Keeping mother alive: psychotherapy with a teenage mother following human trafficking

The power of new traumatic events to reignite memories and the distress of traumatic experiences earlier in life is well known to psychotherapists. When the recent trauma has been extreme, the task of assisting the patient to understand their response in the light of their earlier experience can be doubly challenging. This paper describes the therapy with an adolescent girl and her infant daughter, following the girl's escape from illegal detention, physical abuse and forced prostitution, after she was trafficked to the UK from Eastern Europe. The discussion works towards developing an understanding of the emotional interchange between the mother and infant, and the influence of the mother's traumatic experiences, on that interchange. Projective identification could be seen to occur from the mother, into her daughter, in a reversal of the situation traditionally described. The function of this for the mother and the impact on the developing infant, are considered.     

Therapeutic action in psychoanalytic therapy with toddlers and parents

Psychotherapy with toddlers and parents can focus on promoting attachment, facilitating development and improving interactions. Some techniques provide guidance to the parents, whereas others interpret to them their unconscious fantasies or ‘ghosts’ contributing to the child’s disorder. A recent paper introduced a psychoanalytically oriented technique, which emphasised the therapist’s interaction with the child in the presence of the parent(s). The child was addressed about his/her unconscious motivations in the session and the feelings towards the therapist. Also, the parent’s transference onto the therapist was seen as a vehicle that might further the therapeutic process and was accordingly addressed. The present paper analyses the therapeutic action in such treatments. Whereas work with the parents resembles that of ordinary psychodynamic therapy, therapeutic action is more difficult to conceptualise regarding the toddler, whose understanding of verbal interpretations and the therapist’s dialogues with the parent is more limited than that of an adult. However, a clinical vignette demonstrates a toddler’s precise and swift reactions to communications from mother or therapist. The paper investigates evidence from neuroscience and psychological research as to which communicative channels – beyond words – toddlers might perceive and comprehend. In addition, it is claimed that the countertransference is key to explaining how the therapist understands such communication.     

Pete the diesel: Psychotherapy with a severely disturbed five-year-old boy

The psychic significance of the figure of the grandmother in psychodynamic psychotherapy has received scant attention. This paper develops the concept of the ‘grandmaternal transference’ in parent–infant psychotherapy and explores its identification, its possible functions and its therapeutic significance. The grandmaternal transference has special relevance to parent–infant psychotherapy since the grandmother often represents both the mother’s mother and the child’s grandmother and offers a unique third position between mother and child. Three clinical vignettes illustrate how the grandmaternal transference may operate in this third position. In the first vignette, the therapist becomes in the transference a containing grandmother thereby facilitating maternal containment. In the second case, the therapist may be experienced as a differentiating grandmother able to help mother and infant with separation and individuation. In the third one, the therapist is transferentially experienced as a paternal grandmother who acts as a pseudo-father able to embody the paternal function. In each of these positions, the transference and countertransference – whether positive or negative – require that the therapist responds to rather than enacts the grandmaternal role. The three configurations of the grandmaternal transference have different clinical manifestations and offer different therapeutic ports of entry.     

新生儿疼痛管理方法与培训现状

总结了目前新生儿疼痛管理方法与培训现状.疼痛管理方法包括非药物性止痛方法如口服蔗糖水、非营养性吸吮、襁褓包裹及袋鼠式护理等,药物镇痛如瑞芬太尼与丙泊酚用于小儿气管插管及其他;培训现状包括权威教科书上缺少关于新生儿疼痛管理知识、缺乏特异性调查问卷、缺乏专业师资及培训机构.认为在新生儿的治疗护理中医护人员要坚持科学的认识论,把握医学伦理学的要求,在日常的治疗护理中体现对新生儿的人文关怀,才能进一步提高医疗护理质量,达到医院与患者的双赢.     

‘Please don’t put the whole dang thing out there!’: A discursive analysis of internet discussions around infant feeding

The promotion of breastfeeding is an important focus of intervention for professionals working to improve infant health outcomes. Literature in this area focuses largely on ‘choices’ and ‘barriers to breastfeeding’. It is our argument, however, that women's cultural context plays a key role in infant feeding ‘choices’. In this article, we explore contested representations of infant feeding and infant feeding choices in public debates conducted on a large British parenting website. To sample dominant representations of infant feeding circulating in UK culture, two threads were chosen from the debating board of a busy online parenting community (105 and 99 individual posts, respectively). Participants on the threads were largely women. A feminist informed Foucauldian discourse analysis was used to deconstruct the intersecting constructions of gender, childhood and motherhood implicit in public discussions about infant feeding choices. We identify dominant constructions of women who breastfeed or bottle feed, social representations of both forms of infant feeding, and explore the relationship between constructions of infant feeding choices and constructions of ‘good’ or ‘bad’ motherhood. This analysis functions to trouble the individualist assumptions underpinning the notion of infant feeding ‘choices’, considering the cultural context within which British mothers ‘choose’ how to feed their babies.     

Bereavement and Religion Online: Stillbirth,Neonatal Loss,and Parental Religiosity

Stillbirth and neonatal death often trigger immense and long‐lasting grief in parents. These life‐altering losses both call upon and call into question parents’ religious beliefs and practices. This qualitative research examines the impact of stillbirth and neonatal death on parental religiosity, broadly conceived to include personal spirituality and any religious affiliation, including atheism. It examines religion online, a nontraditional but important social context for grief, especially regarding statistically rare tragedies such as stillbirth and neonatal death. Content analysis of postings on a hub website for “babyloss” parents yields four major themes: religious disorientation, religious reorientation, changed relationships with others, and a quest for meaning.     

Therapeutic moments are the key: foster children give clues to their past experience of infant trauma and neglect

Foster parents often despair over the lack of information about the past experience of the children in their care, particularly with children who have experienced infant trauma and neglect. In the context of family therapy these unknowns pose both a challenge and an opportunity. The author proposes that foster children gives clues to their past experiences in therapeutic moments, which the therapist may recognize as a result of her own inner conversation. In conjunction with a sound theoretical knowledge of infant trauma and neglect, these moments have the capacity to open a dialogue in the relationships between therapist, child and foster family. This dialogical process offers an opportunity for the child's past experience of infant trauma and neglect to be expressed in silence, and the foster parent's present experience to be heard in stillness, opening for them a way to go on beyond the family therapy sessions.     

Infant Developmental Outcomes: A Family Systems Perspective

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty‐two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE‐index) of parent–infant interactions. At 5 months postpartum, in‐depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post‐traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.