times weekly psychotherapy, was placed in two different foster-homes. It is argued that the child's re-enactment of the abuse in the consulting room allowed her to move from a seductive relationship with the therapist to one characterized by basic trust. This was paralleled by her development of a capacity to think and to tolerate affect states. The use of an imaginary twin by the child and the use of powerful countertransference feelings in the therapist are seen as the main therapeutic tools in the treatment. The premature termination of the treatment – due to the therapist's departure – enabled the child to articulate for the first time her feelings, in the transference, about the trauma and the traumatizing agent. The child's progressing moves in the therapy are also presented.