Frustration and disappointment

The paper describes research on children’s responses to failures of gratification. Although this has always been an important area of consideration in psychoanalytic thinking, arguments are put forward for the child’s actual feelings of disappointment being significant in ways that have yet to be fully realised theoretically and clinically within Kleinian object relations. Since Freud first used the term ‘frustration’, it has been applied in psychoanalysis as a means by which to describe in an undifferentiated way all those responses to failures of gratification that have an aggressive content. It will be argued that, in a context of the historical shift in thinking from drive to relational models, there is now perhaps scope to posit the existence instead of two discrete object relational positions towards such failures of aim – that frustrated responses can be differentiated in important structural and developmental ways from disappointed ones, by suggesting that the former are schizoid, whilst the latter are depressive in quality. To try and begin to test the hypothesis that there might be an object relational distinction between feelings of frustration and feelings of disappointment, selected process notes from two training cases became the subject of a combined piece of clinical and theoretical research. I will outline how this research was undertaken and present the findings that arose from the clinical part of it. With the use of a content analysis, a method for gathering interesting quantitative data about the children’s various responses to the failures of gratification was arrived at.     

‘And when you were a child?’: how therapists working with parents alongside individual child psychotherapy bring the past into their work

When a child is offered psychotherapy, it is common that regular meetings will be offered to the parents. However, there are debates in the literature about the degree to which such parent work should include a focus on the parents’ own childhood experiences. This study aimed to examine the way that those offering parent work as part of a study evaluating the treatment of adolescent depression dealt with this issue in their work with parents, both in the study and in routine clinical practice. Design: five therapists were interviewed on the subject of working with parents’ childhood experiences within parent work parallel to child psychotherapy. Data were analysed qualitatively, using Interpretative Phenomenological Analysis. Findings: participants described the need to consider the different parameters of this work to individual adult therapy; in addition, participants felt that it was necessary to negotiate permission to work on the parents’ childhood experiences. They also spoke of making use of insight into the repetition of the parents’ history, the analysis of parental projections and offering containment within the relationship; this varies from the ‘transference work’ of individual therapy and a different style of interpretation was described. Conclusions: there is a need to give more attention to the neglected field of working with parents alongside individual child psychotherapy, especially at a time when such work is under threat within many public services. There are particular technical issues related to work with parents’ own childhood histories that are different to how one might work in individual therapy with a parent.     

Pervasive traumatic loss from AIDS in the life of a 4-year-old African boy

It is estimated that, by the end of this century, over five million children under the age of 10 will have lost their mothers as a result of HIV infection. The psychological implications for the children who survive are extensive. These children suffer not only from bereavements and disruption to family life, they also suffer from prevailing anxieties about their own health and the health of their carers. It is the pervasive threat of death which constitutes chronic trauma for child survivors of HIV infection. Confusions abound in fact and in phantasy of where responsibility lies for the tragedies which surround them. Psychotherapeutic treatment for the survivors concentrates on both the cognitive and the emotional aspects of the traumas to enable the child to grieve and to feel appropriate anger for the tragedy in their life. This paper presents a detailed case history of a 4-year-old African boy of refugee parents who were victims of war as well as AIDS. Using a psychoanalytic framework, the child's distorted perceptions of his world are described and his attempts to make sense of his world and keep hope alive in spite of the continual threat of abandonment is demonstrated.     

To be in touch

This study examined the constellation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – that emerged in the psychodynamic therapy (PDT) of a child diagnosed with borderline personality disorder and treated by two doctoral student therapists. Identification of these interaction structures can inform therapists of what might be expected from patients with particular symptom or behaviour patterns and how interactions change over time. This study also examined each session’s adherence to three session prototypes: PDT, cognitive-behavioural therapy (CBT) and reflective functioning (RF) process. The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a single psychotherapy session. Items reflect a wide range of therapist attitudes and behaviours, patient attitudes and behaviours and interactions between therapist and patient. Experts used the CPQ to define PDT, CBT and RF process session prototypes. The results suggested that four distinct interaction structures could be identified and that their constellations differed between the two therapists and also differed over time within each treatment. Therapists were more structured and accommodating early on in their treatments and more interpretive later. Prototypical PDT process was more prominent in the sessions than RF process, which in turn was more prominent than CBT process. Unique therapeutic processes are at work in every dyad, despite holding the patient and theoretical orientation constant. An effective treatment in one dyad might not work in another due to therapist-specific and dyad-specific effects.     

Assessment for psychotherapy

This paper explores some issues that might arise when one considers having a table hockey game in the therapy room, and describes how an autistic boy, aged four-and-a-half when starting treatment, used that game. The unfolding process from withdrawal to separateness, intersubjectivity and playfulness is illustrated by the progress of two years of twice-weekly psychoanalytic psychotherapy. Special attention is paid to how the play progressed through the intermediate area that the therapist provided.     

To know or not to know: an application of Bion’s K and –K to child treatment1

The authors discuss an application of Bion’s conceptualisation of thinking and non-thinking states (K and –K links) to the treatment of a nine-year-old girl. The authors consider Bion’s interrelated concepts such as K and –K, container/contained, maternal reverie, and the development of thinking through alpha function to be highly applicable to child treatment. The afore-mentioned conceptual elements are used to elucidate case material over two consecutive hours. A K link is established between therapist and patient, the fragility of which link is then demonstrated by its deterioration into a –K link. Complex issues about knowing and not knowing are central in this girl’s clinical presentation. She was conceived through in vitro fertilisation (IVF), and subsequently diagnosed with cerebral palsy. The authors consider the emotional impact of this origin story and how the parents relate to it. The authors discuss how parents sometimes cope with perceived losses by wishing to shield or protect their children. This can have repercussions for children’s efforts to know (K) and not to know (?K). The fear that emotional knowledge will be too painful to bear can interfere with ‘learning from experience’. Bion’s premise that the purpose of analysis is the growth of the mind is synonymous with the child analyst’s goal of fostering development and understanding impediments to development.     

Mommy is only happy! Dutch mothers’ realisation of speech sounds in infant-directed speech expresses emotion,not didactic intent

Exaggeration of the vowel space in infant-directed speech (IDS) is well documented for English, but not consistently replicated in other languages or for other speech-sound contrasts. A second attested, but less discussed, pattern of change in IDS is an overall rise of the formant frequencies, which may reflect an affective speaking style. The present study investigates longitudinally how Dutch mothers change their corner vowels, voiceless fricatives, and pitch when speaking to their infant at 11 and 15 months of age. In comparison to adult-directed speech (ADS), Dutch IDS has a smaller vowel space, higher second and third formant frequencies in the vowels, and a higher spectral frequency in the fricatives. The formants of the vowels and spectral frequency of the fricatives are raised more strongly for infants at 11 than at 15 months, while the pitch is more extreme in IDS to 15-month olds. These results show that enhanced positive affect is the main factor influencing Dutch mothers’ realisation of speech sounds in IDS, especially to younger infants. This study provides evidence that mothers’ expression of emotion in IDS can influence the realisation of speech sounds, and that the loss or gain of speech clarity may be secondary effects of affect.     

Associations of Mother–Child Reminiscing about Negative Past Events,Coping, and Self‐Concept in Early Childhood

Parent–child reminiscing conversations in early childhood have received theoretical attention as a forum for children's self‐concept development, but this has been little addressed in empirical work. This study examines associations between emotion reminiscing and children's self‐concepts and, building from the reminiscing and personality development literatures, also explores the role of children's coping. Sixty 4‐ and 5‐year‐old children and their mothers completed reminiscing conversations about events in which the child had experienced negative emotion, children completed an age‐appropriate assessment of their self‐concept, and mothers and teachers reported on children's coping strategies. Children's self‐perceived timidity was associated with their explanations for negative emotions during reminiscing. Children's self‐perceived negative affect was associated with fewer emotion resolutions during reminiscing, and with distinctive patterns of coping. Both reminiscing and coping made unique contributions to children's self‐concepts, and findings also suggest that coping may in some contexts indirectly connect reminiscing with self‐concept. These findings suggest that reminiscing conversations both reflect children's characteristics and provide a context for learning about their characteristics, along with strategies for emotion management. Copyright © 2013 John Wiley & Sons, Ltd.     

Paternal Postnatal and Subsequent Mental Health Symptoms and Child Socio‐Emotional and Behavioural Problems at School Entry

Research on the effect of paternal mental health problems, particularly on young children, is based predominantly on clinical levels of depression. Furthermore, potential mediators such as marital discord have often been overlooked. This longitudinal community study assessed the association between paternal mental health symptoms in a community sample (N = 705) assessed at 3 months postnatally (Edinburgh Postnatal Depression Scale) and 36 months (General Health Questionnaire) and children's socio‐emotional and behavioural problems at 51 months (Strengths and Difficulties Questionnaire) as reported by mother, father and teacher. Controlling for socioeconomic status and maternal mental health symptoms at 3 and 36 months, paternal postnatal depressive symptoms predicted more father‐reported child problems at 51 months but, in contrast to previous findings, not mother‐reported problems. Paternal mental health symptoms at 36 months predicted both maternal and paternal reports of child problems at 51 months controlling for both paternal and maternal postnatal symptoms. Paternal mental health symptoms at 3 and 36 months were not significant predictors of teacher‐reported child problems. Postnatal marital discord and paternal mental health problems at 36 months both mediated the relationship between paternal postnatal symptoms and later child emotional and behavioural problems. Child gender did not moderate the relationship. Implications for interventions are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Multiple Attachment Representations in Clinical Practice: Case Study of a Six-Year-Old Maltreated Child

Research on attachment predominantly traces the effect of a single or primary attachment and/or attachment style on working models and behavior. However, most children form multiple attachments. This article reviews research on multiple attachment representations in children and considers how such information can usefully be applied to clinical settings. Through the case study of a six-year-old adopted boy with a history of maltreatment, it explores how those internal working models can be assessed in treatment and the clinical value of recognizing different attachment representations and styles. Implications for treatment interventions are explored.