Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent–infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent–infant dyads may illuminate important aspects of the method itself as well as the therapists’ role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent–infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent–infant dyads where child protective issues arise, where caregivers’ insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists’ role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.     

Maternal postpartum depression is a risk factor for infant emotional variability at 4 months

Maternal postpartum depression (PPD) is a risk for disruption of mother–infant interaction. Infants of depressed mothers have been found to display less positive, more negative, and neutral affect. Other studies have found that infants of mothers with PPD inhibit both positive and negative affect. In a sample of 28 infants of mothers with PPD and 52 infants of nonclinical mothers, we examined the role of PPD diagnosis and symptoms for infants’ emotional variability, measured as facial expressions, vocal protest, and gaze using microanalysis, during a mother–infant face-to-face interaction. PPD symptoms and diagnosis were associated with (a) infants displaying fewer high negative, but more neutral/interest facial affect events, and (b) fewer gaze off events.  PPD diagnosis, but not symptoms, was associated with less infant vocal protest. Total duration of seconds of infant facial affective displays and gaze off was not related to PPD diagnosis or symptoms, suggesting that when infants of depressed mothers display high negative facial affect or gaze off, these expressions are more sustained, indicating lower infant ability to calm down and re-engage, interpreted as a disturbance in self-regulation. The findings highlight the importance of not only examining durations, but also frequencies, as the latter may inform infant emotional variability.     

Examining the Association Between Racial Identity Attitudes and Coping With Racism-Related Stress

The authors examined the association between racial identity attitudes and coping with racism-related stress among Asian, Black, and Latinx college students (N = 195). Results of the canonical correlation analysis indicated that higher scores on a combination of all racial identity attitudes were significantly associated with greater active coping for Black and Latinx students. Among Asian students, the authors found that higher scores on conformity, dissonance, and immersion-emersion racial identity attitudes were significantly associated with greater avoidant coping. Los autores examinaron la asociación entre las actitudes de identidad racial y el afrontamiento del estrés relacionado con el racismo en estudiantes universitarios asiáticos, negros y latinxs (N = 195). Los resultados del análisis de correlación canónica indicaron que unos valores más altos en la combinación de todas las actitudes de identidad racial estaban asociados significativamente a un mayor afrontamiento activo en estudiantes negros y latinxs. En estudiantes asiático-americanos, los autores hallaron que unos valores más altos en las actitudes de identidad racial de conformidad, disonancia e inmersión/emersión estaban asociados significativamente a un mayor afrontamiento evasivo.     

Therapeutic Encouragement as Conceptualized by South Korean Youth Counselors

This study explored counselors’ conceptualization and use of encouragement as a therapeutic tool. Responses to two questions from 100 South Korean youth counselors were analyzed using consensual qualitative research–modified. As a result, six categories emerged under each domain. Implications for counseling and future studies are discussed. Este estudio exploró la conceptualización y el uso del apoyo como herramienta terapéutica por parte los consejeros. Usando el método modificado de investigación cualitativa consensual, se analizaron las respuestas proporcionadas a dos preguntas por 100 consejeros surcoreanos que trabajan con jóvenes. Como resultado, surgieron seis categorías bajo cada dominio. Se discuten las implicaciones para la consejería e investigaciones futuras.     

The day the clock stopped. Primitive states of unintegration,multidimensional working through and the birth of the analytical subject

This paper is based on one idea and built around one clinical experience that helped me to broaden my comprehension of it. The idea, underlying the work of several authors, is that when the analytic field is saturated with primitive and unintegrated mental contents, the analyst’s somatic countertransference is a precious indicator of a deep, dissociated form of communication. The clinical experience concerns the difficult elaboration of a complex, multifaceted countertransference that took place during the early stages of the analysis of a sensitive patient who used to communicate in a very dissociated way and that I found hard to contain. This experience, closely described in the article, led me to formulate the clinical idea that the transference field may be made of distinct layers (psychoid, affective, verbal), and that each one of them may potentially convey dissociated, even contrasting bits of information. The corollary of this is that the analyst should be ready to accept contrasting sensations, feelings and thoughts at the same time, as they might be the basic ingredients of a complex reverie. The analyst could find himself/herself in front of his/her own internal unelaborated multiplicity before a symbolic image may emerge to link the scattered pieces of the experience. Nevertheless, the heart of this paper is not about suggesting an idea, but in the sharing of a complex working through, which fostered the birth of a new, more human relational perspective: the capacity of being together in time, in a transitional space where there is neither total separation nor fusion.     

Evaluating Outcome Domains Assessing Caregivers of Individuals with Mental Illness: A Review

In this article, we describe the properties and consider the outcome dimensions of a collection of self‐administered questionnaires that assess caregivers of offspring with mental illness. To this end, we searched the MEDLINE, Web of Science, and PsycINFO databases, as well as reference lists of studies published between 1980 and 2012. We reviewed 43 instruments, and found multiple outcome domains, associated with either objective burden or subjective burden, or both. A number of tools captured additional negative aspects of caregiving (e.g., strain, stress, and worrying) as well as positive aspects (e.g., personal growth, strength, support, rewards, and satisfaction), supplemented by measures assessing caregivers' perceptions and attitudes toward their offspring with SMI (e.g., insight, stigma, and efficacy). This current review of existing measures and their specific domains contributes to a more comprehensive understanding of the caregiving experience and allows both clinicians and researchers to select the most appropriate measurement tools for their purposes.     

Language Anxiety and Counseling Self‐Efficacy

A total of 120 master's‐level counseling students were given the Foreign Language Classroom Anxiety Scale and the Counselor Self‐Estimate Inventory. Significance was found for all 3 hypotheses: (a) nonnative English‐speaking students have significantly more language anxiety than native English‐speaking students, (b) nonnative English‐speaking students’ language anxiety was negatively correlated with counseling self‐efficacy, and (c) native English‐ and nonnative English‐speaking students significantly differed in their perceptions of counseling self‐efficacy. Se administraron la Escala de Ansiedad en Clase de Lengua Extranjera y el Inventario de Autoestimación de Consejeros a un total de 120 estudiantes de máster en consejería. Se encontró significación para las 3 hipótesis siguientes: (a) los estudiantes cuya lengua nativa no es el inglés sufren un nivel considerablemente más alto de ansiedad a causa del idioma que los hablantes nativos de inglés, (b) la ansiedad a causa del idioma de los estudiantes cuya lengua nativa no es el inglés mostró una correlación negativa con la autoeficacia en consejería y (c) los grupos de estudiantes nativos y no nativos en inglés mostraron diferencias significativas en sus percepciones de autoeficacia en consejería.     

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY

Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.