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Topic: Early‐life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long‐term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. Purpose: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. Sources: Peer‐reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. Conclusions: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children. [ABSTRACT FROM AUTHOR]

This paper consists of a discussion of Neil Altman's ‘Psychoanalysis and war’, which was conducted online through PsyBC in the fall of 2006. Discussants were a group of psychoanalytically oriented thinkers chosen by the author and Nancy Hollander, the author of the other paper included in the discussion. The paper represents the full discussion with only minor edits to correct typographical errors and improve clarity. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Doi's paper has successfully spelled out several important points on amae: (1) Amae is an interpersonal process; (2) the origin of amae probably lies in the infant-mother relationship: (3) the concept of amae provides no absolute standard to classify a behavior in terms of amae;, (4) amae is best understood as a combination of patterns of behaviors; and (5) amae is g very broad concept. Implicit, but insufficiently recognized in Doi's paper, is the concept that amae is an interpersonal process of negotiation that is continuously revised throughout life. it is not just a motivational factor embedded in. an individual: underneath the surface phenomenon of amae, an amaeru-ing person usually allows the other to feel needed, valued, and respected. Operationalizing the concept of amae for international research requires that the term be defined in relation to a combination or patterns of behaviors observable in the infant/child-mother dyad. [ABSTRACT FROM AUTHOR]

The paper of the Change Process Study Group of Boston addresses an unsolved conceptual problem: How does one codify intersubjective states? The transfer of concepts from infant research to the adult therapeutic dyad is more than an analogy in that certain primitive aspects of mind appear in infancy, but persist throughout life. The regulation of consciousness is one salient example. The adult therapeutic dyad and the mother–infant dyad can be viewed as self-regulating dynamic systems that are also self-reparative. The concept of implicit relational knowledge is offered as an alternative way of thinking about internal object relations. © 1998 Michigan Association for Infant Mental Health [ABSTRACT FROM AUTHOR]

Counselling and psychotherapy are not common professions that are considered alongside the work of sporting institutions, such as football academies. This paper therefore provides a brief reflection upon the existing research considering the way that such institutions currently engage with the mental health and well‐being of those that they support. In doing so, the world of elite sport engagement is considered before focusing more specifically upon research that has explored how football academies make use of psychological theory and therapy. This paper concludes that counselling and psychotherapy have an important role to play in supporting those at all stages of their football careers. However, delineation with clear roles and boundaries from other professions, such as sport psychology, proves vitally important, and further systematic exploration of this growing area of work is needed. [ABSTRACT FROM AUTHOR]

Despite their negative effects on the emotional, physical, and social wellbeing of students, weight stigma and anti‐fat attitudes are rarely systematically addressed in schools or within school psychology. Weight‐based oppression is regarded differently than other domains of prejudice. Therefore, implicit and explicit bias continue unimpeded, even when practitioners are attentive to other areas of social injustice. Mental health providers serving schools must acknowledge the prevalence of weight stigma and fatphobia to reduce their deleterious and oppressive effects. This conceptual paper outlines the underpinnings of weight stigma, overviews the necessity of addressing it and body image in educational settings, incorporates interdisciplinary perspectives, and proposes a justice‐oriented shift in the conceptualization of weight status within school psychological service delivery. [ABSTRACT FROM AUTHOR]

In this paper, we discuss several largely undisputed claims about mathematics anxiety (MA) and propose where MA research should focus, including theoretical clarifications on what MA is and what constitutes its opposite pole; discussion of construct validity, specifically relations between self‐descriptive, neurophysiological, and cognitive measures; exploration of the discrepancy between state and trait MA and theoretical and practical consequences; discussion of the prevalence of MA and the need for establishing external criteria for estimating prevalence and a proposal for such criteria; exploration of the effects of MA in different groups, such as highly anxious and high math–performing individuals; classroom and policy applications of MA knowledge; the effects of MA outside educational settings; and the consequences of MA on mental health and well‐being. [ABSTRACT FROM AUTHOR]

Aim: To systematically review the literature concerning the psychosocial factors associated with repeat diabetic ketoacidosis for people living with type 1 diabetes. Methods: PsycInfo, Web of Science, CINAHL, PubMed and ASSIA were searched according to a registered study protocol (PROSPERO CRD42020167381). Data were extracted into a coding spreadsheet, and findings were synthesised narratively. Included papers were also subject to a quality assessment. Results: The search yielded 548 unique articles, of which 22 met inclusion criteria for this review. There was considerable variance across studies with regard to design, quality and outcome measured. Nevertheless, there was relatively consistent evidence to suggest that repeat diabetic ketoacidosis in type 1 diabetes is associated with female gender, adolescent to young adult age range, lower socio‐economic status and poor mental health. Some evidence was also observed for the role of ethnicity and, for children and young people at least, family, social and behavioural issues. However, this was limited by issues of methodological rigour and scant investigation. Conclusions: The review identified four psychosocial factors that appear to play a key role in the cycle of repeat diabetic ketoacidosis. Individuals with these factors present may benefit from targeted support and interventions by specialist healthcare professionals. Knowledge and understanding in this area would be considerably enhanced via increased use of prospective study designs and greater consistency in the operationalisation of variables across studies. [ABSTRACT FROM AUTHOR]

Summary writing is a useful instructional tool for learning. However, summary writing is a challenge to many students. This mixed‐method study examined the potential of the Student Mental Model Analyzer for Research and Teaching (SMART) system to help students produce summaries that reflect key concepts and relations in a text. SMART uses the students' summary to generate a multi‐dimensional 3S (surface, structure, semantic) evaluation of the students' mental model. This model is then used to drive feedback to help students revise their summary. The current study is an initial investigation examining whether writing and revising in SMART improves students' summary quality. Students (n = 38) in a graduate‐level online course used SMART for seven reading assignments. The 38 students submitted a total of 357 summaries in response to the seven readings. In 47 cases, students produced both an initial draft and a modified revision. These 47 cases were selected for analysis. In the quantitative phase, MANOVA results indicated that students' summaries improved along the 3S dimensions from initial draft to revision. In the qualitative phase, inspection of exemplar cases revealed how students' mental models changed towards more robust and cohesive knowledge structure for texts. Lay Description: Lay DescriptionWhat is already known about this topicTexts are the main means of acquiring new information.Writing a summary is frequently used as a tool for learning from text.Even proficient readers often struggle to learn from text due to insufficient support.Automated summary evaluation (ASE) can help students revise their summaries.What this paper addsWe introduce the Student Mental Model Analyzer for Research and Teaching (SMART) system.SMART uses a written summary to evaluate the quality of the learner's mental models.SMART analyses a student's mental model in surface, structural and semantic dimensions.SMART helps students improve content‐coverage and overall quality of their summaries.Implications for practiceSMART can be a supplement in classrooms to help students learn from complex texts.Teachers can use SMART to provide real‐time, personalized, formative feedback at a scale.Students can use SMART to comprehend the text to prepare for meaningful class discussion.Scholars can use SMART to investigate expertise development in summary via instruction. [ABSTRACT FROM AUTHOR]

Background: A new diagnosis of complex post‐traumatic stress disorder, CPTSD, has been agreed by the World Health Organization, WHO, and evidence is needed for what psychological treatment might be effective, particularly from those with experience of the disorder. We used a novel participatory approach to explore patient views and simultaneously studied the impact on the patient researchers of the research process itself. In this paper, we report on the latter section of the study how the involvement in research of patients with CPTSD affected their mental health. Symptoms of CPTSD may include emotional dysregulation, feelings of self‐worthlessness and difficulties in relationships. Objective: The aim of this study section was to explore whether patients' mental health could be promoted through empowering them to participate in research on CPTSD. Design: The study had a qualitative, participatory design. The clinician who led the research (first author) held group meetings with patient researchers to explore the impact of the research process. The clinician also kept notes on the process in a reflective log. Setting and participants: Six patient researchers participated in research with other patients with lived experience of CPTSD in an NHS outpatient unit in a London hospital. Intervention studied: The research process itself was analysed in group meetings with researchers which the clinician recorded and transcribed. Findings: Participation in research may promote increased self‐confidence and social inclusion for those with CPTSD. Conclusion: Involvement in research may be seen as an empowering intervention because patients felt it contributed to recovery. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) that has caused the coronavirus disease 2019 (COVID‐19) pandemic represents the greatest international biopsychosocial emergency the world has faced for a century, and psychological science has an integral role to offer in helping societies recover. The aim of this paper is to set out the shorter‐ and longer‐term priorities for research in psychological science that will (a) frame the breadth and scope of potential contributions from across the discipline; (b) enable researchers to focus their resources on gaps in knowledge; and (c) help funders and policymakers make informed decisions about future research priorities in order to best meet the needs of societies as they emerge from the acute phase of the pandemic. The research priorities were informed by an expert panel convened by the British Psychological Society that reflects the breadth of the discipline; a wider advisory panel with international input; and a survey of 539 psychological scientists conducted early in May 2020. The most pressing need is to research the negative biopsychosocial impacts of the COVID‐19 pandemic to facilitate immediate and longer‐term recovery, not only in relation to mental health, but also in relation to behaviour change and adherence, work, education, children and families, physical health and the brain, and social cohesion and connectedness. We call on psychological scientists to work collaboratively with other scientists and stakeholders, establish consortia, and develop innovative research methods while maintaining high‐quality, open, and rigorous research standards. [ABSTRACT FROM AUTHOR]

Aim: To systematically review literature on health-related quality of life (HRQoL) of children and adolescents (≤18yo) with cerebral palsy (CP) from low- and middle-income countries (LMICs) to identify trends in HRQoL and areas for future research.Method: We systematically reviewed six key bibliographic databases and two reviewers independently screened results. Peer-reviewed original articles examining HRQoL of children from LMICs were eligible.Results: A total of 22 524 papers were identified, of which 16, from eight LMICs, were included. Four measures of HRQoL were used; Child Health Questionnaire Parent Form 50 (n=5); Paediatric Quality of Life Inventory 3.0 and 4.0 (n=4); CP Quality of Life Questionnaire for Children (n=4); Lifestyle Assessment Questionnaire CP (n=3). Children with CP from LMICs (n=1579; 2-18y) had significantly poorer HRQoL on all instrument dimensions when compared to age-matched controls (p<0.003) and on all except two dimensions when compared to peers in high-income countries (p<0.001). Physical well-being dimensions of HRQoL were poorest overall and associated with impaired motor function.Interpretation: Research to improve HRQoL in LMICs is required and should address all aspects of HRQoL. Future research is recommended to incorporate multi-respondent assessment, utilize both general and CP-specific measures of HRQoL, and delineate adolescents as a unique cohort. What this paper adds Children with cerebral palsy from low- and middle-income countries are at high risk of poor health-related quality of life (HRQoL). Physical well-being was poorest dimension of HRQoL and associated with impaired motor function. [ABSTRACT FROM AUTHOR]

As we recognize how taxing our profession can be, therapist's self-care has become a salient topic in mental health. However, we are still discerning how to promote self-care in our practice and in training. In this paper, we present a study on the personal gains that MFT students experienced after participating in the Person-of-the-Therapist Training (POTT). We propose that the reported changes (better understanding of self, change to self, relational changes, and change as a process) constitute improvements in the trainees' well-being, and can therefore be considered self-caring behaviors and practices. We state that models like POTT, that focus on embracing our vulnerability, can help clinicians be more caring toward ourselves. We conclude this paper by presenting clinical and training recommendations. [ABSTRACT FROM AUTHOR]

In China, nursing is a profession with considerable stress, which may cause both physiological and psychological problems. The present study conducted a cross‐temporal meta‐analysis of 244 papers using the Symptom Checklist 90 (SCL‐90) to investigate the changes in the mental health level of Chinese nurses (N = 71,286) from 1998 to 2016. Results showed that (a) relationships between scores of all nine types of mental problems in the SCL‐90 and year were significantly positive, indicating that the mental health level of nurses decreased steadily in the past 19 years; (b) relationships between three social indicators (patient‐to‐nurse ratio, unemployment rate, and divorce rate) and scores of all nine types of mental problems in the SCL‐90 were significantly positive, suggesting that the increase in these social indicators may be responsible for the decrease in Chinese nurses' mental health level. [ABSTRACT FROM AUTHOR]

The post-earthquake psychopathological investigation (PEPSI) was designed to probe the short-and long-term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub-sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow-up phase outcomes. Despite a significant decrease in psychopathology rates between 1990 and 2012, prevalence rates of post-traumatic stress disorder and depression among study participants in 2012 were greater than 15 and 26 per cent, respectively. The paper also notes the strengths and limitations of the study vis-à-vis future research and highlights the importance and potential practical implications of similar assessments and their outcomes. [ABSTRACT FROM AUTHOR]

An editorial is presented on the Editorial Advisory Group for the British Psychological Society (BPS) journals has delighted to present this special issue of landmark papers. Topics include the many different spheres of influence of psychological knowledge, the opportunity to delve outside of your immediate area of interest and read the whole spectrum of papers, and the emphasis on theoretical enhancement and of presenting theoretical interpretations of empirical findings.

Fragmentation of processes and interventions plague the psychotherapies (Gilbert & Kirby,). Part of the problem is that we have not agreed on a framework that could be the basis for integrating knowledge and the scientific enquiry of processes and interventions. This paper outlines an approach that brings together a variety of different disciplines in the service of consilience (Wilson, , Consilience: The unity of knowledge, Vintage, New York, NY; Siegel,). It presents the importance of an evolutionary framework for understanding the proclivities and dispositions for mental suffering and antisocial behaviour, and how they are choreographed in different sociodevelopmental contexts. Building on earlier models (Gilbert, , Human nature and suffering, Routledge, London, UK; Gilbert, , Clin. Psychol. Psychother., 2, 135; Gilbert, , Br. J. Med. Psychol., 71, 353; Gilbert, , Case formulation in cognitive behaviour therapy: The treatment of challenging cases, Wiley, Chichester, UK, pp. 50–89) the call is for an integrative, evolutionary, contextual, biopsychosocial approach to psychology and psychotherapy. Practitioner points: Evolutionary functional analysis is part of an evolutionary, contextual, biopsychosocial approach to mental health that can serve as a scientific platform for the future developments of psychotherapy.Therapist skills and training will increasing need to focus on the multidimensional textures of mental states especially the context‐social‐body linkages.Therapies of the future will also focus more on the moral aspects of therapy and address the need to promote prosocial and ethical behaviour to self and others. [ABSTRACT FROM AUTHOR]

Objectives: There is considerable evidence that early parenting has profound effects on a range of physiological and psychological maturation processes. Furthermore, psychotherapy often addresses some of the distortions and developmental difficulties that have arisen from early childhood. While research has focused on obvious candidates such as abuse and neglect, this paper reviews some of the core themes related to a less investigated area, specifically parental shame on child development. Role shame sensitive parenting styles will be explored against an evolutionary background that contrasts early human and modern human rearing contexts. We also outline a study examining the role of shame in psychological controlling and dysfunctional parenting styles, its relationship to different dimensions of shame and fears of compassion. Design: An online survey was conducted containing self‐report measures of dysfunctional parenting styles, three dimensions of shame (external, internal, and reflected), fears of compassion, mental health indices, and a measure of psychological flexibility. Methods: An online survey was accessed by 333 parents (306 being female) with a child between the ages of 3–9 years. Results: Two hierarchical multiple regressions indicated support for our two primary hypotheses, with shame explaining significant variance in both psychological controlling and dysfunctional parenting styles over and above that explained by psychological inflexibility, parental mental health, and fears of compassion. Additionally, results from standard multiple regressions indicated that fears of compassion account for significant variance in external shame, as well as internal and reflected shame. Conclusions: Recommendations for future research include focusing on parental motivation in order to help support parents and children are provided. Practitioner points: Shame is a major factor for how parents engage in parenting practices and respond to their childrenPractitioners need to be sensitive to the shame parents can experience and asses for itAssessing shame‐threat in parenting and shifting to compassionate motivation can lead to more responsive and positive parenting [ABSTRACT FROM AUTHOR]

Low‐income Latinas/os are exposed to widespread mental health disparities in the United States. Most recently, a resurgence of anti‐immigration narratives has led vulnerable Latina/o immigrants to experience considerable contextual stressors with multiple deleterious consequences for their overall well‐being, including significant disruptions to their parenting practices. Within this context of adversity and despite the multiple benefits associated with parent training (PT) prevention interventions, the availability of contextually and culturally relevant PT interventions remains limited in underserved Latina/o communities. This paper constitutes a contribution to this gap in knowledge by presenting a model of intervention delivery utilized in the dissemination of culturally adapted versions of the evidence‐based intervention known as GenerationPMTO.© The proposed model also describes a process of change that we have documented in empirical research with low‐income Latina/o immigrant parents who have been exposed to the adapted interventions. The manuscript is organized in four sections. First, an overview of the model is discussed, along with a brief summary of major theories. Next, the core components of the model are described, complemented by the presentation of a case study. Finally, implications for prevention and clinical intervention are discussed. [ABSTRACT FROM AUTHOR]

Aim: To describe 5-year motor and functional outcomes after paediatric arterial ischaemic stroke (AIS) and to explore factors associated with poorer long-term outcome.Method: Thirty-three children (21 males, 12 females) with AIS were recruited to a single-site, cross-sectional study, from a previously reported prospective longitudinal stroke outcome study. Children were stratified according to age at diagnosis: neonates (≤30d), preschool (>30d-5y), and school age (≥5y). Motor and functional outcomes were measured at 5 years after stroke. Neurological outcomes were evaluated using the Pediatric Stroke Outcome Measure (PSOM) at 1 month and more than 4 years after stroke.Results: At 5 years after stroke, motor function, quality of life, fatigue, adaptive behaviour, activities of daily living, and handwriting speed were significantly poorer than age expectations. The preschool group had the highest percentage of fine and gross motor impairment. Poorer fine motor skills were associated with subcortical-only lesions and large lesion size. Poorer gross motor outcomes correlated with preschool age, bilateral lesions, and PSOM impairment at 1 month.Interpretation: Children are at elevated risk for motor and functional impairments after AIS, with the preschool age group most vulnerable. Identifying early predictors of poorer outcomes facilitates targeted early intervention and long-term rehabilitation.What This Paper Adds: Following paediatric stroke, children are at elevated risk of motor and functional difficulties. Stroke occurring between 30 days and 5 years of age may result in poorer motor and functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: It is often held that in imagining experiences we exploit a special imagistic way of representing mentality—one that enables us to think about mental states in terms of what it is like to have them. According to some, when this way of thinking about the mind is paired with more objective means, an explanatory gap between the phenomenal and physical features of mental states arises. This paper advances a view along those lines, but with a twist. What many take for a special imagistic way of thinking about experiences is instead a special way of misconstruing them. It is this tendency to misrepresent experiences through the use of imagery that gives rise to the appearance of an explanatory gap. The pervasiveness and tenacity of this misrepresentational reflex can be traced to its roots in a particular heuristic for monitoring and remembering the mental states of others. The arguments together amount to a new path for defending the transparency of perceptual experience. [ABSTRACT FROM AUTHOR]

Summary: Background: Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. Aims: To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. Methods: We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random‐effects meta‐analysis. Results: We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta‐analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom‐specific anxiety (MD: −8.51, 95% CI −12.99 to −4.04, P = 0.0002) and lessen symptom‐induced disability (MD: −2.78, 95% CI −5.43 to −0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. Conclusion: There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases. [ABSTRACT FROM AUTHOR]

Aim: Health-related quality of life (HRQoL) and peer relationships were investigated in adolescents with developmental coordination disorder (DCD) and attention-deficit-hyperactivity disorder (ADHD).Method: Adolescents with DCD (n=9), ADHD (n=9), DCD and ADHD (n=10), and typically developing adolescents (n=16) completed the following questionnaires: KIDSCREEN-52 Health-Related Quality of Life Questionnaire and Peer Relations Questionnaire for Children. Twenty-five participants took part in semi-structured interviews.Results: Adolescents with DCD and ADHD had lower HRQoL on the mood and emotions, school environment, and financial resources scales of the KIDSCREEN-52 than adolescents in the DCD and typically developing groups (all p<0.05). On the Peer Relations Questionnaire for Children, the DCD and ADHD group reported significantly higher victimization compared with those in the typically developing (p=0.030) and DCD (p=0.010) groups. Qualitative interviews among young people with DCD and ADHD revealed feelings of marginalization and victimization. Descriptors such as 'misfits', 'oddballs', 'weird', and 'the rejects' were used to describe themselves.Interpretation: HRQoL and peer relationships are negatively affected in adolescents with DCD and ADHD. WHAT THIS PAPER ADDS?: Children with developmental coordination disorder (DCD) do not display poorer overall health-related quality of life (HRQoL) versus typically developing controls. Having DCD and attention-deficit-hyperactivity disorder (ADHD) was associated with poorer HRQoL. Adolescents with DCD and ADHD experience significantly higher levels of peer victimization than typically developing adolescents. HRQoL and peer relationships are significantly associated in adolescent respondents. [ABSTRACT FROM AUTHOR]

Interviews with survivors of intimate partner violence were conducted to gain information on the transition from violent relationships to new non‐violent relationships. A subset of this data was re‐analysed using Social Relational Theory to gain further insight into the roles of children and important others who were identified as impacting this transition for mothers who had exited violent relationships. This paper reviews two major themes discovered during the SRT analysis that were inherent in the women's experiences: (i) agency of children, family, peers and community and (ii) power. In addition, this paper suggests implications for research, intervention and psychotherapeutic practice. [ABSTRACT FROM AUTHOR]

Aim: To develop and validate a disease-specific parent proxy and child quality of life (QoL) measure for patients aged 2 to 18 years surviving cerebral sinovenous thrombosis (CSVT) and arterial ischaemic stroke (AIS).Method: Utilizing qualitative and quantitative methods, we developed a 75-item Pediatric Stroke Quality of Life Measure (PSQLM) questionnaire. We mailed the PSQLM and a standardized generic QoL measure, Pediatric Quality of Life Inventory (PedsQL), to 353 families. Stroke type, age at stroke, and neurological outcome on the Pediatric Stroke Outcome Measure were documented. We calculated the internal consistency, validity, and reliability of the PSQLM.Results: The response rate was 29%, yielding a sample of 101 patients (mean age 9y 9mo [SD 4.30]; 69 AIS [68.3%], 32 CSVT [31.7%]). The internal consistency of the PSQLM was high (Cronbach's α=0.94-0.97). Construct validity for the PSQLM was moderately strong (r=0.3-0.4; p<0.003) and, as expected, correlation with the PedsQL was moderate, suggesting the PSQLM operationalizes QoL distinct from the PedsQL. Test-retest reliability at 2 weeks was very good (intraclass correlation coefficient [ICC] 0.85-0.95; 95% confidence interval 0.83-0.97) and good agreement was established between parent and child report (ICC 0.63-0.76).Interpretation: The PSQLM demonstrates sound psychometric properties. Further research will seek to increase its clinical utility by reducing length and establishing responsiveness for descriptive and longitudinal evaluative assessment.What This Paper Adds: A pediatric stroke-specific quality of life (QoL) measurement tool for assessments based on perceptions of importance and satisfaction. Moderate-to-high reliability and validity established for a new clinical scale evaluating QoL among children with stroke. Perceived QoL measured using the Pediatric Stroke Quality of Life Measure appears lower in children with neurological impairment. [ABSTRACT FROM AUTHOR]

Aim: Economic appraisal can help guide policy-making for purchasing decisions, and treatment and management algorithms for health interventions. We conducted a systematic review of economic studies in cerebral palsy (CP) to inform future research.Method: Economic studies published since 1970 were identified from seven databases. Two reviewers independently screened abstracts and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Any discrepancies were resolved by discussion.Results: Of 980 identified references, 115 were included for full-text assessment. Thirteen articles met standard criteria for a full economic evaluation, two as partial economic evaluations, and 18 as cost studies. Six were full economic evaluations alongside clinical studies or randomized controlled trials, whereas seven involved modelling simulations. The economic case for administration of magnesium sulfate for imminent preterm birth is compelling, achieving both health gain and cost savings. Current literature suggests intrathecal baclofen therapy and botulinum toxin injection are cost-effective, but stronger evidence for long-term effects is needed. Lifestyle and web-based interventions are inexpensive, but broader measurement of outcomes is required.Interpretation: Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost-effective, although stronger evidence of clinical effectiveness is needed. What this paper adds Cost-effectiveness evidence shows prevention is the most significant strategy. Some treatments are cost-effective, but stronger evidence for long-term effectiveness is required. Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores the contribution of social identity change to international students' health and well‐being. International students typically face a range of challenges from the time they leave their home country, including the need to adapt both to a new culture and norms and to a new educational landscape. Previous research informed by the Social Identity Model of Identity Change (SIMIC) suggests that during such life transitions, an individual's group memberships and associated social identities can provide a buffer against the threats to well‐being that such transitions present. To examine the relevance of SIMIC for the transitions that international students' experience, semistructured interviews were conducted with 15 international students attending an Australian university. Thematic analysis provided support for the relevance of SIMIC's social identity gain and social identity maintenance pathways in the transition and revealed a number of associated factors that acted as either facilitators (e.g., a host family that supported community integration) or barriers (e.g., experiencing culture shock) to social identity change. These findings present the first qualitative support for SIMIC within an international student population and help to flesh out the specific ways in which social identity processes contribute to both positive and negative health and well‐being outcomes. [ABSTRACT FROM AUTHOR]

Aim: To describe health-related quality of life of Australian children and adolescents with Down syndrome and compare it with norm-referenced data.Method: A cross-sectional survey was conducted with parents of 75 children and adolescents (43 males, 32 females) with Down syndrome aged 5 to 18 years (mean age 13y 2mo, SD 4y 8mo). The proxy-report KIDSCREEN-27 questionnaire was administered and five dimensions of health-related quality of life were measured. Data were analysed descriptively and compared with normative data.Results: Total group mean scores for psychological well-being, autonomy and parent relation, and school environment dimensions were within normal threshold values, whereas mean scores for physical well-being, and social support and peers dimensions, were poorer. For participants with Down syndrome aged 8 to 18 years, the difference with normative data for proxy-reported physical well-being, psychological well-being, and social support and peers dimensions favoured typically developing children. Adolescents (13-18y) with Down syndrome scored poorer on all dimensions than children (5-12y) with Down syndrome.Interpretation: Our findings assist a better understanding of the lived experiences of children and adolescents with Down syndrome, as perceived by their parents, and suggest aspects of health that could be influenced to optimize their quality of life.What This Paper Adds: Proxy-reported psychological well-being and autonomy were within the normal range for children with Down syndrome. Physical well-being and social support scores were significantly lower than normative data. Proxy-reported scores for adolescents with Down syndrome were consistently poorer than for children with Down syndrome and the differences were clinically important. [ABSTRACT FROM AUTHOR]

What emotional experience settles a disturbed state of mind? In this paper I use the work of three psychoanalytic clinicians (John Steiner, Eric Brenman and Henri Rey) to describe the negative state of mind of a patient and draw on clinical material to illustrate my efforts to settle deep emotional disturbance. Recognizing the size of the emotional task by conceptualizing the depth and breadth of the pathological organization, along with thinking carefully about the ingredients of a ‘strengthening introject’ and locating an ‘introjective site’, taking into account the developmental disparity between therapist and patient are all seen as essential counter‐transference processes required to facilitate movement from a bad to a good state of mind. [ABSTRACT FROM AUTHOR]

Abstract: With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight‐based discrimination has also intensified. While research has demonstrated the negative effects of weight‐based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self‐perceived weight‐based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi‐stage probability sample of non‐institutional, English‐speaking adults, ages 35 to 89 in 2005–2006. Our findings demonstrate that the effect of weight‐based discrimination on psychological well‐being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self‐rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well‐being. [ABSTRACT FROM AUTHOR]

Aim: To examine long-term outcomes of selective dorsal rhizotomy (SDR) 10 to 17 years after surgery.Method: Participants who underwent SDR had spastic diplegic cerebral palsy (CP), completed baseline gait analysis, and were 16 to 25 years old at follow-up. Non-SDR participants (i.e. controls) were matched on important clinical parameters at baseline but did not undergo SDR. All study participants completed six surveys assessing pain, quality of life, participation, function, and mobility. Treatment history for lower extremity surgery and antispasticity injections was tabulated. A subset of each study group returned for three-dimensional gait analysis, including kinematics, metabolic energy cost, and physical examination. Gait Deviation Index (GDI) was calculated to measure gait quality.Results: The study cohort had 24 participants with SDR and 11 without SDR. Of these, 13 patients with SDR (five males, eight females; median [IQR] age 17y 2mo [16y 8mo-17y 9mo]) and eight without SDR (three males, five females; median [IQR] age 19y 2mo [17y 3mo-21y 11mo]) completed baseline and follow-up gait analysis. Spasticity significantly decreased in those with SDR (p<0.05). Gait Deviation Index improved more in participants without SDR than those with SDR (Δnon-SDR =12.8 vs ΔSDR =9.1; p=0.01). Compared with the SDR group, participants without SDR underwent significantly more subsequent interventions (p<0.05).Interpretation: Patients in both the SDR and non-SDR groups showed improved gait quality more than 10 years after surgery. Participants without SDR had a larger improvement in gait pathology but underwent significantly more intervention. There were no differences between groups in survey measures. These results suggest differing treatment courses provide similar outcomes into early adulthood.What This Paper Adds: Selective dorsal rhizotomy (SDR) and non-SDR groups had significant improvement in gait pathology over time. The non-SDR group had significantly better gait compared with the SDR group at follow-up. The groups had similar levels of energy cost, pain, and quality of life. Non-SDR participants underwent significantly more orthopaedic surgery and antispasticity injections than SDR participants. Use of a clinically similar control group highlights that different treatment courses may result in similar outcomes into young adulthood. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the relationship between quality of life (QoL) and health-related quality of life (HRQoL) and assessed factors other than health that contribute to differences in QoL in young males with Duchenne muscular dystrophy (DMD).Method: In this cross-sectional study, QoL and HRQoL measures were completed by 98 parents and 85 children. The Quality of My Life (QoML) questionnaire measured QoL and HRQoL as single-items, and the Pediatric Quality of Life 4.0 Generic Core (PedsQL) questionnaire was used as a multidimensional measure of HRQoL. Simple regression was used to examine the relationship between single-item measures of HRQoL and QoL. Multivariable regression was used to investigate factors that may contribute to difference in QoL and HRQoL.Results: While ratings of QoL and HRQoL were significantly correlated with one another, HRQoL only accounted for 21% and 44% of the variability in QoL by child- and parent-reports respectively. None of the factors measured contributed ratings of the child's QoL to be much higher than HRQoL.Interpretation: QoL and HRQoL are related but distinct constructs as rated by children with DMD and their parents. Further research is needed to elucidate factors outside HRQoL that contribute to QoL.What This Paper Adds: Quality of life (QoL) and health-related quality of life are distinct concepts rated by young males with Duchenne muscular dystrophy (DMD) and their parents. Factors outside of 'health' contribute to overall QoL in the paediatric population with DMD. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in-depth, semi-structured interviews conducted with seven ( n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental-health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as 'flawed' against the mental illness as 'bad' and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed. [ABSTRACT FROM AUTHOR]

This paper reports on the first phase of a larger study aimed at investigating factors hindering family work and exploring ways to improve the amount and quality of family contact within a community aged mental health service in Melbourne, Australia. During the first phase of the project, 28 mental health professionals were interviewed about their views and experiences. Interviews were transcribed, coded, and analysed in terms of repeating themes. The range of attitudes, beliefs and feelings about family work is summarised in this paper. Polarities emerged around questions of whether or not to engage family members, and if so, what function family work fulfils. The interviews also provided useful information on clinicians' beliefs about what would increase the possibility of family work. The paper concludes with a discussion about how to recognize and value family work in this area and target sustainable interventions during the second phase of the study. [ABSTRACT FROM AUTHOR]

Purpose To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years). Methods The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials ( RCTs), non- RCTs and before and after comparisons ( BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences ( SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non- RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data. Results The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non- RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms ( SMD −0.30, 95% confidence interval ( CI) −0.60 to −0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms ( b = 0.03, 95% CI 0.01 to 0.05), psychological stress ( b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being ( b = −0.03, 95% CI −0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained. Conclusions There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients. [ABSTRACT FROM AUTHOR]

Accessible summary · This article looks at the richness inherent in our life experience and engages on a journey to examine this richness in the light of two experiences (or epiphanies) on a clinical training course. It demonstrates how, as a result of continued refection and reflexive analysis, my understanding of these experiences transformed over a period of time. · The field of inquiry was a training in psychoanalytic counselling. My ongoing analysis of the experiences provided an evaluation of some key features of that culture and the nature of clinical training, particularly in psychoanalytic milieu. · The article concludes with a discussion about the academic culture in which I am now working and the way in which it influences my writing style (in, for example, this article). It concludes that the discourse of this culture prevents us from reaching our creative spiritual core and examines how we can overcome this limitation. In this paper I will argue that investigating our professional experiences can enrich our understanding, widen our perspective, transform our inner lives and create an endless source of discovery about ourselves, society and the professional discursive systems that we inhabit. I will call such events, after Denzin's work in 1989, epiphanies. In order to develop the theme I will give an account of my own experience of two such epiphanies on a psychoanalytic training course in counselling. I will then present my reflexive analysis of these events over the years, including my reflections on the peer review comments for this paper, and finish with some questions arising out of the study relating to the current status of nursing as an academic profession. [ABSTRACT FROM AUTHOR]

Children in the protection and care system are highly vulnerable and need more than protection and physical care. This paper outlines elements of an innovative therapeutic programme, Take Two, which combines trauma and attachment-informed practice with a clinical outcomes focus. An important feature was the embedding of a research and evaluation partnership between the programme and a university. The paper discusses the challenges of implementing a research approach into a highly sensitive ‘messy’ or non-routine environment. The paper portrays the value of a trauma and attachment perspective within a developmental and ecological framework to guide understanding and intervention with these children and their network. A description of the client group is followed by analysis of outcome measures: the Trauma Symptom Checklist for Children and the Social Network Map. Findings include the significant reduction of trauma-related symptoms, an increase in the percentage of friends identified and an increase, albeit not significant, in the percentage of people described as very close. The results point to the importance of family in the lives of these children. This study explores this type of research in situ and its value in building knowledge and strengthening practice. [ABSTRACT FROM AUTHOR]

The paper addresses the ambiguous nature of supervised meetings between children and their non-residential parent(s) which, according to the current legal idea, should serve the best interest of the child. In Finland the meetings between the child and the non-residential parent can be ordered supervised if there are justified grounds for assuming that they constitute a risk for the child's safety. In many parts of Europe the need for such kinds of meetings controlled by outsiders has increased. The aim of the paper is to consider the child's position and the closely related issue of the child's interest in supervised meetings, based on the daily experiences of the supervisors. Data are gathered by focus group interviews and analysed qualitatively in terms of categorization analysis. As a result, the child's position is an ambiguous phenomenon with multiple interests. Obviously the child's interests will be met in some cases, although paradoxically it is mostly the interests of the parents and most often the fathers, which seem to demand more attention. Thus adult-centredness, meanings of gender, time together with both the positive and possible detrimental outcomes for the child need further reflection. [ABSTRACT FROM AUTHOR]

Research indicates that there is a high level of trust in health professionals but also a high level of non-disclosure of mental health issues to general practitioners (GPs). This paper explores the issue of patients’ willingness to disclose mental health problems to GPs through interviews with 33 patients from the lower half of the North Island of New Zealand. Patients’ willingness to disclose related to a range of factors but this paper focuses on fear and sense of control as these issues have received little attention in the extant literature and provide important discussion points for the conduct of consultations. Fear of the consequences of consultation warrants attention if general practice is to be promoted as the preferred point of contact for mental health consultations. The research reported here suggests that trust in a range of institutions and agencies, not just in the individual practitioner, would need to be achieved for the GP to be the preferred point of contact. [ABSTRACT FROM AUTHOR]

This paper describes a project in which family interventions in psychosis services were successfully established in a routine clinical setting. This has involved the development of a whole-team training approach, an accredited one-year training course, and a clinical approach which integrates the systemic and cognitive-behavioural psychoeducational approaches. Since the original description of this project ( Burbach and Stanbridge, 1998 ) the training course and service have been evaluated and the clinical approach has been further developed. These developments, particularly the ‘cognitive interactional’ approach and collaborative therapeutic stance, are detailed. The paper explores the factors which have contributed to the successful establishment and maintenance of the service, and describes more recent initiatives to bring about more family/carer-friendly mental health services. [ABSTRACT FROM AUTHOR]

In recent times much has been made of integrative tendencies and common ground between therapeutic orientations, previously locked into highly oppositional frames. This is evident in the rapprochement between psychoanalysis and cognitive-behavioural therapy in adult mental health. It is a trend that is also evident in the shifting relationship between systemic and psychoanalytic orientations. This paper begins with an overview of factors influencing the wider integrative ethos before considering the specific circumstance of the relationship between systemic family therapy and psychoanalysis. The paper considers both the past history of oppositionality between the two orientations as well as some current developments that might facilitate a more creative dialogue. Particular attention is paid to issues of similarity and difference between the therapeutic relationship in systemic family therapy and the psychoanalytic framework of the transference/countertransference. Implications for therapeutic technique are explored. The aim is not to minimize difference but to encourage cross-fertilization between these therapeutic orientations in the interest of patients/families who may benefit from an integrated response. [ABSTRACT FROM AUTHOR]

Schemas are one of the key concepts of modern psychotherapy. However, there remains much confusion regarding the nature of this concept. For example, it is sometimes confused with related concepts (e.g. core beliefs) and often used incorrectly to describe specific forms of cognition (e.g. self-referent beliefs). The present paper suggests that core beliefs and self-referent beliefs are sub-components of schemas, and thus should not be used synonymously with the parent concept. For many clinicians, these distinctions may appear rather pedantic or academic, but we would argue that correct differentiation is essential if one intends to deliver good therapy. It is suggested that a more appropriate understanding of the concept of schemas would draw clinicians' attention to many of the information processing mechanisms and biases that both hinder and facilitate therapeutic change. This paper also makes suggestions about how one could clarify the nature of schemas in terms of specific dimensions, which may provide better precision with respect to their use and function within clinical settings. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Two recent papers in the journal, Nicholas Agar's "Functionalism and Personal identity" and Eric Olson's "What Does Functionalism Tell Us About Personal identity," address an account which appeals to a functionalist view of mental states in support of a psychological continuity view of personal identity. This paper is not primarily a reply to Agar's paper. It is agreed that his "functional necessary condition for two mental states to be copersonal," namely that "it is possible to trace a chain of actual and potential causes between them that includes no non-psychological intermediate," and that this rules out the possibility of teletransportation and the like. This is in accord with, and is a helpful supplement to the view that persons are "autonomous self-perpetuators," and that the successive stages of their careers are linked by immanent causation.

This paper presents the findings of a systematic review of the current evidence for the effectiveness of stress management interventions for those working in the mental health field. Research articles from 1966 to 2000 which reported studies undertaken in the United Kingdom and which specifically identified participants as mental health workers were included in the review. Studies from other European countries and from the USA were examined as potential models of good practice. The review demonstrated that a great deal is known about the sources of stress at work, about how to measure them and about their interaction and impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempted to moderate, minimize or eliminate some of these stressors. Three papers were retrieved which reported intervention strategies for workers classified as working within the mental health arena. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Taking as its starting point a series of traditional divisions and debates, this paper approaches issues of 'mental' health through the specific lens of the emotions. Key themes and organising principles here include the following: (i) reason versus emotion (ii) biology versus society (iii) the micro and the macro divide, and finally (iv) the medicalisation-demedicalisation of society. Each of these divisions is critically assessed and some 'new' ways forward provided through a commitment to the emotions, their relationship to 'mental' health and to rationality and, more generally, to their 'fate' in late 20th century Western society. The paper concludes with some further reflections on these and related emotional health matters, including a critique of the very notion of 'mental' health as a contradiction in terms. [ABSTRACT FROM AUTHOR]

This paper investigates potential mental health benefits of outdoor and adventure education programs. It is argued that experiences made in successful programs can increase self-efficacy, mindfulness and subjective well-being. Furthermore, programs may reduce feelings of time pressure and mental stress amongst participants. Evidence comes from two pilot studies: In the school project "Crossing the Alps" (Study 1), 14-year-old participants reported an increase in life satisfaction, mindfulness and a decrease in the PSQ Subscale 'demand' after a successful nine-day hike through the German, Austrian, and Italian Alps. In the university project "Friluftsliv" (Study 2) participants scored higher in life satisfaction, happiness, mindfulness, and self-efficacy and lower in perceived stress after having spent eight days in the wilderness of the Norwegian Hardangervidda region, miles away from the next locality. The findings suggest that outdoor education and wilderness programs can foster mental health in youths and young adults. [ABSTRACT FROM AUTHOR]

Diary writing is a centuries-old method of recording events, experiences, thoughts, and feelings that might offer potential as a tool that consumers and nurses could utilize in recovery-oriented practice. While the diary has been used within health disciplines to detail and communicate personal experiences to enable collaborative examination of progress, a diary can also provide a more complete picture of what life is like; not only within the confines of a health service environment, but also outside. In recent times, the diary appears to be experiencing a renewed interest in terms of health care. People experiencing a mental health challenge might use diary-based forms of communication to promote understanding between themselves and mental health workers, and ultimately the use of this form of narrative therapy might facilitate person-centred, recovery-based actions. The present study paper, therefore, explores multiple perspectives on the use of diaries in the therapeutic context. Suggesting that diaries have not yet been utilized to their fullest potential by and with consumers and clinicians, this discussion raises issues and offers clarity about diary forms and their uses in the health context. It also discusses the barriers to their use and how to engage consumers and clinicians in recovery-oriented work. [ABSTRACT FROM AUTHOR]

Postdeployment reintegration may present an exceptional challenge to service members and their families; yet, overcoming this challenge seems to strengthen family relationships through a shared sense of purpose. Navigating family reintegration may be an important determinant of long-term psychological well-being. If the needs of military families are to be answered effectively, it is of critical importance to identify the skills that facilitate positive reintegration following deployment. This article proposes psychological flexibility as a group of interrelated skills that could be directly intervened on to facilitate not only resilience but also positive growth and development. This paper focuses on the conceptualization of family reintegration in terms of psychological flexibility, including common deficits observed in this population and potential goals of treatment. Video Abstract. [ABSTRACT FROM AUTHOR]

Seldom is the work of philosophers invoked by health professionals when examining aspects of care from a philosophical perspective. Instead, students of health care, especially nurses, have been introduced to ‘philosophies’ which are often superficially examined and poorly understood. This practice fails to develop in students an appreciation of the work of philosophers or to acquire the art of critical thinking. The introduction of models and theories of nursing in the past three decades has alerted nurses to the importance of possessing critical skills in order to identify sound theory and implement good practice. This paper goes beyond mere philosophising and examines aspects of mental health care from the perspectives of one of nineteenth century Europe’s most notable philosophers, Friedrich Nietzsche. It argues that understanding his work can enhance one’s ability to reflect on nursing practice, as well as bringing a new dimension to how we analyse ‘mental health’ problems. His work provides many insights into how we can improve our understanding of the effect of mental illness and mental health care on the individual, and how we conceptualise the process of care. This paper provides an overview of his life’s work, his impact on the history of ideas and develops some of the more provocative implications of his work for mental health care. [ABSTRACT FROM AUTHOR]

This paper discusses the manipulation of mental representations, particularly in relation to the psychoanalytic concepts of conscious or unconscious fantasy. A distinction is made between the unconscious phenomenal (experiential) aspect of representations and the nonexperiential, quasi-structural aspect. The concept of the representational world is described and elaborated, and its development is seen as a consequence of the infant's interaction with itself and The external world, Processes such as identification and projection can be seen in terms of changes in self and object representations, and the same is true for all the mechanisms of defense. The content of unconscious wishes is transformed, by use of such mechanisms, into representations that are acceptable to consciousness, Major transformations of unconscious representational content occur in the process of creating unconscious (preconscious) fantasy, and further transformations are frequently needed before such (preconscious) fantasies are permitted access to consciousness. The concept of projective identification is considered in the light of the ideas put forward in the paper. [ABSTRACT FROM AUTHOR]