Attachment and Affect between Mothers with Depression and their Children: Longitudinal Outcomes of Child Parent Psychotherapy

The present investigation examined the longitudinal effects of Child-Parent Psychotherapy (CPP) for toddlers and their mothers with depression on: a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Mothers with depression (M_age?=?31.7 years; 92.8% White, 3.5% Black, 2.1% Hispanic, 2.3% other) and their toddlers were randomized to receive CPP (DI; n?=?66) or to a control group (DC; n?=?64). Mothers without depression and their toddlers (NC; n?=?68) were recruited as an additional comparison group. Dyads were assessed at baseline (T1; 20 months old), post-intervention (T2; 36 months old), and follow-up (T3; 9 years old). Data from a mother-child conflict task was coded as a measure of observed outcome variables. Change in post-intervention attachment security assessed via the Strange Situation was evaluated as a mediator between intervention condition and maternal and child affective expression and dyadic cohesion at T3. Change to secure attachment post-intervention significantly mediated the association between intervention condition and T3 maternal warmth and child anger/problem behavior. Toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 displayed higher levels of maternal warmth at T3 and lower levels of child anger and problem behavior at T3. Implications for the use of CPP as a preventive intervention and the importance of attachment as a mediator of long-term outcomes are discussed.

     

Response to Commentaries

In replying to the commentaries, I continue to explore differences between a complexity model of the mind and an intrapsychic one, and elaborate aspects of the complex negotiation process that occurred between my patient, Kerri, and me. Taking up Chefetz's notion that a “change in self-state predicts observed fluctuations in the capacity to mentalize,” I consider ways that self-states in both the patient and analyst fluctuate, influence, and reorganize the unfolding process, including the systemic capacity to mentalize.     

Penetrating Subjectivity: Response to Commentaries

In response to the commentaries by Altman, Straker, and Suchet, the author considers the ways in which thirdness—in various manifestations—has aided in the continuing process of thinking about race. She responds to Straker’s invitation to interrogate further what it means to write from within and without a context, considering some of the defensive strategies that manifest when writing about race from a position of whiteness. Following Suchet’s lead, the paper looks too at the notion of the decolonization of the mind and how this is a project that unfolds in parallel with the decolonial moment being witnessed in broader socioeconomic contexts. In response to Altman’s commentary on the clinical aspects of the paper, the author engages with what it means to enter more fully into a process of mutual recognition when working in cross-racial dyads and considers, finally, the question of far she is able, as a white clinician and writer, to jeopardize the self in the process of unsettling whiteness.     

Metacognitive Experiences: Response to Commentaries

The stimulating commentaries by Huber (2004), Lee (2004), and Pham (2004) raised important questions. This response elaborates on some of their themes by addressing the assessment of naive theories, the role of expectations, the influence of metacognitive experiences on consumer choice, as well as parallels between different metacognitive experiences and moods. Receiving thoughtful and stimulating commentary from three of my favorite consumer researchers, whose work has influenced my own thinking, is a great privilege. In this response, I elaborate on some of the themes of their commentaries (Huber, 2004; Lee, 2004; Pham, 2004), although space constraints do not allow me to do full justice to their thoughts.     

Parent Socialization of Coping and Child Emotion Regulation Abilities: A Longitudinal Examination

This study examined the hypothesis that parent socialization of coping (SOC) would have a longitudinal relation with child emotion regulation abilities. Participants included a sample of 256 parents of 5- to 12-year-old children (child M age = 8.36, SD = 2.03, 54.7% male; parent M age = 34.49, SD = 6.20, 59% female). Data on demographic information, parenting behaviors, and child emotion regulation abilities were collected via online questionnaires at baseline and 12 months. Results from longitudinal structural equation modeling (SEM) analyses suggested that parent SOC, measured at baseline, predicted child adaptive and maladaptive emotion regulation, measured 12 months later. More specifically, parental engagement coping suggestions predicted child's adaptive emotion regulation, whereas parental disengagement coping suggestions predicted child's maladaptive emotion regulation. Further, child gender emerged as a moderator in the longitudinal association between socialization of engagement coping and child adaptive emotion regulation: Whereas this association was small and marginally significant for girls, it was large and statistically significant for boys. Results highlight the importance of parent SOC as potentially contributing to emotion regulation abilities of 5- to 12-year-olds.     

A Secure Base from which to Cooperate: Security,Child and Parent Willing Stance,and Adaptive and Maladaptive Outcomes in two Longitudinal Studies

Early secure attachment plays a key role in socialization by inaugurating a long-term mutual positive, collaborative interpersonal orientation within the parent-child dyad. We report findings from Family Study (community mothers, fathers, and children, from age 2 to 12, N = 102, 51 girls) and Play Study (exclusively low-income mothers and children, from age 3.5 to 7, N = 186, 90 girls). We examined links among observed secure attachment at toddler age, child and parent receptive, willing stance to each other, observed in parent-child contexts at early school age, and developmental outcomes. The developmental outcomes included parent-rated child antisocial behavior problems and observed positive mutuality with regard to conflict issues at age 12 in Family Study, and mother-rated child antisocial behavior problems and observed child regard for rules and moral self at age 7 in Play Study. In mother-child relationships, the child’s willing stance mediated indirect effects of child security on positive mutuality in Family Study and on all outcomes in Play Study. In father-child relationships, both the child’s and the parent’s willing stance mediated indirect effects of child security on both outcomes. Early security initiates an adaptive developmental cascade by enlisting the child and the parent as active, willingly receptive and cooperative agents in the socialization process. Implications for children’s parenting interventions are noted.     

Marriage at the Summit: Response to the Commentaries

This article serves as a response to the 13 commentaries on the target article, which introduced the suffocation model of marriage in America. This reply has four main sections. First, it presents an elaborated version of the suffocation model that was inspired by the commentaries. Second, it addresses three areas of significant disagreement that emerged as we digested the commentaries. Third, it examines the circumstances under which being instrumental for one's spouse's needs benefits the self. And fourth, it takes strides toward the development of a mathematically formal version of the suffocation model. It concludes with a discussion of the ways in which policymakers, clinicians, and individual Americans can capitalize upon the suffocation model to strengthen marriage and, in doing so, bolster personal well-being.     

Parent-Professional Alliance and Outcomes of Child,Parent, and Family Treatment: A Systematic Review

This review systematically explored research examining the relation between parent-professional alliance and outcomes of psychosocial treatments provided to children, and their parents and families. Study findings and methodological characteristics were reviewed to investigate the evidence linking the alliance between parents and professionals to outcomes of child, parent, and family treatment as well as to identify factors that may influence the alliance-outcome association. A systematic review of the literature was conducted that included a search of three electronic databases using specified search terms, followed by a hand search to identify relevant studies. A total of 46 studies (37 published articles and 9 unpublished dissertations) met inclusion criteria. Overall, the findings indicated that higher levels of parent-professional alliance were significantly associated with improved clinical outcomes and stronger treatment engagement. However, some studies found that the parent-professional alliance was not significantly related to clinical outcomes or treatment engagement, and a few studies showed that higher levels of alliance were related to less positive clinical outcomes and lower levels of treatment engagement. Several theoretical (problem type, child age, parent sex) and methodological (source and timing of alliance measurement, alliance-outcome informants, outcome domain, timing of outcome measurement) factors were identified that could influence the alliance-outcome association. Together, our findings emphasize the importance of alliance awareness when working with parents as well as a need for future studies to investigate factors influencing the quality of the parent-professional alliance and alliance-outcome association in child, parent, and family treatment.     

ADHD and Depression Symptoms in Parent Couples Predict Response to Child ADHD and ODD Behavior

Parents of children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) often have elevated ADHD and depressive symptoms, both of which increase the risk of ineffective parenting and interparental discord. However, little is known about whether child ADHD/ODD behavior and parent ADHD or depressive symptoms uniquely or synergistically predict the quality of parenting and interparental communication during triadic (mother-father-child) interactions. Ninety parent couples, including 51 who have children diagnosed with ADHD, were randomly assigned to interact with a 9–12 year-old confederate child (84 % male) exhibiting either ADHD/ODD-like behavior or typical behavior. Parents reported their own ADHD and depressive symptoms, and parents and observers rated the quality of parenting and interparental communication during the interaction. Actor-partner interdependence modeling indicated that child ADHD/ODD behavior predicted less positive and more negative parenting and communication, independent of adult ADHD and depressive symptoms. Parent couples including two parents with elevated ADHD communicated more positively while managing children exhibiting ADHD/ODD behavior than couples managing children behaving typically or couples with only one parent with elevated ADHD symptoms. Couples including one parent with, and one parent without, elevated ADHD or depressive symptoms parented less positively and more negatively, and communicated more negatively, when managing children exhibiting ADHD/ODD behavior than when managing children behaving typically. Taken together, depending on the similarity of ADHD and depressive symptom levels in parent couples, adults managing children exhibiting ADHD/ODD behavior may parent or communicate positively or negatively. Findings highlight the need to consider the psychopathology of both parents when treating children with ADHD in two-parent homes.     

Response to Commentaries: Actions as Perceptual-Conceptual "Gestalts"

The author clarifies the objective and essence of the psychological, or perceptual-cognitive, approach to voluntary movement. According to that approach, voluntary movements are organized and performed as meaningful, perceptible events with bodily and environmental aspects. Body-oriented control is thus not neglected in the perceptual-cognitive approach but is actually an important issue. He further clarifies how material and psychological factors relate to each other in motor control and why they are not considered a coalition of constraints. The central importance of the sparse coding principle for the perceptual-cognitive approach is underlined. Finally, the author argues that the psychological information format is particularly suitable for motion control and stresses the power of the perceptual-cognitive approach to possibly provide a unifying framework for understanding human voluntary movements.     

A Response to Carolyn Ellman and Meira Likierman: Reply to Commentaries

In my reply to Likierman and Ellman, I remark on the difficulty of responding accurately to written case material. I underline some problems resulting from the necessarily abbreviated information contained in even the most carefully constructed and detailed presentations. Using the responses to my Richard paper, I attempt to show that in the absence of complete information, respondents tend to substitute their own imaginative assumptions for missed or incomplete information. They also tend to borrow from preferred theory to organize these assumptions as well as the conclusions that follow. Like unmarked wind currents, these tendencies can carry discussions far off the author's intended course.     

Parent Cognitions as Predictors of Child Treatment Response in Attention-Deficit/Hyperactivity Disorder

Using a subsample of 105 children and their parents (100 mothers, 57 fathers) from the Multimodal Treatment Study of Children with ADHD (the MTA), the value of parents' baseline cognitions as predictors of children's treatment outcome at 14 months was examined. Measures of parents' cognitions about themselves, their ADHD children, and their parenting, as well as a self-report measure of dysfunctional discipline were included. Both mothers' and fathers' self-reported use of dysfunctional discipline predicted worse child treatment outcome. Low self-esteem in mothers, low parenting efficacy in fathers, and fathers' attributions of noncompliance to their ADHD child's insufficient effort and bad mood also were associated with worse child treatment outcome. All of these predictive relations were obtained even after MTA treatment effects had been taken into account. Secondary analyses indicated that mothers had a more external locus of control, lower self-esteem, lower parenting efficacy, and a greater tendency to attribute noncompliance to their ADHD child's bad mood than did fathers.