Two modalities of manic defences: Their function in adolescent breakdown

The aim of this paper is to explore two different modalities of manic defences and their specific underlying anxieties. I will describe the relation between these defences and the role of the superego and their specific function in adolescent breakdown. While one type of manic defence operates by the ego’s identification with a sadistic superego the other one operates via evacuation of a guilt-inducing superego. I will illustrate the proposed ideas with clinical examples from the analysis of two adolescents. This paper stresses the specific differences between these two modalities and the clinical importance of both identifying and addressing the enactment in the transference of the unconscious phantasies and anxieties (paranoid and depressive) that give rise to these two types of defences.     

The effects of baby bath and massage by fathers on the family system: The sunraysia australia intervention project

Instruction in baby massage and the Burleigh Relaxation Bath technique was given to one-half of our sample of 32 couples who had just had their first child. This brief intervention, given at 4 weeks post-partum, led to beneficial behavioural and psychological effects for the family system when assessed at 12 weeks postpartum. Depression and marital satisfaction were assessed with mothers and fathers at 4 weeks and 12 weeks after the birth of their child, and self-esteem was measured at 12 weeks only. The mothers and fathers who were shown baby bathing and massage techniques showed higher degrees of marital satisfaction and self-esteem, as well as lower levels of depression at 12 weeks post-partum, than parents who did not receive instruction. It seems likely that brief interventions which educate new parents concerning functional techniques of baby care may favourably affect their feelings of competence and be of benefit to the entire family system.     

Family interaction and child psychopathology: A comparison of two observation strategies

We examined two systems of assessing family interactions that are in common usage: a home based observation of free parent-child interaction and a clinic based observation of a structured mother-child problem solving discussion. Participants were 18 depressed, 27 conduct disordered and 16 comparison children and their mothers. Results indicated that: 1) these observations may yield very different data about child, and to a lesser extent, parent behavior, 2) parental affect in the clinic was related to their level of aversive behaviour in the home, 3) levels of both aversive and positive behavior for children and their mothers were correlated within each setting, 4) accuracy of diagnostic classifications made on the basis of the observational data were highest for comparison and conduct disordered children, but lowest for depressed children observed in the clinic, and 5) the inclusion of data on mothers' behavior increased classification accuracy for conduct disordered children only.     

Observed behaviors during clinical interviews predict improvement in depression

A considerable percentage of depressed patients do not respond to antidepressive treatment. Early indicators of prognosis are needed. The aims of this study are to examine (a) whether the interpersonal behavior of patients and psychiatrist, as assessed by means of direct observation of behavior during a baseline clinical interview, might have predictive value with respect to therapeutic outcome and (b) which predictive potency measures of psychomotor activation, as assessed by less refined methods, such as global clinical judgment, might have. In the analysis used, speech-pause behavior was taken as the basic structure of the interaction. The relations of other behaviors such as looking and hand and head movement with this structure were determined. Evidence is presented that in a group of 31 depressives, improvement after a period of 10 weeks was related to observed behaviors during a baseline interview. The behaviors of the patients are interpreted as relational or nonrelational. The relational behaviors (i.e., looking yesnodding, gesturing) occur less in patients who will improve, whereas the nonrelational behaviors (i.e., intensive body touching, head movements) occur more in these patients. The nonrelational behaviors are presumed to be indicative of the state of arousal. The predictive potency of these variables could not be explained by their relationship with the baseline severity of depression, which in itself also predicted improvement. Moreover, global clinical assessment of psychomotor activation (i.e., retardation and agitation) could not be related to outcome.     

A structural model for postpartum responses to the somatic and cognitive items on the Beck Depression Inventory

A distinction can be drawn between those items on the Beck Depression Inventory (BDI) that reflect mainly cognitive and emotional symptoms and those that reflect somatic symptoms. Responses to the BDI were obtained from women at 3, 6, 9, and 24 weeks postpartum. The covariances of cognitive and somatic symptom scores across the four time points were closely fit by a structural equations model referred to as the simplex. The modeling indicates that earlier cognitive scores directly predict later somatic scores but that early somatic scores do not directly predict later cognitive scores. Other data confirm the results.Much of this research was supported while the first author was an NIMH Fellow at the University of Iowa (MH15168).     

Maternal and adolescent depressive symptoms and family conflict: An autoregressive cross-lagged examination of competing models in multi-stressed mothers and adolescents

Maternal and adolescent depression are challenges that often co-occur. Many studies have drawn bivariate associations between maternal depressive symptoms, adolescent depressive symptoms, and family conflict, but few have examined reciprocal effects. Even among extant studies, there is a lack of clarity related to directionality of influence. Three competing theoretical models may explain the relationship between maternal depressive symptoms, adolescent depressive symptoms, and family conflict, and these processes may differ by adolescents’ sex. Using three time points of data from 187 diverse mother-adolescent dyads, we fit a taxonomy of autoregressive cross-lagged structural equation models to simultaneously evaluate the competing theoretical models and also examine differences by sex using multiple-group analyses. Results indicate a symptom-driven model whereby adolescent depressive symptoms predicted increases in family conflict. Sex differences were also found. For males, but not females, greater adolescent depressive symptoms predicted subsequent increases in maternal depressive symptoms, which then predicted lower family conflict—possibly indicating maternal disengagement/withdrawal. Our findings suggest addressing adolescent depressive symptoms in order to prevent family conflict and that distinctive targets for the prevention/intervention of family conflict should account for differences by adolescents’ sex.     

Correspondence between resident- and staff-report on the QABF: Do justice-involved youth agree with residential staff?

Residents in juvenile residential treatment facilities (JRTFs) often display various emotional, behavioral, and educational needs. Researchers have recently developed behavioral interventions to increase residents' appropriate behavior such as cooperation with facility staff instructions, accepting feedback from facility staff, and tolerating unpleasant events. However, there is not a generally accepted tool for assessing the operant function of residents' problem behavior in JRTFs. For various logistical reasons, indirect functional assessments may be more appropriate in a JRTF than manipulating either antecedent or consequent events. This study obtained scores on the Questions About Behavior Function (QABF) assessment for 17 residents from two dormitory staff members for each resident. To increase the number of respondents, each resident completed a QABF for their own behavior. Results revealed moderate to high correspondence (i.e., agreement) for highest and lowest potential operant function of problem behavior between combinations of JRTF staff and residents. These preliminary findings suggest additional research with the QABF in JRTFs is warranted.