Psychodynamic Psychotherapy of a Child with Internalizing Symptoms: A Study of Outcomes

When psychopathology is considered as a developmental phenomenon, the data on child psychotherapy must be of interest to all therapists. The aim of this study was to assess the results of psychodynamic psychotherapy in a child with internalizing symptoms using data obtained from the patient, her mother, her teacher and her psychotherapist. A systematic single case study was performed. The data were obtained using the following tools: interviews, the Rorschach Method, the Child Behaviour Check List for Children and Adolescents, the Teachers Report Form and questionnaires completed by the patient's mother and therapist. The psychotherapeutic treatment lasted for 40 sessions and the patient was 8 years old at the start of therapy. She presented with head and stomach aches after the sudden death of her father, as well as difficulty adapting to her new school. The Rorschach results indicated improvement in cognitive triad variables, interpersonal relations and expressing affection. Data from the patient, mother and therapist converged to yield the clinical picture of a more spontaneous girl, dealing better with her feelings and more socially integrated. This points to the importance of using mixed methods to assess psychotherapies and of consulting multiple informants.     

Mourning Bit by Bit

In this piece I describe the process of mourning my mother since her death in 2001, via my short animated documentary ‘Oneironauts – the Dream Travellers’ (2011) and my more recent experiences as the mother of a young baby. I consider my experience in the context of Freud's ‘Mourning and Melancholia’.     

Parent-specific reciprocity from infancy to adolescence shapes children's social competence and dialogical skills

Reciprocity – the capacity to engage in social exchange that integrates inputs from multiple partners into a unified social event – is a cornerstone of adaptive social life that is learned within dyad-specific attachments during an early period of neuroplasticity. Yet, very little research traced the expression of children’s reciprocity with their mother and father in relation to long-term outcomes. Guided by evolutionary models, we followed mothers, fathers, and their firstborn child longitudinally and observed mother–child and father–child reciprocity in infancy, preschool, and adolescence. In preschool, children’s social competence, aggression, and prosocial behavior were observed at kindergarten. In adolescence, children’s dialogical skills were assessed during positive and conflict interactions with same-sex best friends. Father–child and mother–child reciprocity were individually stable, inter-related at each stage, and consisted of distinct behavioral components. Structural equation modeling indicated that early maternal and paternal reciprocity were each uniquely predictive of social competence and lower aggression in preschool, which, in turn, shaped dialogical skills in adolescence. Father–adolescent reciprocity contributed to the dialogical negotiation of conflict, whereas mother–adolescent reciprocity predicted adolescents’ dialogical skills during positive exchanges. Results highlight the role of parent–child reciprocity in shaping children’s social collaboration and intimate relationships with non-kin members of their social world.     

Phenotype and function of neonatal DC

Newborns face complex physical and immunological changes before and after birth. Although the uterus is a sterile environment for the fetus, it also contains non‐self material from the mother. Birth involves the transition from the sterile intra‐uterine environment to an environment rich in microbes and requires rapid induction of appropriate responses to control these microbes. In this review we focus on the similarities and differences of human and murine neonatal DC and their reaction to various stimuli. A better understanding of the newborn immune system – in particular, the DC–T‐cell interaction – will be beneficial for the development of improved strategies to prevent or treat infections in this vulnerable population and prepare the immune system to cope with allergens and tumors later in life.     

Moral uncertainty: A case study of Covid-19

BackgroundMost writing about uncertainty in healthcare has addressed empirical uncertainty – that is, resulting from insufficient or conflicting facts.ObjectiveTo consider moral uncertainty by exploring how different theories apply to a single clinical case.MethodIn this philosophical reflection, I briefly acknowledge empirical uncertainty before introducing and exploring the topic of moral uncertainty – defined as the question of what to do when we do not know what (morally) to do—using a case study of my own mother’s deterioration and death from Covid-19.ResultsI identify and apply a number of philosophical theories relevant to managing moral uncertainty, including utilitarianism, deontology, practical rationality and feminist philosophy.ConclusionDifferent moral theories lead to different conclusions about the best course of action in situations of moral uncertainty.Practice implicationsDetailed analysis and close reading of a single case can provide insights into how to act in morally complex situations, but learning is in the form of enriched understanding, not formulaic rules.     

The Link between Depression in Mothers and Offspring: An Extended Twin Analysis

Family studies have shown that maternal depression is a risk factor for depression in children. It is unclear, however, to what extent the familial transmission of depression from mother to child involves genes and how much is due to environmental adversity. This study used an extended twin design to assess the importance of environmental factors in the association of depression in mothers and children while simultaneously accounting for genetic relatedness in a UK. community sample of twins aged 8 to 17 years and their mothers. A model that constrained the genetic and environmental parameters to be equal within the two generations and included genetic and environmental paths between mother and offspring (twins) was tested with data from 1468 families. Significant environmental paths were found when maternal ratings were used. When cross-informant data were used (maternal depression and child self-reports of depression), the environmental path was no longer significant. However, for cross-informant data where children were classified as having high depression scores or scores within the normal range, significant environmental effects were found. These findings are interpreted in light of the strengths and weaknesses of the extended twin and other designs.     

Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors

OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of S?o Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), S?o Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical Indicators of Risks in Infant Development proved to be robust despite the specificities of each region.     

Ethical issues surrounding the provider initiated opt – Out prenatal HIV screening practice in Sub – Saharan Africa: a literature review

Background

Prevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt – Out Prenatal HIV Screening Approach, recommended by the World Health Organization (WHO) lately has been adopted and translated into policy in most Sub – Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature.

Methods

Papers published in English and French Languages between 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review.

Discussion

Most authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society (Beneficence). The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities.

Conclusions

The Opt – Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt – Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice.

     

On the evolution of attachment-disordered behaviour

Using an example of a goose which grew up in complete isolation, this article shows how escape behaviour increases through all its developmental steps by lack of a sufficient secure primary attachment object. If a gosling has no mother, its fear influences wide parts of its behaviour and blocks the capacity to approach another animal in order to form a new attachment. But the urge for attachment is still alive and provokes strong conflicts between this urge and fear. In these situations displacement activities and apathy occur – attachment-disordered behaviour. Under partly artificial circumstances, a change to ‘normal’ attachment behaviour took place by reduction of escape motivation, which enabled the goose to accept her brood. From this moment on the attachment-disordered behaviour, the displacement activity and the apathy disappeared. Implications to human behaviour are drawn – a comparison between displacement activity and neurotic symptoms, the state of apathy and personal disorder. A synthesis of ethological and psychoanalytical models concerning etiological and therapeutic aspects is discussed. Fear and attachment, not aggression and sexuality – our ‘animal heritage’ – are the primary factors which influence our development. The balance of fear and attachment is the basis for a healthy or unhealthy development of social relationships. This applies to social living animals as well as to humans.     

Of Distance and Desire: The Many Metamorphoses of George Michael and the Origins of his Creativity

This paper argues for George Michael's significance to contemporary culture, a significance that requires a radical reinterpretation of his life. My discussion suggests that what is at stake in understanding Michael's life is a pattern of internalized homophobia. The method of this paper is to trace the double structure of his consciousness – his awareness of his role as icon and his private state of despair – by isolating moments in both parts of his life. From these, I attempt to extract an understanding of Michael's inner world that found expression in his lyrics. These encounters I explore in light of Kohut's theory of narcissism and Winnicott's ideas of transitional objects. In addition, George Michael's later years were defined by two losses, that of his lover and that of his mother. Michael's relationship to his grief is the focus of this essay. Drawing upon the biographies that have been written about George Michael and the interviews he gave over his career, I attempt to trace the origin of his depression to his early encounters with loss. These losses, I maintain, were reactivated at the peak of Michael's fame and led ultimately to withdrawal and artistic silence in his final years.     

The Effects of Opposite‐Sex Twinship on the Adult twin

In this small‐scale indicative study I explored the issue of individuation in relation to the life stories of a group of adult opposite‐sex twins, using a psycho‐social approach and a narrative interview methodology (Hollway & Jefferson, 2013). I found that none of the six interviewees reported having had a close relationship with their mother in infancy and childhood but five said they had had a close relationship with their co‐twin, which endured in later life. Cleaving to the co‐twin seemed to complicate and disrupt identity formation and the development of mature adult relationships. I concluded that the respondents in the study had experienced a similar psycho‐social challenge to that of same‐sex twins – how to honour their twinship while at the same time attempting to forge a unique identity – but that they seemed to have faced an additional challenge when it came to developing adult relationships with members of the opposite sex.     

Roots and routes to resilience and its role in psychotherapy: a selective,attachment-informed review

Developmental research on resilience is summarised and illustrated with a case example. Self-reflection, positive relationships, and agency foster resilience in the face of adversity. Attachment and resilience are related categories. The different patterns of attachment – secure, insecure-organised and insecure-disorganised – are manifest in different patterns of resilience, depending on prevailing environmental conditions. However, the greater the environmental adversity, the less will the resilience factors emerge. Clients tend to present for psychotherapy when resilience strategies have failed. The therapeutic relationship has neurochemical and relational characteristic mirroring the secure mother–infant bond. These foster mentalising, stress innoculation, affect co-regulation, self-esteem, and agency, forming the basis for enduring and more flexible resilience strategies.     

Birds,Beasts and Babies: Notes from An Infant Observation

This essay is based on my final report covering the second year of my Infant Observation of baby Max. I attempt to convey my experience and the impact it has had upon me and this takes me into a number of different areas: into the content and symbolism of what I observed, into the relationships between observer and child, mother and infant, analyst and analysand and into stories and mythology. As images and symbols are amplified threads link together. Synchronicity is one of the uniting factors and I relate my thoughts and observations to the work and theories of others. Beasts appear – the goldfinch, the fly, the Gruffalo, the mouse, the Wild Things … and more – and I consider how these might offer a window into Max's inner world. I focus on the interface between internal and external worlds and reflect upon the concept of an intermediate space and the question of meaning.     

Contributions of early adversity to pro-inflammatory phenotype in infancy: the buffer provided by attachment security

Adversity early in life is associated with systemic inflammation by adolescence and beyond. At present, few studies have investigated the associations between different forms of adversity and inflammation during infancy, making it difficult to specify the origins of disease vulnerability. This study examined the association between multiple forms of early adversity – socioeconomic status disadvantage, familial stress, maternal depression, and security of attachment – and individual differences in a composite measure of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, and tumor necrosis factor-alpha) and the inflammatory protein C-reactive protein that were collected via saliva when (n = 49) children were 17 months old. In addition to gauging the direct effects of adversity, we also tested the hypothesis that infants’ attachment relationship with their mother might buffer infants against the immunologic effects of early adversity. Results show that familial stress, maternal depression, and security of attachment were directly associated with infant salivary inflammation and that attachment status moderated the effect of maternal depression. The findings suggest that exposure to certain forms of adversity very early in life may engender a pro-inflammatory phenotype with possible life-long implications for health.     

Sudden infant death syndrome and early family interpersonal relationships.

The medical profession are concerned with diseases or disorders, their diagnoses, and the appropriate treatment of their patients. The relevant processes involve interpersonal relationships in physical examinations, associated with the conventional social ritual courtesies. There are only two certainties – birth and death – with areas of probabilities and uncertainties in between. One such uncertainty is the sudden death of an infant in its first year. After the obstetrical birth processes, the specific health of the neonate involves the paediatrician. His skill and modern technical resources have enabled numbers of the prematurely born to survive. Has the modern neonate evolved over the centuries to have some needs that must be worked out between mother and her baby? To attribute hands-on experiences to genes takes away four holding hands from what they feel, the eyeball movements and what they see, the noses and what they smell, and the breast milk for the energy to move the muscles no longer in floating weightlessness.     

THE THERAPEUTIC USE OF PETS IN PRIVATE PRACTICE

abstract The therapeutic use of pets has usually involved institutional visitation. Noting Freud's comments on the discovery of the profound connection between himself and his dogs, and recent research on the regulatory functioning sustained by a libidinal pair‐bond, this paper reports the therapeutic uses of the clinician's companion animal, a Labrador retriever, in a psychoanalytically oriented private practice. Patients were sitting up and seen once or twice a week. I argue that the containment of the treatment setting, attachment theory and a number of Winnicott's concepts – the good enough mother, the True and False Self, and the development of concern – are pertinent to an understanding of this approach to treatment, and that the right companion animal may contribute to the emergence of a True Self. The companion animal has the qualities of ‘devotion’, offers expressions of love and acceptance, tactile opportunity and responsiveness. I make a distinction between a ‘corrective object relationship’ and a ‘corrective emotional experience’, and take into account analytic debates about the ‘corrective emotional experience’. Through clinical vignettes I demonstrate the value of a trained companion animal as a psychotherapeutic addition in a private practice.     

Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children’s socio-emotional functioning

Parental mentalizing – the parent’s ability to envision the child’s mental states (such as desires, thoughts, or wishes) – has been argued to underlie a parent’s ability to respond sensitively to their child’s emotional needs, and thereby promote advantageous cognitive and socio-emotional development. Mentalizing is typically operationalized in terms of how parents talk to or about their infants. This work extends research on mentalizing by operationalizing parental mentalizing exclusively in terms of nonverbal, bodily based, interactive behavior, namely parental embodied mentalizing(PEM). The purpose of the current research was twofold: (1) to establish the reliability and validity of the PEM coding system; and (2) to evaluate whether such measurement predicts infant and child cognitive and socio-emotional functioning. Assessing 200 mother–infant dyads at 6 months using the coding of PEM proved both reliable and valid, including predicting child attachment security at 15 and 36 months, and language abilities, academic skills, behavior problems, and social competence at 54 months, in many cases even after taking into consideration traditional measures of parenting, namely maternal sensitivity. Conceptual, empirical, and clinical implications are discussed.     

Maternal mentalization affects mothers’ – but not children’s – weight via emotional eating

Previous research on childhood obesity has shown that maternal obesity is an important risk factor for this malady. Because biological and environmental factors are able to explain the transgenerational transmission of obesity only in part, psychological risk factors (e.g., emotional eating) have become more important in recent research. As maternal mentalization – which lays the foundation for the child’s ability to regulate his/her emotions – has not yet been investigated, we examined the effects of mentalization on maternal and childhood obesity. By investigating groups of obese (n = 30) and normal-weight (n = 30) mothers and their children aged 18 to 55 months, we found, contrary to our expectations, that obese mothers’ mentalization (Reflective Functioning Scale) was similar to that of mothers with normal weight and that mentalization showed no direct effect on the child’s weight. However, we found hints of an indirect influence of mentalization via emotional eating on mothers’ but not on children’s weight and via mother–child attachment (Attachment Q-Set) on children’s weight. Possible reasons for these inconclusive effects are discussed.