Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

Organizational schism: Looking after a psychiatric service

What is opposed to psychoanalysis is not psychiatry but psychiatrists. (Freud, 1916–1917, p. 254)     

Effects of a Peer Engagement Program on Socially Withdrawn Children with a History of Maltreatment

Children with a history of child maltreatment often have limited social interactions with other children and adults. This study examined the effects of a Peer Engagement Program, consisting of peer mentoring and social skills training with positive reinforcement, in three children with low levels of oral and social interaction. A multiple baseline, single-subject research design was used to test whether introduction of the intervention was associated with increased, directly observed oral interaction and engagement in social activities with peers and adults. The Child Behavior Checklist (CBCL) and the Social Skills Rating Scale (SSRS) were administered before and after intervention. All children showed increased levels of oral and social interaction and improved scores on the SSRS and the CBCL.     

Maternal ADHD: Parent-Child Interactions and Relations With Child Disruptive Behavior

This study examined how ADHD symptoms in mothers of children with ADHD relate to their behavior during parent-child interactions and to their children's disruptive behavior. Findings indicated that mothers’ retrospective self-ratings of ADHD symptoms were related to their present negativity during parent-led play. Mothers’ self-ratings of current inattentive symptoms were related to their impatience during child-led play. Maternal ADHD symptoms were also related to their ratings of their children's ADHD and oppositional-defiant behaviors. Identifying relations between maternal psychopathology, such as ADHD symptomatology, and behaviors during parent-child interactions may yield clues to additional parent behavioral changes that would enhance treatment outcomes for young children with ADHD.     

Mentoring Youth with Psychiatric Disorders: The Impact on Child and Parent Functioning

ABSTRACT

This study examined the effectiveness of a behavioral mentoring program aimed at serving youth with psychiatric disorders. Participants included 30 youth (8–12 years old) receiving services in a mentoring program for a mental health population and 30 wait-listed youth and their maternal caregivers. Participating in mentoring services was related to higher family functioning across a number of domains including child behavior, parenting stress, perceived parent social support, and perceived parent-child relationship quality. As predicted, parenting stress mediated the relationship between mentoring and children's externalizing behavior problems. Results suggest that mentoring services may be a useful adjunct service for highly stressed families with children with emotional and behavioral disorders.     

Task conflict,information processing,and decision-making: The damaging effect of relationship conflict

A popular theoretical assumption holds that task-related disagreements stimulate critical thinking, and thus may improve group decision making. Two recent meta-analyses showed, however, that task conflict can have a positive effect, a negative effect, or no effect at all on decision-making quality (De Dreu & Weingart, 2003; De Wit, Greer, & Jehn, 2012). In two studies, we built upon the suggestion of both meta-analyses that the presence of relationship conflict determines whether a task conflict is positively or negatively related to decision making. We hypothesized and found that the level of perceived relationship conflict during task conflict (Study 1), and the actual presence (vs. absence) of relationship conflict during task conflict (Study 2), increased group members’ rigidity in holding onto suboptimal initial preferences during decision making and thus led to poor decisions. In both studies the effect of relationship conflict on decision making was mediated by biased use of information.     

Contribution of parents' adult attachment and separation attitudes to parent‐adolescent conflict resolution

This study examined the contribution to parent‐adolescent conflict resolution of parental adult attachment styles and attitudes toward adolescent separation. Questionnaires were completed by 295 couples with early to late adolescent children. Structural equation models were used to test self and partner influences on conflict resolution for three attachment orientations: confidence (model A), anxiety (model B) and avoidance (model C). Model A showed self influences between parents' confidence orientation and negotiation and also via positive attitudes towards separation. Also, the fathers' use of negotiation was facilitated by the mothers' confidence orientation and vice versa, indicating partner influences as well. Model B showed self influences between parents' anxiety orientation and the use of dominance and withdrawal and also via negative attitudes towards separation. Model C showed self influences between parents' avoidance orientation and dominance and withdrawal, and a partner influence between fathers' avoidance and mothers' use of dominance. The results indicated that the parents' adult attachment system and the parenting system were related in the area of conflict resolution, and that self influences were stronger than partner influences.     

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

For many years psychoanalytic and psychodynamic therapies have been considered to lack a credible evidence-base and have consistently failed to appear in lists of ‘empirically supported treatments’. This study systematically reviews the research evaluating the efficacy and effectiveness of psychodynamic psychotherapy for children and young people. The researchers identified 34 separate studies that met criteria for inclusion, including nine randomised controlled trials. While many of the studies reported are limited by sample size and lack of control groups, the review indicates that there is increasing evidence to suggest the effectiveness of psychoanalytic psychotherapy for children and adolescents. The article aims to provide as complete a picture as possible of the existing evidence base, thereby enabling more refined questions to be asked regarding the nature of the current evidence and gaps requiring further exploration.     

The Oedipus complex as observed in work with couples and their children

In work with couples where there is a child referred to a Child and Adolescent Mental Health Service, there are opportunities to observe and to work with unresolved Oedipal issues brought by the parents to the task of creating a family. These conflicts can be seen enacted by the child or children, either internally or externally. Examples are given from five cases: the first two from brief family work where the children are under five and the difficulties are to some extent resolved. The next two demonstrate more intractable problems of psychopathology where the parental Oedipal conflicts are handed down to the next generation, and the paper concludes with an example of couple work in relation to individual therapy with a child, where despite the pressure of considerable pathology in the parents' backgrounds there is a will to integration and progress is made.