Clinical Assessment of Prementalizing Modes of Psychic Functioning in Children and Their Parents in the Context of Trauma

ABSTRACT

As psychoanalytic psychotherapy for children depends on their capacity to mentalize, it is essential to integrate this dimension in their psychological assessment. Mentalization refers to the capacity to identify and comprehend the mental states (feelings, thoughts and intentions) underlying and explaining one’s own behaviors and those of others. This vital ability, which develops during the first five or six years of life in the context of a secure parent-child attachment, is often impaired in children subjected to neglect and maltreatment. Based on rigorous and systematic clinical observations made in youth protection and child psychiatry services, the authors suggest that the children in these settings, along with their parents, frequently present a prementalizing mode of psychic functioning. Further, the authors propose operationalizing the teleological, psychic equivalence, and pretend modes as they might be observed in older children and their parents. To this end, they begin by identifying behaviors, attitudes, and relational patterns potentially linked to each of these modes within a theoretical framework. Next, they describe the characteristics of these children’s narratives, play, and artistic productions. Lastly, three clinical vignettes are used to illustrate how the prementalizing modes are manifested. The results of this clinical assessment can guide the choice of techniques to be used in child psychotherapy.     

Cognition and daily activities in a general population sample aged +55

ABSTRACT

Objective: We tested the association of individual cognitive domains measured with the Mini-Mental State Examination (MMSE) and disability.

Method: Cross-sectional study in a population-based cohort aged ≥55 years (n = 4,803). Sample was divided into two groups: individuals with cognition within the normal range (CNR) (n = 4,057) and those with cognitive impairment (CI) (n = 746). Main outcome measures: The MMSE, the Katz Index (Basic Activities of Daily Living, bADL), the Lawton and Brody Scale (Instrumental Activities of Daily Living, iADL), and the Geriatric Mental State (GMS-AGECAT).

Results: MMSE-orientation was associated with disability in bADL, iADL and a decrease in social participation, regardless of cognitive status. MMSE-attention was associated with disability in iADL, but only in CNR. MMSE-language was associated with disability in bADL, iADL and with reduced social participation, but only in CI. Conclusions: The associations observed between disability and orientation may have clinical and public health implications.     

Is avoidance of illness uncertainty associated with distress during oncology treatment? A daily diary study

Objective: The aim of this study was to explore the daily relationship between illness uncertainty, avoidance of uncertainty, well-being and treatment-related distress among patients with cancer receiving treatment with curative intent. It was hypothesised that daily illness uncertainty, daily avoidance of uncertainty and daily treatment-related distress would be negatively associated with daily well-being. It was also hypothesised that daily illness uncertainty and daily avoidance of uncertainty would be positively associated with daily treatment-related distress.

Design: Thirty-one patients receiving oncology treatment with curative intent completed a daily diary for seven consecutive days. Data were analysed using multilevel modelling.

Main outcome measures: Daily illness uncertainty, avoidance of illness uncertainty, treatment-related distress and well-being.

Results: As hypothesised, on days when patients with cancer reported heightened treatment-related distress they experienced diminished well-being. And on days when patients reported more experiential avoidance of illness uncertainty, they also experienced heightened levels of treatment-related distress. No other daily associations were significant.

Conclusion: These findings indicate that patients with cancer experience day-to-day fluctuations in distress and well-being throughout oncology treatment. Avoidance of illness uncertainty-related thoughts and/or emotions are associated with daily distress, but not daily well-being.