On Attachment to Internal Objects

This paper considers some clinical implications of attachment theory from the perspective of the theory of internal object relationships and the unconscious phantasies that derive from such relationships. The paper focuses on the contributions of Bowlby and his followers, particularly Mary Main, who has developed a language-based methodology to study representational processes in adults and children, bridging the gap between the systematic study of human behavior and clinical psychoanalysis. The theory of inherent role responsiveness in the internal object world—mental representations of self and other in interaction and externalized in complementary role relationships through exchanges of unconscious and conscious messages—is presented as the psychoanalytic complement of Bowlby's theory of internal working models of attachment. Role responsiveness occurs internally as well as externally, so that one can speak of attachment to phantasy objects as well as external objects. Clinical examples illustrate how the therapist, through maintaining a free-floating responsiveness to the patient's enactments, may reconstruct the internal working models of attachment and their origins in the transference. The paperthus illustrates the way in which the origins of phantasy derive from the wished for and feared states related to early experiences of felt security, or lack of it, in relation to the attachment objects, thereby integrating the psychoanalytic theory of phantasy with attachment theory.     

Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later

Objective: We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation.

Design: Divorced mothers and children (age 9–12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families.

Main Outcome Measures: Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task.

Results: Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group.

Conclusions: Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.     

Apahe Age Groups

Previous communications have indicated that interpretations of Rorschach protocols resultant from testing the Apaches of the Mescalero Indian Reservation produce information which conforms closely to that obtained by standard anthropological and psychoanalytic investigative techniques.

Anthropologic and psychoanalytic observations demonstrate that the effects of acculturation are less disruptive to the personality organization of old-age than of middle-age and young-age Mescalero and Chiracahua Apaches. In the present communication, a comparison is made of Rorschach protocols derived from testing of those three-age groups. The interpretation of those protocols confirms the assumptions based on the anthropological and psychoanalytic observations.     

Effects of Varying Feedback Accuracy on Task Acquisition: A Computerized Translational Study

Research has shown that the accuracy of instructions influences responding immediately and under later conditions. The purpose of the present study was to extend this literature and use a translational approach to assess the short- and long-term effects of feedback accuracy on the acquisition of a task. Three levels of inaccurate feedback were compared across groups. Participants who received accurate feedback performed best, while participants exposed to inaccurate feedback performed poorly in direct relation to the degree of inaccuracy. Once inaccurate feedback was corrected, this relation was less apparent. However, the effects of prior exposure to inaccurate feedback persisted in subsequent conditions when participants were exposed to accurate feedback. The effects of feedback accuracy on task acquisition also varied across individuals, suggesting that the effect may be idiosyncratic.     

A Review of “Parental Alienation: DSM-5 and ICD-11”

Abstract

Conversations with Milton H. Erickson, M.D., -by Jay Haley. New York: Triangle Press, 1985, Three volumes: Vol. 1: Changing Individuals, 326 pages, $24.50; Vol. II: Changing Couples, 176 pages, $17.50; Vol. III: Changing Children and Families, 168 pages, $17.50

Helping Patients and Their Families Cope with Medical Problems, edited by Howard B. Roback. San Francisco: Jossey-Bass, 1984, 543 pages, $29.95

Principles of Family Systems in Family Medicine, edited by Sergio Henao&;Nellie P. Grose. New York: Brunner/Mazel, 1985, 423 pages, $40.00

Parents, Children, and Change, edited by L. Eugene Arnold. Lexington, MA: Lexington Books, 1985, 204 pages, $21 hardcover, $9.95 paperback

Child Sexual Abuse: New Theory and Research, by David Finkelhor. New York: The Free Press, 1984, 304 pages, $22.50

Changing the Abusive Parent, by Arnold P. Goldstein, Harold Keller,&;Diane Erne. Champaign, IL: Research Press, 156 pages, $12.95

Annual Editions: Marriage and Family, 85-86, edited by Ollie Pocs&;Robert H. Walsh. Guilford, CT: Duskin Publishing Group, 1985, 256 pages, $8.95

Marital Interaction: Analysis and Modification, edited by Kurt Hahleweg&;Neil S. Jacobson. New York: Guilford Press, 1984, 450 pages, $40.00

Handbook of Cross-Cultural Counseling and Therapy, edited by Paul Pedersen. Westport, CT: Greenwood Press, 1985, 353 pages, $45.00.

Cognitive-Experiental Therapy: An Integrative Ego Psychotherapy, by Melvin L. Weiner. New York: Brunner/Mazel, 1985, 262 pages, $30.00     

Surrogate motherhood i: Responses to infertility

Abstract

Surrogate motherhood is one of three recently developed paths to parenthood resulting from modern technological medical research. It is, however, a path filled with legal “potholes” and psychological “rocks.” Mental health specialists, especially marital and family therapists, need to be familiar with this difficult road because they may well be called upon to provide their professional services to people attempting to negotiate it. This paper introduces a number of the potential hazards as well as the points at which therapeutic and related services may be needed.     

IDENTITY AND DISTINCTION IN SPINOZA'S ETHICS1

Abstract: In Ethics 1p5, Spinoza asserts that “In Nature there cannot be two or more substances of the same nature or attribute”. This claim serves as a crucial premise in Spinoza's argument for substance monism, yet Spinoza's demonstration of the 1p5 claim is surprisingly brief and appears to have obvious difficulties. This paper answers the principle difficulties that have been raised in response to Spinoza's argument for 1p5. The key to understanding the 1p5 argument lies in a proper understanding of the substance‐attribute relationship and the principles of metaphysical individuation that Spinoza accepts.     

Cancer during pregnancy: Two case studies

When a pregnant woman develops cancer, death and life are competing in her body and in her mind. In this article, two cases of pregnant cancer patients are described. The pregnant women were accompanied through their journey toward delivery and during the first months with their newborn. The process of being in intensive cancer treatment during pregnancy, of giving birth, and of building an early relationship with the infant is explored.     

Development of a Family-based Program to Reduce Risk and Promote Resilience Among Families Affected by Maternal Depression: Theoretical Basis and Program Description

Depression is a family matter. It not only diminishes the quality-of-life of the depressed person, but also strains the resources of the family unit and increases the children's risk of developing significant problems that start early and persist into adulthood. Although treatment of a parent's depression is critical, many families also need professional intervention to reduce children's risk. This article reviews the evidence on needs of these families and shows that the theoretical and clinical evidence exists to support the design of interventions for families affected by maternal depression. A preventive intervention developed from this foundation is described, the Keeping Families Strong (KFS) program, that is designed to promote resilience and reduce the risk for psychological disorders in children of parents with depression. The pilot study on the KFS program, conducted in adult mental health outpatient settings, is described. Families participate in 10 meetings 90 min each, with a group for parents and for children (10 years and older) conducted concurrently. The program structure and content are described, the challenges of implementing a family preventive intervention in actual clinical settings are discussed, and a case example is provided, as well as preliminary outcome data on ten families. In sum, we provide a strong rationale for the potential of preventive interventions for families affected by maternal depression.