The Unreal Child1

Unrepresented mental states lead to an impaired ability to feel emotions and trust in oneself, one’s history and in the world. The article explores the question of how representations of oneself and the relevant other, the mother, become possible in the course of therapy when dissociative processes previously made this impossible, and what role unconscious communication plays in the analytic realm. This question will be explored by examining the theories of André Green, Philip Bromberg, and Howard Levine.     

A Multifaceted and Dyadic Examination of Intimate Relationship Quality during Pregnancy: Implications for Global Relationship Satisfaction

Understanding how couples navigate and negotiate the challenges and demands of pregnancy has important implications for family health. The aim of this study was to apply a multidimensional model of intimate relationship quality in a sample of 154 pregnant, cohabitating couples, to investigate the association between a range of intimate relationship processes (i.e., emotional intimacy, conflict management, sexual quality, received respect and acceptance, and received support) and the global relationship satisfaction of each partner. Semistructured clinical interviews were administered to each partner assessing multiple qualities of the relationship, and participants completed home surveys of global relationship satisfaction each day for 14 days. Results demonstrated that multiple dimensions of the intimate relationship were associated with greater relationship satisfaction. Some processes (e.g., degree of emotional intimacy and closeness, conflict management) had larger effects on relationship satisfaction than others (e.g., quality of the sexual relationship). Furthermore, some processes were more important for maternal than paternal satisfaction (e.g., emotional intimacy, support, respect). Finally, results varied, to some degree, as a function of whether parents were transitioning to parenthood for the first time. We discuss the implications of adopting a multidimensional approach to studying the specific relationship processes associated with global relationship satisfaction and present implications for clinicians working with couples navigating the transition into parenthood.     

New Fathers’ Perceptions of Dyadic Adjustment: The Roles of Maternal Gatekeeping and Coparenting Closeness

Although the association between maternal gatekeeping and relationship functioning has been explored by a few studies, none of these have focused on fathers’ perceptions of these constructs. Given that today's new fathers are challenged by elevated expectations for active parenting and coparenting even as most new mothers remain primary caregivers of infant children, this is a critical omission. This study examined the associations between new fathers’ perceptions of maternal gatekeeping and change in dyadic adjustment as mediated through coparenting closeness. Maternal gatekeeping was reported by 182 fathers at 3 months postpartum, coparenting closeness was reported at 3 and 6 months postpartum, and dyadic adjustment was reported during the third trimester of pregnancy and at 9 months postpartum. Fathers’ perceptions of relative change in coparenting closeness from 3 to 6 months mediated associations between fathers’ perceptions of maternal gatekeeping at 3 months and relative change in dyadic adjustment from the third trimester to 9 months postpartum. In particular, findings indicate that greater perceived maternal gate opening was associated with higher levels of dyadic adjustment through higher levels of coparenting closeness, whereas greater perceived maternal gate closing was associated with lower levels of dyadic adjustment through lower levels of coparenting closeness. This study highlights the importance of studying fathers in the context of the family system and the role of the coparenting relationship at the transition to parenthood in couple relationship functioning.     

Therapist Interventions Associated with Productive Emotional Processing in the Context of Attachment-Based Family Therapy for Depressed and Suicidal Adolescents

Productive emotional processing is considered a key change mechanism in attachment-based family therapy (ABFT). This study examined the impact of attachment-based family therapy therapist interventions aimed to promote productive emotional processing of primary adaptive emotions in a sample of 30 depressed and suicidal adolescents who had participated in a larger randomized clinical trial. Results of sequential analyses revealed that relational reframes and therapists’ focus on primary adaptive emotions were associated with the subsequent initiation of adolescents’ productive emotional processing of primary adaptive emotions. In contrast, interpretations, reassurances, and therapists’ focus on adolescents’ rejecting anger toward their parents were all followed by the discontinuation of adolescents’ emotional processing that had already begun. Finally, therapists’ general encouragement of affect and focus on adolescents’ unmet attachment/identity needs were associated with both the initiation of adolescents’ productive emotional processing, and with the discontinuation of such processing once it had already begun. Theoretical and clinical implications are discussed.     

Family Functioning among Rural Teens and Caregivers: Interactive Influence on Teen Dating Violence

Multi-informant assessment of family functioning is considered best practice in research and clinical settings. However, in the area of teen dating violence, multi-informant assessment of family functioning has received limited attention. The current study investigated whether and to what extent caregiver and adolescent perceptions of family functioning interact in their influence on adolescent dating violence. Participants were 493 adolescents and their primary caregivers from a rural southeastern community in the United States. As hypothesized, a paired-samples t test showed that adolescents’ scores on the family functioning measure were significantly lower than their caregivers’ scores. Logistic regressions revealed that adolescents’ positive views of family functioning were significantly associated with a lower likelihood of dating violence victimization but not perpetration and that caregivers’ views on family functioning moderated the impact of adolescent-reported family functioning on both dating violence outcomes. Post hoc analyses showed that adolescents with negative perceptions of family environment were most likely to be victims and perpetrators of dating violence when their parents also reported more negative views of family environment. The article concludes with a discussion of how these findings can: (a) advance our understanding of the impact of family functioning on teen dating relationships and (b) inform practical efforts aimed at preventing dating aggression among teens.     

Introducing SYPRENE: An International Practice Research Network for Strategic and Systemic Therapists and Researchers

SYPRENE, a new international Systemic Practice Research Network (PRN), has been established to fill the gap in practice-based research on the effectiveness and efficiency of strategic therapies. This article presents the rationale for the creation of SYPRENE and describes data collection methods, and the encoding system implemented within this PRN. More developments are expected in the recruitment of practitioners, the types of data collected, findings, and the implementation of SYPRENE in supervision, trainings, and professional schools.     

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.     

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.