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.     

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.     

Predictors of Involvement and Warmth of Custodial Fathers in Israel: Comparison with Married and Noncustodial Divorced Fathers

This study compared the levels and predictors of paternal warmth and involvement of 218 custodial fathers to 222 married fathers and 105 noncustodial (NC) divorced fathers in Israel. The examined predictors were fathers' perceptions of their own fathers; their own caregiving behaviors and parental self‐efficacy; and child characteristics and coparental coordination. Results indicated that being a custodial father was associated with more involvement than being a married or NC divorced father. Regression analyses revealed that experience of care with own father predicted fathers' involvement, whereas own father control was related to lower paternal warmth. Lower avoidant caregiving and high paternal self‐efficacy predicted both paternal involvement and warmth, whereas perceiving the child as more difficult predicted lower paternal warmth. Higher levels of coparental coordination were associated with more paternal involvement, whereas low coparental coordination was associated with less involvement, primarily among NC divorced fathers. These interactions highlight the distinct paternal behavior of custodial fathers. Unlike married and NC divorced fathers, they showed more warmth, regardless of their avoidant caregiving. Results are discussed in light of the different roles played by fathers in the three groups.     

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.     

Multiple Levels of Family Factors and Oppositional Defiant Disorder Symptoms Among Chinese Children

Family factors are closely associated with child developmental outcomes. This study examined the relationship of oppositional defiant disorder (ODD) symptoms and factors at whole family, dyadic, and individual levels in Chinese children. Participants, who were recruited from 14 primary schools in north, east, and south‐west China, included 80 father‐child dyads and 169 mother‐child dyads. Children in the participating dyads were previously diagnosed with ODD. Results revealed that family cohesion/adaptability was indirectly associated with ODD symptoms via parent–child relationship and child emotion regulation. Parent–child relationship affected ODD symptoms directly and indirectly through child emotion regulation. In addition, the effects of family cohesion/adaptability on parent emotion regulation and child emotion regulation were mediated by the parent–child relationship. The tested model provides a comprehensive framework of how family factors at multiple levels are related to child ODD symptoms and highlights the importance of understanding child emotional and behavioral problems within the family context, more specifically within the multiple levels of family relationships.     

Jung's Erotic Phenomenology: I. A New Translation

In the introduction to The Psychology of the Transference (1946), Carl Jung sketched out a theory of “erotic phenomenology” which condenses his teaching about sexuality and romantic love into a very concise summary. But the meaning of this passage is obscured in the English translation given in the Collected Works of C. G. Jung. I propose here a new translation which makes Jung’s meaning clearer, along with a commentary which explains it in the context of Freudian drive theory and German 19^th century philosophy. Invoking the concepts of instinct, mind, and Eros (both the passion and the divine figure), Jung’s theory says that male sexual desire can be cultivated or repressed in four distinct ways, each associated with a female symbolic figure or anima image: Eve, Helen, Mary and Sophia.     

Understanding autism: how family therapists can support parents of children with autism spectrum disorders

The number of children diagnosed with an Autism Spectrum Disorder has increased dramatically in the last 20 years. Parents of children with autism experience a variety of chronic and acute stressors that can erode marital satisfaction and family functioning. Family therapists are well-suited to help parents stay connected to each other as they create a "new normal." However, family therapists need updated information about autism, and they need to understand how family therapy can help parents of children with autism. Because having a child with autism affects multiple domains of family life, this paper explores how family therapists can utilize an integrative approach with parents, enabling them to flexibly work with the domains of action, meaning, and emotion.