Time and again: Intermittent Brief Dynamic Therapy

Abstract

The author notes that in many of the settings in which Brief Therapy takes place that a client may return after the ending for a further series of sessions. Time-limited therapy has placed an emphasis upon the termination phase of the therapy and linked this to the process of individuation and separation. Such an approach, as articulated by Mann (1973 Mann, J. 1973. Time-limited psychotherapy, Cambridge, MA: Harvard University Press.  [Google Scholar]), which draws conceptually from the work of Winnicott (1965 Winnicott, D. W. 1965. The maturational processes and the facilitating environment, London: Hogarth Press.  [Google Scholar]) and the notion that the infant achieves unit status from the original undifferentiated merger with the mother, is not easily compatible with Intermittent Brief Dynamic Therapy. The work of attachment theorists and Stern (1985 Stern, D. N. 1985. The interpersonal world of the infant, New York: Basic Books.  [Google Scholar]) provide an alternative basis upon which to conceive of the development of the infant. While emphasizing the importance of attending to affects at points of separation and ending, as is evidenced in the work of Della Selva (2004 Della, Selva P. C. 2004. Intensive short-term dynamic psychotherapy, London: Karnac.  [Google Scholar]), such a framework is more readily compatible with the development of Intermittent Therapy, and with the realities of the settings in which much brief work takes place. The author also comments upon the flexibility inherent in Winnicott's own practice of brief consultations, and the implications of this for the development of Intermittent Brief Dynamic Therapy. The paper includes a case study that illustrates this debate and which provides evidence for the therapeutic potency of a form of Brief Dynamic Intermittent Therapy where a dynamic focus maintains a structuring pattern to the narrative over a sequence of several periods of Brief Therapy, spread over a number of years.     

Perspectives on Focus Group Participation and Remuneration

Recruiting participants from underserved and marginalized communities for behavioral research is an essential yet challenging task. We examined participants' motivation to participate in a focus group about health communication and their beliefs about appropriate remuneration for participation. Twelve focus groups were conducted with low-income African American and Latina adolescent girls and African American women. We utilized a grounded theory approach and thematic analysis to examine views about research participation and remuneration. This study can inform important considerations about the consent process, study recruitment, and remuneration.     

The segment as the minimal planning unit in speech production: Evidence based on absolute response latencies

A minimal amount of information about a word must be phonologically and phonetically encoded before a person can begin to utter that word. Most researchers assume that the minimum is the complete word or possibly the initial syllable. However, there is some evidence that the initial segment is sufficient based on longer durations when the initial segment is primed. In two experiments in which the initial segment of a monosyllabic word is primed or not primed, we present additional evidence based on very short absolute response times determined on the basis of acoustic and articulatory onset relative to presentation of the complete target. We argue that the previous failures to find very short absolute response times when the initial segment is primed are due in part to the exclusive use of acoustic onset as a measure of response latency, the exclusion of responses with very short acoustic latencies, the manner of articulation of the initial segment (i.e., plosive vs. nonplosive), and individual differences. Theoretical implications of the segment as the minimal planning unit are considered.     

Developmental course of the temporal relationship between gaze direction and vocal production in typical and Down's syndrome infants

This study was aimed at examining the temporal relationship between gaze and vocal production behaviour among typically developing infants, infants with Down's syndrome, and their mothers. If gaze–voice timing behaviour is an organizing principle of communicative interaction in typical population, then studying it should provide insight into how children with Down's syndrome and their mothers use this temporal relationship to structure their exchanges. Forty-four mother–infant dyads (22 dyads with a Down's syndrome child and 22 with a typical child) were observed. The developmental course of timing pattern was not different between DS and typically developing infants from 4 to 19 months (DA). Insofar as the timing patterns differed between DS and typical infants at 20 months, this could be explained by their differing level of language acquisition. With the use of language, the timing patterns will reappear equal in the both populations. Results suggest that (i) the children's behaviours could be partially explained by the behaviours of their mothers. The mother–child dyad would be the mould that shapes the child's future sociolinguistic skills, and (ii) for the two populations, the timing-pattern changes could be explained by the emergence of language.     

Cognitive Performance in Adolescence: Links With Early Maternal Stimulation and Children’s Anxious Behaviors

Abstract

This study tested a developmental model of cognitive performance in adolescence and explored potential mechanisms explaining the relations of early maternal stimulation and children’s anxious behaviors with adolescents’ cognitive performance. We utilized the NICHD SECCYD dataset (n?=?1,112). Measures included questionnaires, coded observations, and self-report measures from infancy to adolescence. Results revealed that children who experienced greater early maternal stimulation and less anxious behaviors had better cognitive performance at age 15. Children’s English self-efficacy, the quality of child–teacher relationships, and children’s behavioral classroom engagement in middle childhood mediated the relation between early maternal stimulation and adolescent cognitive performance. Identifying pathways from earlier maternal and children’s characteristics to children’s later cognitive performance is an important step toward further understanding why early precursors have a long lasting impact on cognitive performance, and has implications for educational settings.     

Bereavement and triangular relationships in a case of a child suffering from anorexia

This paper describes the mother–child assessment of a five-year-old girl suffering from anorexia since weaning, which was carried out in an Italian NHS neuropsychiatric child and adolescent unit. The author aims to show how she was able to link the little girl’s refusal of food to a death in the maternal family, which occurred soon after her birth. As well as this post-traumatic formulation, the author links the child’s anorexia to two related aspects of the family dynamics: avoidance of the awareness of death and the inability to manage triangular relationships, due to important intrusion and exclusion anxieties. Using extracts from the sessions, the author shows how the little girl was able to begin to work through the death phantasy which was previously inaccessible to her and her family. The concept of the death phantasy is defined and explored and possible analogies between this case and what is observed in some anorexic adolescent girls and their families are described.     

Using Baby Books to Increase New Mothers' Self‐Efficacy and Improve Toddler Language Development

Maternal self‐efficacy (MSE) has been shown to be important, yet little is known about how it develops over time and whether increasing knowledge about child development and parenting results in feeling more efficacious, especially for first‐time mothers. Furthermore, research is lacking about whether increased maternal self‐efficacy results in better child outcomes such as more receptive and expressive language. Using a randomized three‐group design, this study explores whether educational books, embedded with information about typical child development and optimal parenting, increase MSE for women over the first year and a half of motherhood and whether these increases result in better language skills for children at 18 months of age. Hierarchical linear model analyses show that MSE starts high and remains high and that providing educational books further increases the development of MSE. Increases in MSE have a positive impact on children's language skills, as does providing books, irrespective of educational content. These findings support the importance of MSE and demonstrate an inexpensive way to increase MSE and improve child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.     

The Great Mother and the Terrible Mother: mimesis,alterity and attachment in adolescence

This paper discusses attachment, the longing for familiarity and sameness (mimesis), the search for difference and separateness (alterity) and the problem with the Other¹ seen through the lens ofthe individuation process in adolescence. These are explored with reference to relational aspects and Levinas and Girard's divergent views of the Other. The relational space, which in Phillip Bromberg's (2003) words is ‘uniquely relational, but still uniquely individual’ and in which analyst and patient ‘stand together in the space between realities’, might under exceptional circumstances be transformed into ‘a twilight space where the impossible becomes possible’ (p. 573). I will sketch a developmental trajectory starting from primitive states, in which the presence of the Other,as a separate entity cannot be tolerated and where the patient strives for total mimesis. Should the analyst prematurely shatter this illusion, she becomes an alien ‘Other’; a wolf in sheep's clothing. I trace the current psychoanalytic paradigm shift to an emphasis on the co‐creation of meaning in the interpersonal space and explore what alterity consists of and how much of the other's unknowability can be tolerated and respected without a translation into one's own idiom. The clinical vignettes illustrate aspects of therapy which normally lie outside the analytical remit and are culled from an inpatient setting and private practice.     

Motherhood in adolescent mothers: Maternal attachment,mother–infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother–infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother–infant dyads compared to 30 adult mother–infant dyads. At infant 3 months, mother–infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother–infant dyads (vs. adult mother–infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother–infant dyads (vs. insecure adult mother–infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother–infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.