A randomized controlled effectiveness trial of parent management training with varying degrees of therapist support

This study examined the effectiveness of a Swedish parent management training (PMT) intervention for parents of children aged 3 to 10 within the context of regular social service. Self-referred parents of 159 children (aged 3 to 10) with conduct problems were randomly assigned to either 11 practitioner-assisted group sessions (PMT-P), or a single instructional workshop followed by self-administration of the training material (PMT-S), or a waitlist control group. Intent-to-treat analyses showed that both PMT-P and PMT-S improved parent competence and reduced child conduct problems compared to the waitlist at posttest. Both training conditions showed further significant improvements at the 6-month follow-up. In direct comparison, PMT-P was superior to PMT-S on measures of child conduct problems at both posttest and follow-up. Improvement in child conduct was mediated by improvement in parent competencies and homework fidelity. The findings in this study have implications for large-scale dissemination of parent management training through different means of delivery.     

The dual aspect of fantasy: Flight from reality or imaginative realm? Considerations and hypotheses from clinical psychoanalysis1

This paper discusses the view that fantasizing, understood as a flight into fantasy, belongs to a type of mental functioning distinct from imaginative fantasy. From this the idea emerges, proposed by Winnicott, that withdrawal into fantasy assumes a dissociative quality, which is formed early on as a defensive solution following the loss of hope in object relations. Such a defence becomes the foundation for a dangerous enclave in which the individual ends up enclosing himself, experiencing an illusory self-sufficiency. In this perspective, the author maintains that the flight into fantasy must be understood as a risk factor for the draining of the self or for a crystallization into psychopathological structures, becoming an automatic activity of 'non-thought' that substitutes for the working-through processes necessary for the development of the mind. The paper investigates this psychopathological dynamic, which was already present in Breuer and Freud's writings, examining subsequent contributions of various authors. Clinical material (of both children and adults) illustrates how the flight into fantasy may take the form of an anti-relational realm of the mind, compromising the operations necessary to the integration of psychic life. There is also a discussion of which therapeutic tools may help the patient to gradually abandon the withdrawal in favour of an authentically nourishing relational nature.