‘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.     

Feminism's Third Wave

Summary

“Third wave” feminists, raised in the wake of an established feminist movement as well as a strong anti-feminist backlash, are beginning to define their own feminist agenda. “Third wave” feminists are exploring the contradictions in their lived experience as feminists, and examining the inter section of feminism with their other identities. Young feminists' self-expression has been characterized (by feminists and non-feminists) as “self-obsessed” and “divorced from matters of public purpose” (Bellafante, 1998, p. 57 & 60). In this essay, we provide an alternative view of “third wave” expression, seeing young feminists' honesty in their struggles with various identities as a resurgence of grass roots activism; a return to “the personal.” In this essay, we call for an intergenerational dialogue between second and third wave feminists, and encourage feminist therapists to support and validate young feminists.     

Condom Use and Contraception Non-Use Amongst 16-19 Year Olds: A Within Subjects Comparison

Abstract

The present study used a within subject design to examine which situation specific factors discriminated between the use of condoms and non-use of contraception in the context of preventing unwanted pregnancy. Adapting the methodology of Gold et al (1991, 1992), 215 16 to 19 year olds completed a questionnaire concerning the most recent time they had experienced sexual intercourse without using contraception (the “without contraception” encounter) and me most recent time they had experienced sexual intercourse using a condom (the “with a condom” encounter). The results showed that although past behaviour did not differentiate between the two encounters, situational factors relating to preparation for action, affect and interpersonal interaction were important. However, when analysed for men and women separately most of the differences were only found for women. In particular, the results suggest that women report non-contraception use as associated with feeling more guilty, having a partner who is less motivated to use contraception than they are, with neither themselves nor their partner raising the desire to use contraception, not expecting to have sex and not discussing contraception and not having contraception available. In contrast, for men, only the availability of contraception appeared to differentiate between the two encounters. The results are discussed in terms of the usefulness of the methodology and the associated shift in emphasis from users and non-users of contraception to use and non-use. The implications of the results in terms of health education interventions are also considered.     

Physical activity levels in young adult Hispanics and Whites: Social cognitive theory determinants

The psychosocial determinants of health-impairing physical inactivity among Hispanic populations have not been well explored nor have systematic comparisons been made with White populations using Social Cognitive Theory (SCT) measures. Three exercise-relevant efficacy measures (task, scheduling, and response efficacy), three exercise-relevant expectancy measures (physical health, psychological health, and self-evaluative), and self reports of activity levels were obtained from 20-year-old male and female Hispanics (n?=?94) and Whites (n?=?94). Activity levels for the two groups were analyzed in separate regression analyses that included the six SCT measures and gender as predictors. The set of seven predictors accounted for 51% of the variance in self-reported activity levels in each analysis. For young adult Hispanics, task efficacy, response efficacy, mental-health expectancies, and self-evaluative expectancies predicted activity level. For young adult Whites, scheduling efficacy and self-evaluative expectancies predicted activity level. Gender was not a significant predictor of activity level for either group. A multivariate analysis of variance indicated that the only SCT predictor on which Hispanics and Whites significantly differed was mental-health expectancies. The results of this study indicate that the psychosocial determinants of exercise are qualitatively different for the two groups and that the determinants of physical activity levels for young adult Hispanics may not be as effective as those of young adult Whites in sustaining lifelong exercise habits. Thus the present study offers a promising strategy for detecting inactivity-related physical- and mental-health risks at an age when lifelong habits of physical activity are still being formed.     

Young women’s construction of their post-cancer fertility

Younger women diagnosed with cancer often face compromised fertility as a result of their treatment. However, previous research has adopted a biomedical model of fertility and utilised hypothetico-deductive research methods which have not allowed for full exploration of women’s subjectivity. This study explored younger women’s construction of their fertility post-cancer, and their discussions of fertility with healthcare professionals, from a social constructionist epistemology. Semi-structured one-to-one interviews were conducted with eight women aged 18–26, across a variety of cancer types. Foucaultian Discourse Analysis identified three subject positions associated with fertility concerns: ‘Inadequate woman: Accepting the motherhood mandate’; ‘Adequate woman: Resisting the motherhood mandate’; and ‘Survival of the fittest: Woman as genetically defective’. Implications of these subject positions included feelings of inadequacy, fear and devastation; feeling undesirable to romantic partners; and concern about passing on cancer-positive genes. In describing healthcare professional interactions, women adopted positions of ‘Satisfied patient’; ‘Passive recipient patient’; or ‘Resisting the passive patient position’. Accounts of inadequate information provision were associated with anger and frustration, whereas feeling adequately informed was associated with satisfaction at making decisions about fertility preservation. These results suggest that fertility is of importance to young women cancer survivors, and that compromised fertility can negatively impact subjectivity.