Learning and teaching the theories of Melanie Klein

I shall attempt to bring together here thoughts of experienced clinicians and teachers who have taught Melanie Klein's theories to child psychotherapists. However, most of the contributors have also taught Klein to clinical trainees in adult psychoanalytic work and to different groups abroad and, in some cases, to already trained psychotherapists or psychoanalysts. Klein's theories are introduced at different stages in the different child psychotherapy programmes in London. For instance, the students at the Tavistock are introduced to Klein's theories before they are necessarily in their own psychoanalysis, while other trainings introduce her theories in the introductory years of the clinical training.

William Halton is one of the longest-running teachers of Klein in the Tavistock Child Psychotherapy Training and brings his 'framework' culled from many years of experience. Maria Rhode has taught the Narrative to students at the Tavistock for many years. Elizabeth Spillius, psychoanalyst, writer and teacher, brings her experiences teaching Klein to non-Kleinians. Karen Proner teaches at the Tavistock, in Italy and the United States.

TEACHING MELANIE KLEIN William Halton 10 Lincoln Road London N2 9DL     

Maternal stress and behavioral adaptation in methadone- or buprenorphine-exposed toddlers

The current study examined the relationship between early interaction, parenting stress, maternal psychological distress symptoms, and behavior problems and health-related quality of life among children born to mothers in opioid maintenance treatment (OMT) in Norway during the period 2005–2007 (N = 36). This group was compared with a normative sample of mothers without substance abuse problems and their children (N = 36). There were significant group differences (p < .01) in perceived child problems in toddlerhood. In a regression model, mothers’ self-reported psychological distress symptoms in terms of depression and anxiety symptoms significantly predicted child behavior problems (p < .01) and health-related quality of life (p < .01) rather than parenting stress. No significant, unique effect of exposure was found after controlling for other factors that could influence developmental outcomes. These findings add to the growing evidence on the importance of maternal psychological well-being for child development, and underscore the need to address opioid-maintained women's personal maladjustment and the constellation of stress experienced by mothers in recovery.     

Assessing the quality of life of HIV infected persons: Clinical and descriptive information from studies with the hopes

Abstract

We have recently developed and psychometrically evaluated an HIV-specific quality of life instrument. The new instrument is called the HIV Overview of Problems-Evaluation System (HOPES) which was adapted from an established cancer-specific quality of life instrument called the CARES. In this paper we review the psychometric properties of the HOPES, examine the quality of life impact of HIV infection in a cross-sectional evaluation of 318 patients using data from the HOPES and describe other work in progress or planned using the HOPES.     

Development of the Idiographic functional status assessment: A measure of the personal goals and goal attainment activities of people with AIDS

Abstract

This study presents the development of the Idiographic Functional Status Assessment (IFSA), an interview to assess functional status according to each person's unique point of view. This idiographic method asks people to state their personal goals in terms of things they want to accomplish, problems they want to solve, situations they hope to avoid, roles and relationships they want to maintain, and pursuits they want to relinquish. After describing their goals, respondents rate goal attainment activities they have pursued in the past month in terms of level of difficulty, dependence and other performance dimensions. In a study of 224 people with AIDS, the idiographic measure provided functional status scales that were relatively stable over time, and that correlated well with other subjective well-being measures and heath status criteria. Goal content measures derived from the interview can be used to distinguish sub samples that differ in terms of the determinants of quality of life.     

Satisfaction profile (SAT-P) in 732 patients: Focus on subjectivity in hrqol assessment

Abstract

A 32-item questionnaire aimed at assessing patient's satisfaction about every day life is presented. In the Satisfaction Profile (SAT-P) patients are asked to evaluate their own satisfaction level on 32 daily life aspects concerning the last month. 732 participants were enrolled into the study: 490 in-patients suffering from different types of chronic diseases (e.g., chronic heart failure, severe respiratory failure, coronary heart disease) and 242 healthy persons of working age. SAT-P validity was confirmed by comparing its scores with the NHP, EPQ and STAI-X2 scores. The factor analysis extracted 5 factors which corresponded to the hypothesised areas (54% of variance explained). Test-retest reliability and internal consistency were confirmed: Pearson's coefficients were ranging from 0.45 to 0.93 and Cronbach's alpha coefficient was 0.92. SAT-P responsiveness, evaluated by comparing baseline and 6 months follow up scores from 45 chronic heart failure patients, resulted to be satisfatory, although further studies are needed. These results, together with the “user-friendly” structure, the brief administration and scoring time, the simple graphic representation, suggest to consider the SAT-P a useful complementary tool in HRQoL assessment. The Italian, English and French versions are available.     

Postsurgical physical activity and fatigue-related daily interference in women with non-metastatic breast cancer

Purpose: Women undergoing surgery for breast cancer experience side effects, such as fatigue, reduced quality of life (QOL) and depression. Physical activity (PA) is associated with improved psychological adjustment during treatment and survivorship, yet little is known about how PA relates to fatigue, depression and QOL in the period following surgery for breast cancer. The purpose of the study was to examine the relationships between these constructs in women who recently underwent surgery for breast cancer.

Methods: At 2–10 weeks post-surgery, 240 women with non-metastatic breast cancer reported intensity and duration of moderate and vigorous PA (MVPA), fatigue (intensity and interference), depressed mood, clinician-rated depression and functional QOL.

Results: In the path analysis models tested, women that reported greater weekly MVPA reported less fatigue interference, greater functional QOL, less depressed mood, and lower clinician-rated depression. Tests of indirect effects suggested that fatigue interference may be an intermediate pathway by which MVPA relates to functional QOL, clinician-rated depression and depressed mood.

Conclusion: Women who are more physically active in the months after breast cancer surgery show greater psychological adaptation in the initial phases of their treatment.     

Follow-up effects of social comparison information on the quality of life of cancer patients: The moderating role of social comparison orientation

Objective: To examine how social comparison orientation (SCO) moderates the effects of three types of social comparison information on the global quality of life of cancer patients 2 weeks and 3 months later. Design: Cancer patients (n?=?226) were provided with social comparison information just prior to undergoing radiation therapy, using audiotapes. Each participant was confronted with one of three tapes: (1) focusing on procedural aspects, (2) focusing on emotional reactions and (3) focusing on coping strategies. Main outcome measures: Quality of life as measured with the Cantril self-anchoring scale [Cantril, H. (1965). The pattern of human concerns. New Brunswick, NJ: Rutgers University Press]. Results: With increasing SCO, a lower quality of life was reported after listening to the emotion tape, while a higher quality of life was reported after listening to the coping tape. These effects were found 2 weeks as well as 3 months after the radiation therapy had ended. Conclusion: Social comparison information may have longitudinal effects on quality of life, but these effects are to an important extent dependent on the nature of the information and individual differences in SCO.