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.     

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

The Relationship Between Trajectories of Family/Cultural Stressors and Depression and Suicidal Ideation Among Substance Using Mexican-American Adults

We used an intersectional minority stress perspective to examine the association between family/cultural stress and mental health among substance-using Mexican-Americans. Employing a unique longitudinal sample of 239 socioeconomically disadvantaged, non-injecting heroin-using Mexican-Americans from San Antonio, Texas, we examined how culturally relevant stressors are related to depression and suicidal ideation. First, we identified depression and suicidal ideation prevalence rates for this disadvantaged sample. Second, we determined how cultural stress is experienced over time using stress trajectories. Third, we evaluated how family/cultural stressors and stress trajectories are related to depression and suicidal ideation outcomes. Results showed high rates of baseline depression (24 %) and suicidal ideation (30 %). We used latent class growth analysis to identify three primary stress trajectories (stable, high but decreasing, and increasing) over three time points during 1 year. We found that the increasing stressors trajectory was associated with higher rates of depression and suicidal ideation, and that stress trajectories had unique relationships with mental illness. We also showed that baseline stressors, sum stressors, and high but decreasing stressors maintained positive associations with mental illness after controlling for baseline depression. Our results highlight the importance of focusing on within-group, culturally specific stressors and addressing both operant and cumulative stressors in the study of mental health for marginalized populations and suggest the importance of early intervention in minimizing stressors.     

Neglecting neglect: some thoughts about children who have lacked good input,and are ‘undrawn’ and ‘unenjoyed’

This paper looks at emotional neglect in the early years of life, and postulates some probable long-term sequelae of such neglect. It argues that there is a continuum of neglect; ranging from the severest form, as seen in institutional orphanages, to milder variations. A range of theoretical and research traditions, including developmental psychology, attachment theory and neuroscience are used, alongside psychoanalytic ideas, to attempt to delineate some of the key features and patterns that arise. A question is raised as to whether we have sufficient diagnostic categories or theoretical ideas to make sense of neglected children. Thought is given to the very specific clinical challenges of working with children who are neglected, and how the clinical task might differ from working with children who have suffered other forms of early damage, such as physical abuse. It is argued that these children suffer a multiple, overdetermined form of neglect; their initial neglect because of the form of caretaking they did (or did not) receive being compounded by their inability to use help and then also the tendency of professionals to similarly neglect these children, who can be difficult to relate to and hard to ‘warm’ to.     

Improving Classroom Quality with The RULER Approach to Social and Emotional Learning: Proximal and Distal Outcomes

The RULER Approach to Social and Emotional Learning (“RULER”) is designed to improve the quality of classroom interactions through professional development and classroom curricula that infuse emotional literacy instruction into teaching–learning interactions. Its theory of change specifies that RULER first shifts the emotional qualities of classrooms, which are then followed, over time, by improvements in classroom organization and instructional support. A 2-year, cluster randomized controlled trial was conducted to test hypotheses derived from this theory. Sixty-two urban schools either integrated RULER into fifth- and sixth-grade English language arts (ELA) classrooms or served as comparison schools, using their standard ELA curriculum only. Results from multilevel modeling with baseline adjustments and structural equation modeling support RULER’s theory of change. Compared to classrooms in comparison schools, classrooms in RULER schools exhibited greater emotional support, better classroom organization, and more instructional support at the end of the second year of program delivery. Improvements in classroom organization and instructional support at the end of Year 2 were partially explained by RULER’s impacts on classroom emotional support at the end of Year 1. These findings highlight the important contribution of emotional literacy training and development in creating engaging, empowering, and productive learning environments.     

Avoiding unbearable pain

This presentation describes the way in which defence mechanisms and resistance manifested themselves in the analysis of a man with a narcissistic personality disorder. In the course of the analysis, there were changes in the forms taken by the defence and the resistance, signalling important genetic and dynamic conditions in his life. Both represented desperate attempts to avoid the unbearably painful feelings and affects which he had experienced in his childhood, and bore witness to early and primitive defence mechanisms such as denial, splitting and projective identification. The defence can also be seen as an expression of an unconscious fear of being re-traumatised. The idealisation of the analyst in the first years of the analysis can therefore be understood as a precondition for entering into this kind of process. It also represented a defence against aggressive and homosexual feelings in the transference which first became clear during the final phase of the analysis and could then be worked through. At this point, the analyst's reactions to his own unconscious countertransference were of help in understanding what was actually going on. This analysis may also suggest that defects and trauma in the earliest years may be conducive to alexithymia, deficient contact between feelings and words, linked to the risk of developing serious psychosomatic illnesses. This may be a consequence of the fact that the child's feelings and affects were neither accepted, understood nor affirmed in words, or they may even have been met with rejection or ridicule. A connection between narcissistic personality disorders and alexithymia can possibly be seen here.     

Categorization of two-dimensional and three-dimensional stimuli by 18-month-old infants

In two experiments, 18-month-old infants’ categorization of 3D replicas and 2D photographs of the same animals and vehicles were compared to explore infants’ flexibility in categorization across different object representations. Using a sequential touching procedure, infants completed one superordinate and two basic-level categorization tasks with 3D replicas, 2D cut out photographs, or 2D images on photo cubes (“2D cubes”). For superordinate sets, 3D replicas elicited longer mean run lengths than 2D cut outs, and 3D replicas elicited equivalent mean run lengths as 2D cubes. For basic-level sets, infants categorized high-contrast animal sets when presented with 3D replicas, but they failed to categorize any of the 2D photograph sets. Categorization processes appear to differ for 3D and 2D stimuli, and infants’ discovery of object properties over time while manipulating objects may facilitate categorization, as least at the superordinate level. These findings are discussed in the context of infants’ representation abilities and the integration of perception and action.     

Conceptualizations of Social Class in Afrtican American Women:

This article addresses the multiple definitions of social class in African American people and how the therapist's understanding of these definitions is important in therapeutic interventions with African American women. The article discusses: (a) the traditional ways in which social class has been defined in social science and the limits of these conceptualizations; (b) the multiple definitions of class within the African American community; and (c) treatment concerns for African American women based on class issues. Clinicians working with African American and other women who vary by class should be able to assess how class variables influence their therapeutic interventions with these women.     

“It Makes Me Worry About Her Future Pain:” A Qualitative Investigation of White Mothers of Non-White Children

In the United States, increasing numbers of White women are mothering children of color. Little is known about their psychosocial experiences of racially socializing non-White children within a culture that transmits socially constructed meanings about race. Such messages influence employment and quality and access to health care. Thirteen White mothers of non-White children (school age to adulthood) residing in the U.S. were interviewed. Their psychosocial experiences and racial socialization practices were explored. Through an analysis of transcribed interviews and interview notes, seven themes emerged: (1) Looking Like a Family and Looking Alike; (2) Mothering as Vulnerability; (3) Teen Daughters’ Perceptions of Black Men as Undesirable and Frightening; (4) Exposing Children to Culture; (5) Children and Mothers’ Experiences as “Other”; (6) Hostility from Black Women; and (7) Not Talking About Race. Study's limitations and future research are discussed.     

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.