Jungian theory of dreaming and contemporary dream research – findings from the research project ‘Structural Dream Analysis’

The research method ‘Structural Dream Analysis’ (SDA) is described which allows for systematic and objective analysis of the meaning of dreams produced by patients in Jungian psychotherapies. The method focuses especially on the relationship between the dream ego and other figures in the dream and the extent of activity of the dream ego. Five major dream patterns were identified which accounted for the majority of the dreams. The clients’ dream series were dominated by one or two repetitive patterns which were closely connected to the psychological problems of the dreamers. Additionally, typical changes in the dream series’ patterns could be identified which corresponded with therapeutic change. These findings support Jung's theory of dreams as providing a holistic image of the dreamer’s psyche, including unconscious aspects. The implications for different psychoanalytic theories of dreaming and dream interpretation are discussed as well as implications for the continuity hypothesis.     

Attachment & Child Health (ATTACH) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress

Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function—parents’ capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child—may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children <36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.     

Male callers to an Australian perinatal depression and anxiety help line—Understanding issues and concerns

There is increasing recognition of the issues facing men in the perinatal period. Vulnerability factors and issues in the partner relationship contribute to mental health risk and can impact the quality of the father–infant relationship. Yet, there is limited understanding of fathers’ help-seeking when they or their partner are experiencing mental health issues in the context of caring for a new baby. The present study examines fathers’ contacts with the Perinatal Anxiety and Depression Australia (PANDA) National Helpline. The study reviewed contacts from fathers and their identified needs for assistance, relationship issues, and support needs; 70% of male callers (N = 129) reported concerns about the mother's mental health, and 57% were concerned about relationship breakdown. Significant numbers of men raised issues about their own mental health (43%) and many were concerned about the impact of maternal mental state on the relationship with the infant. When compared to community data, there were elevated rates of concerns about depression and anxiety. Men also described difficulties with the fathering role and with regulating their own feelings of guilt and frustration. These findings highlight the needs of men for support when a mother experiences perinatal problems and also the risk for distress in fathers.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

Post-discharge outcomes for mothers and the mother–infant relationship following admission to a psychiatric Mother–Baby Unit

Mother–Baby Unit research has focussed on maternal psychopathology over the course of an admission. Less is known about the baby's well-being, the shared relationship, or the mother's recovery. In an initial sample of 45 women, we describe discharge and post-discharge outcomes for maternal psychopathology (using maternal report and the Global Assessment of Function, GAF) and the mother–infant relationship (using the Child and Adult Relational Experimental Index, CARE Index). Three months post-discharge, one third of women described themselves as “completely recovered,” one third were experiencing significant deterioration and 17% were readmitted to inpatient care. Poorer GAF scores were associated with a clinical diagnosis of comorbid personality disorder, antenatal presence of the index illness, partner illicit substance use, maternal perception of her bond, infant social withdrawal, and child protection concern. Post-discharge, the mother–infant relationship results were concerning. Only 17% were regarded as adequate. Improvement was observed across this period in 56% but relational deterioration occurred for 35%. Maternal and relational outcomes were weakly correlated at discharge (r² = 0.29, p = 0.07) but this was lost post-discharge (r² = 0.03, p = 0.89). The shared relationship and infant mental health should both be targets for intervention; both during MBU admission, and post-discharge.     

The effects of the Newborn Behavioral Observations (NBO) system in early intervention: A multisite randomized controlled trial

The purpose of this pilot study was to evaluate the effect of an infant mental health intervention, the Newborn Behavioral Observations system (NBO), versus usual care (UC) on infant neurodevelopment and maternal depressive symptoms in early intervention (EI). This multisite randomized trial enrolled newborns into the NBO (n = 16) or UC group (n = 22) and followed them for 6 months. Outcome measures included the Battelle Developmental Inventory (BDI-2), Bayley Scales of Infants Development (BSID-III), and Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D and BSID-III were collected at 3- and 6-months post EI entry and the BDI-2 was collected at EI entry and 6-months post-EI entry. We estimated group differences [95% CI], adjusting for program characteristics. At 6 months, the NBO group had greater gains in Communication (b = 1.0 [0.2, 1.8]), Self-Care (b = 2.0 [0.1, 3.9]), Perception and Concepts (b = 2.0 [0.4, 3.6]), and Attention and Memory (b = 3.0 [0.4, 6.0]) than the UC group. The NBO group also had greater decline in maternal postnatal depressive symptoms (b = −2.0 [−3.7, −0.3]) than the UC group. Infants receiving the NBO infant mental health intervention had greater gains in cognitive and adaptive functions at 6 months than infants receiving UC. Caregivers receiving NBO care had greater improvements in maternal depressive symptoms than caregivers receiving UC.     

Parenting after Weight Loss Surgery: A Conceptual Model and Two Case Reports

The ways families approach eating, shape, and weight can result in stress for individual family members and challenge the overall functioning of the family. This is further complicated among families with a parent who has history of obesity or undergone weight loss surgery (WLS). Although WLS can positively impact other family members, it can also exacerbate conflicts regarding feeding and weight. Such conflicts can involve uncertainty regarding the extent to which the entire family should make the dietary changes recommended for the post-WLS parent. Conflict might also center on the appropriate level of concern regarding the children’s risk of developing (or maintaining) obesity. This paper uses two case examples to describe the application of a specialized, time-limited intervention: Parent-Based Prevention following Bariatric Surgery (PBP-B). The program was developed to address the unique challenges and concerns that arise after, or are exacerbated by, WLS. Each detailed case example illustrates a common child-feeding challenge and the employment of key PBP-B strategies throughout the course of treatment. In the first case, the parent who had undergone WLS believed the family’s current eating behaviors were the same as those that had led to her own overeating, obesity, and co-occurring psychiatric symptoms, while her husband disagreed. In the second case, both parents were concerned about their son’s weight, yet due to their prior eating histories, they felt unable to construct boundaries around the feeding experience. Both cases follow families through the entire intervention and illustrate key points and challenges. These cases underscore the need for novel treatment modalities to support families following parental WLS.     

Barriers and Facilitators to Implementing Attachment-based Family Therapy into a Child Welfare Setting: A Qualitative Process Evaluation

Child welfare systems (CWSs) worldwide show increased interest in adopting empirically informed clinical strategies to increase treatment effectiveness. Many empirically supported treatments (ESTs) exist, but little is known about EST implementation barriers and facilitators in CWS. This study explored CWS providers’ experiences of implementing attachment-based family therapy (ABFT) in home-based services of the Flemish CWS (in Belgium). Sixteen CWS providers (twelve counselors and four supervisors) involved in three home-based services were interviewed. The Consolidated Framework for Implementation Research (CFIR) was used to guide collection, coding, and analysis of interview data. Findings revealed that implementation success was related to ABFT's fit with the CWS's mission, philosophy, and existing practices. CWS providers’ belief in the compatibility between ABFT and CWS increased investment in implementation efforts and persistence to overcome challenges and setbacks. Some barriers pertained to the learning of ABFT and some barriers pertained to systems level challenges such as lack of leadership and support, poor coordination with referral sources and other youth care partners, and lack of policy support. For successful expansion of ESTs into CWS settings, various barriers at multiple systemic levels need to be addressed.     

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.     

Sitting In: The Experience of Learning and Practicing Family Therapy through Being a Co-Therapist in Hong Kong

This article explores family therapy trainees’ subjective experiences of working as cotherapists with a supervisory-level therapist in a Chinese context, regarding their perceptions of and positioning in it and also their opinions on the benefits and/or pitfalls of cotherapy. Individual interviews with a total of six cotherapists revealed three themes: (1) Cotherapy was perceived as an experiential learning journey that evolved from anxiety and excitement to empowerment and nurturing; (2) a collaborative master–apprentice relationship of openness, trust, and mutual respect was developed with both sides’ interactive effort, which included common commitment and concern for the client, the supervisor’s awareness and explicit address of the role hierarchy, principle setting prior to the cooperation, and honest pre- and-postsession sharing and discussion; (3) the dual-purpose supervisor–trainee cotherapy brought direct benefits for all involved parties and for others. The findings have useful implications for integrating treatment and training for optimal training/learning outcomes and for advancing knowledge transfer from senior to junior and from academia to the field, with reference to local cultural characteristics.