Comparison of Mothers' and Fathers' Opinions of Parent–Child Interaction Therapy

Opinions of parenting programs mostly have been obtained from mothers. Because mothers and fathers' interactions with children differ, gathering data from both parents regarding behavior modification and parenting programs is necessary. This project was part of a larger study and compared mothers and fathers' acceptability of Parent-Child Interaction Therapy (PCIT) and its various components. Acceptability data were obtained using the Treatment Evaluation Inventory-Short Form and a modified version of this measure assessing specific PCIT components. The sample consisted of 40 community mother-father pairs of a young male child. Findings suggest gender differences in PCIT treatment acceptability and various PCIT components.     

Of “sleep and dream: A psychoanalytic essay' by Joyce McDougall (discussion)

Abstract

The author describes experiences gathered during several years of teaching psychodynamic psychotherapy with psychologists and psychiatrists within a 2-year-training programme in Shanghai, China. Questions and problems of the reception of psychoanalysis – shame, sexuality, harmony, abstinence – as well as the possibilities and limitations of exporting psychoanalysis are discussed. The possible future development of psychoanalysis in China is also outlined.     

Editorial

With the aim of increasing knowledge about processes of change in psychodynamic individual child psychotherapy, sessions that could be called turning points were analysed.     

Types of sexual transference and countertransference in psychotherapeutic work with children and adolescents

The question of normal sexuality begins to arise in the treatment of severely sexually abused or sexually offending patients. The author suggests that it is an interesting and delicate moment during the process of recovery when less perverse, more normal sexuality appears mixed with, or even disguised by, the more habitual perverse fantasies. Writers in the adult field have drawn distinctions between perverse, eroticized and normal erotic transferences, and between Oedipal and post-Oedipal sexuality. Some have also distinguished between countertransferences in the analyst of an erotised versus a normal erotic nature. The paper discusses whether these distinctions could have any relevance for child patients. Freud and Klein have taught us much about the child's sexuality in relation to his interest in and attraction to his parents as sexual beings. But can we also detect some origins in earlier experiences in infancy of the child's later capacity to feel himself a sexual being capable of being wanted by an other? How might such a feeling of sexual self-worth differ from narcissism and from sexualised exhibitionism? The paper asks how therapists might deal with such problems and such possibly healthy developments.     

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.     

You can't miss what you've never had: Can you?: The challenges and struggles of single parenthood from a psychoanalytic perspective

The issue of the growth of single-parent families has been in the forefront of political, social and moral debate in recent years. Children from single-parent families tend to be over-represented in clinic populations. Yet this state of My being may be no more potentially pathological than the nuclear family, which can become conceptually idealized The aim of this paper is to look behind the statistics and examine the impact on children of life in a single-parent family, to explore how this may be managed, and to look for potentiating factors which can enable good-enough development to unfold. Case material is used to illustrate the theme.     

Report on ‘A conversation about unintegration,disintegration and integration’ with papers by Anne Alvarez and Edna O'Shaughnessy,chaired by Margot Waddell, 25 february 2005 1

This paper attempts to explore the nature and consequences of trauma in infancy by an exploration of a prototype of trauma when babies are born addicted to heroin. The trauma not only involves a painful withdrawal from the drug and invasive medical procedures carried out in isolation in a special care baby unit, but often also an ongoing cumulative trauma of the lack of availability of a receptive containing parent. The paper raises specific issues about these babies as well as about trauma in general. It examines current psychoanalytic, attachment and other theories about trauma and resilience, and includes an infant observation of a baby in a special care baby unit who was born addicted. A detailed case is presented, illustrated by sequences of drawings by an 11-year-old boy who had been born addicted. These show how the lack of containment of any sort in infancy had profound effects on the child's ability to process his emotional experience in any meaningful way. An attempt is made to evaluate the effectiveness of the psychotherapy using criteria derived from Mary Main's work on disordered/chaotic infants. This involves a shift from disintegration and a lack of resolution of any crisis towards the emergence of the possibility of a hopeful outcome.     

Clinical Commentary

This paper describes a lengthy period of psychotherapy with a child. This treatment began only after a prolonged contact with other child and adolescent mental health services during which the child's difficulties, which had initially seemed to be ordinary behavioural problems, had proved puzzlingly intractable to a variety of interventions. Subsequent psychotherapy revealed a profound disorder of development which lay bath the Surface presentation. In a climate where Asperger's syndrome is often felt to be untreatable, this paper argues that some children, at least, can benefit from psychotherapy and can be helped towards real mental growth. Asperger's syndrome in children bears some striking similarities to narcissistic personality disorder as described in the adult psychoanalytic literature and this paper discusses some of the theoretical and clinical implications of the innate origins of Asperger's syndrome.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

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.