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Depressive disorders in early childhood are associated with high psychosocial impairment and tend to remain stable over time without adequate treatment. Short-term psychoanalytic therapy is a common form of child psychotherapy, yet there is a lack of empirical evaluation of this approach for young children with depressive disorders. Therefore, this secondary evaluation of a study on the treatment of anxiety disorders used an uncontrolled pre-post design in a clinical setting to investigate whether children with depressive comorbidity would evidence significant diagnostic and symptomatic remission after treatment with manualized short-term Psychoanalytic Child Therapy (PaCT). Nineteen children who had an anxiety disorder and a (subclinical) depressive disorder (assessed with the Preschool Age Psychiatric Assessment using DSM-IV criteria) were treated with PaCT. After treatment, 15 of 19 children (78.94 %) were remitted and 15 of 17 children (88.24 %; 2 were lost to follow-up) were free of depressive disorders at the 6-month follow-up. Further analyses revealed significant effects for pre- to post and pre- to follow-up comparisons regarding internalizing symptoms and overall problems using parent- and (nursery-)teacher-ratings. These results suggest that short-term PaCT shows promise as a treatment for childhood depressive disorders.

Suicides Among Adolescents in a Major German City Abstract. Objective: Adolescent suicide is a major contributor to the overall mortality in this age group. This study examined sex and age differences in suicide methods. Method: The investigation is based on death certificates from the years 1996 to 2019 of the city of Leipzig and includes all suicides in the age group under 25 years. The impact of sex and age on the method and location of suicide was examined using chi square statistics. Moreover, we verified the association between suicides and death by drug overdose through statistical regression. Results: 140 suicides were included in the study. The suicide methods differed between the age groups ( χ ² = 17,878; p = .022). Individuals under 21 years of age committed suicide almost exclusively by strangulation, jumping from heights, railway suicide, or deliberate intoxication. With the onset of early adulthood, the spectrum of methods expanded. Suicide methods were also different between the sexes ( χ ² = 35,166; p < .001): Male adolescents preferred highly lethal methods such as strangulation, whereas in female adolescents intoxication was the leading method of suicide, with a predominance of antidepressants. The annual rates of suicide and death by drug overdose were found to correlate (Pearson correlation = 0,571, p = .004). Minors ( χ ² = 3.125, p = .077) tended to avoid their own residential environment as a place of suicides compared to adults. Conclusion: When assessing the individual suicide risk and weighing safeguarding measures in clinical practice, the differences shown in the choice of methods should be taken into account.

Assessment of Maltreatment in Childhood and Adolescence In view of mounting evidence for substantial prognostic relevance of child maltreatment for the future developmental course, assessment of maltreatment in children and adolescents is increasingly gaining attention. At the same time, maltreatment assessment is replete with difficulties, ranging from the definition of maltreatment and establishment of threshold values determining when events meet prognostically relevant criteria, to poor agreement between sources. The aim of this paper is to provide an overview of instruments for assessing maltreatment in children and adolescents. This overview serves as a point of departure to emphasize the importance of various sources for the purpose of assessing maltreatment and to consider the unique role of the child's or young person's perspective. We conclude with preliminary proposals regarding the role of maltreatment assessment in clinical practice.

LIFE Child Depression - a prospective longitudinal cohort study on the origin of depressive disorders between childhood and early adulthood LIFE Child Depression is a prospective longitudinal study on the origin and course of depressive symptoms and disorders between child- and adulthood. The aim of the study is to identify patterns of developmental courses of symptoms and disorders and to investigate the interplay of psychosocial, biological and genetic risk and protective factors in the development of depressive disorders. The present paper gives an overview on results of the study. The sample was already assessed three times. A clinical sample was recruited from two local child psychiatric in- and outpatient services in Leipzig, a control sample was recruited from a children's health check program at our medical faculty (LIFE Child Health) and from the local registration office. We found some important context- and parent-associated risk factors for depressive disorders, such as negative life events, low socioeconomic status and depression in mothers (but not in fathers). Moreover, we found some characteristic biological and cognitive-emotional characteristics of children with depressive disorders, such as low stress-related cortisol, low evaluation of own performance, and more negative cognitions in dealing with stressful situations, low self-esteem and a general impairment of emotional processing of human faces. Only some of the risk factors were found to be specific to depression. Instead, most of them can be regarded as general risk factors for psychological disorders in childhood. It is also noteworthy, that some of the risk associations were gender-specific and need to be looked at from a differential point of view. Our study gives important indications for prevention for children at risk for depressive disorders as well as for therapeutic approaches.

After the birth of a child, parents may experience episodes of stress and psychological strain. Some infants show psychological or somatic stress in the form of early regulatory disorders. While the close connection between parental psychological stress, early regulatory disorders, and the development of the parent-child relationship is well documented, current data on effective treatment options are lacking. Previous care services mostly operate on a preventive basis; evidence-based psychotherapeutic services with a special focus on the parent-child relationship are rare.SKKIPPI is a multicenter research project (Berlin, Flensburg, Hamburg, Leipzig) and consists of several study parts with a mixed methods approach: an epidemiological cohort study, two randomized controlled intervention studies (RCTs), and a qualitative study. A population-based cohort study records the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use of health and social services by parents and their children within the first two years of life, using online questionnaires and telephone interviews. The aim of the two RCTs is to evaluate the efficacy of a focused, dyadic parent-infant psychotherapy (Eltern-Säugling-Kleinkind-Psychotherapie, ESKP) compared to routine treatment in inpatient and outpatient settings. The focus of these RCTs is on the improvement of maternal sensitivity and on mother-child attachment, as well as child development and the reduction of mother-child psychopathological symptoms. The qualitative study intends to reconstruct the perspectives of parents on the assistance system and to explore reasons for underuse. The results are expected to help develop preventive as well as therapeutic strategies in the German health system.

Objective: Within the present study we investigated prevalence rates of psychological symptoms in underage and full-age unaccompanied refugees in youth welfare institutions., Methods: Sociodemographic characteristics and mental health problems in the areas of emotion and behavior were assessed using screening data from both self-reports and caregiver reports of 105 youths., Results: Symptoms of depression (42 %), behavior (35 %) and posttraumatic stress (32 %) were most frequently reported. There were no significant differences in frequencies of psychological symptoms between groups of underage and full-age unaccompanied refugees. Whereas youth reported more problems with peers, caregivers reported more psychological problems of youths in the areas of emotion, behavior, and hyperactivity., Conclusion: The data underline the need for psychological interventions of young unaccompanied refugees., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: There is increasing consideration of a family-focused perspective of the psychosocial consequences of cancer., Objectives: This study examined the psychosocial situation of children and adolescents (11 to 17 years old) of cancer patients assessing their psychological distress and coping over time., Methods: A total of 110 children and adolescents were assessed post-treatment of parents with cancer (t1), 6 (t2) and 12 months (t3) after t1. Participants completed validated questionnaires assessing coping (KidCope) and depressive symptoms (CES). These data were compared with a matched sample from the general population., Results: The children reported using a combination of coping measures. In particular, active coping was perceived as being helpful. In terms of coping, there were only small gender differences and 6 months after completion of treatment of the parents (t2), depressive symptoms of the children were still elevated. Depression diminished over time and was near the level of the comparison group at t3., Conclusion: Children and adolescents are particularly psychologically distressed after cancer treatment of parents. This distress was connected with not helpful coping strategies. The extended adjustment of children/adolescents of cancer patients has to be considered in the clinical and psychosocial care of the families.

We provide a summary of a recently published study on Psychoanalytic Child Therapy (PaCT; Göttken, White, Klein, von Klitzing, 2014) for young children with emotional and affective symptoms. Consisting of approximately 20 psychotherapy sessions, therapists treat families in parent-child, child-alone, parent-alone settings, aiming to uncover and work through a relational theme underlying the symptoms. Thirty families were entered into a wait-list controlled study in an outpatient setting (n = 18 treatment group; n = 12 waitlist) with the aim of assessing the effectiveness of PaCT (Göttken u. von Klitzing, 2014) for 4- to 10-year-olds with anxiety disorders. After treatment, over half of the children of the treatment group no longer met criteria for anxiety disorder while no children of the control group remitted during the wait-list interval. In addition, parent, child and teacher reports showed significant symptom reduction. The pattern of results lend preliminary support to psychodynamic intervention as an effective tool for treating childhood anxiety and affective disorders and call for future randomized controlled trials to provide additional evidence for these promising effects.

We examined the self-reported anxiety in different situations (social anxiety, cognitive fears, fears of injury) and the use of regulation strategies (problem orientation, problem avoidance and seeking social support) in a sample of N=175 primary school children (mean age 8 years 4 months). At time of recruitment we oversampled for children with internalizing symptoms. In addition, mothers rated the overall anxiety of their children. According to their mothers 14.3% of the children showed anxiety symptoms in an abnormal range which is comparable to prevalence rates of children from population samples. 19.4% of the children described themselves as being anxious in an abnormal range. The correlations between different measures of children's self-reported anxieties were low to moderate. We found no significant correlations between mothers' and children's reports. The higher children's self-reported overall and cognitive anxiety, the more frequently they reported seeking social support in frightening situations. Girls reported more frequently pm cognitive fears than boys. Regarding regulation strategies we found that boys reported more problem orientation than girls whereas girls reported more social support seeking than boys. The results are discussed and practical implications are outlined.

Background: Children of parents with cancer are at risk of developing mental disorders. RESULTS from divorce research also reveal that sibling relationships can protect the mental health of children in difficult times., Objective: Does having a sibling help to cope with an oncological disease of a parent and thus act as a protective factor?, Methods: A group of 271 children were examined in a multicenter study. 54 % made use of the offered psychosocial support. Only children (N = 89) and children with siblings (N = 182) were compared with respect to their mental health (Strength and Difficulties Questionnaire, SDQ, parental and self-assessment)., Results: The group comparison between only children and siblings showed no significant differences in the SDQ (assessed by healthy/ill parent). In the self-assessment 2 % of the only children and 9 % of the siblings showed significant results on the SDQ. The group comparison between only children and children with siblings failed to reveal any important differences in mental health. The study indicates that a negative relationship quality (Sibling Relationship Questionnaire, SRQ) is associated with increased problems in the peer group., Conclusions: The existence of a sibling is not per se a protective factor. Only children do not show more signs of emotional stress than children with siblings.

The aim of the present study was to examine the current strain and impairment of children with depressive and anxiety disorders in terms of their development and family environment compared to children without mental disorders. Conclusions for dealing with clinical disorders in preschool are to be derived. Internalizing symptoms/disorders were measured dimensionally with the Strengths and Difficulties Questionnaire (SDQ; multi-informant approach) and categorially with the Preschool Age Psychiatric Assessment (PAPA). The sample consisted of n = 93 children with pure anxiety disorders, n = 20 children with depressive and anxiety disorders, n = 42 children with subclinical symptoms of depression and anxiety disorders, and n = 76 children without mental disorders. We assessed stability of symptoms, as well as agreement between mothers, fathers and kindergarten teachers regarding internalizing symptoms which was higher between mothers and fathers than between parents and kindergarten teachers. In comparison to kindergarten teachers parents reported more internalizing symptoms. Regarding the overall impairment, family adversity, family environment and maternal psychopathology children with depression and additional anxiety disorders showed the highest scores. There were no differences in overall impairment between children with pure anxiety disorders and without mental disorders. Finally, implications for practice are discussed.

Recent work implicates the capacity to mentalize as a predictor of therapeutic success of psychodynamically oriented psychotherapy for adults. However, little, if any, research focuses on similar associations in childhood. In the current study, we investigated the role of maternal reflective functioning (RF) in the treatment of 25 children with clinically diagnosed anxiety disorders and a high level of externalizing comorbidity in an outpatient setting. Before and after treatment of their children with short-term Psychoanalytic Child Therapy (PaCT), we assessed maternal RF using the Parent Development Interview and requested parents to report on symptoms of their 4-10-year-old children using the Child Behavior Checklist (CBCL). RF proved highly stable and showed no significant change from pre- to post-treatment over an average treatment interval of 41 weeks. While remission in internalizing symptoms was unrelated to pretreatment maternal RF, children with high-RF mothers showed significant remission of externalizing comorbidity in comparison to children with low-RF mothers both immediately after treatment as well as at six-month follow-up. These preliminary results support parental RF as a valuable prognostic criterion for successful treatment of externalizing symptoms with PaCT. These findings call for replication in large-scale follow-up studies with children diagnosed with externalizing disorders.

Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

The Berkeley Puppet Interview (BPI) enables us to investigate psychological symptoms of children aged four to eight years under a multi-informant perspective by the means of self and parent report measures. 45 families with one parent suffering from cancer have been examined with regard to internalizing and externalizing symptoms of the children. Results have been compared to two different age-appropriate samples (Swiss preschool study of Basel and German KiGGS study). A small, highly selective sample of twelve children aged four to eight years could have been examined both from the self and parent perspective. Our results show, that four to eight year old children of cancer patients do not differ from other children of the same age in the way they express emotional symptoms in the BPI, but they are judged more emotionally burdened than other children by their parents (SDQ). Self and parent report do not significantly correlate. It seems as if parents in families struck by a cancer disease see their children's emotional symptoms more pronounced than the children themselves do express in the puppet interview. Implications for clinical and research practice will be discussed.

A cancer disease in the family is an emotional crisis with psychological distress for the partner. The study observed the psychological distress of female partners of cancer patients with underage children (HADS-D). The results were compared with the psychological distress of the cancer patient as well as a representative comparison group of women from the general population. Every second female partner showed clinically anxiety scores. On average, the female partners were significantly more anxious than male cancer patients and even more afraid than women from the general population. Regarding the degree of depression, between the partners there were no differences. With regard to mental distress, a medium correlation was found on the pair level. Based on the use of psycho-oncological support the high emotional distress on the female partners is discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: Both, children of somatically ill parents and children of single-mothers are at risk to develop mental health problems and low QoL. This study investigates the effect on children when their single-mothers are exposed to cancer., Methods: In a Cross-sectional design a sample of N=47 children of single-mothers exposed to parental cancer was compared to a sample of N=135 children of mothers (living in partnership) exposed to cancer (multi informant approach)., Results: SDQ and KIDSCREEN showed no differences between children of single-mothers and children of mothers in partnership. In the focused sample older children (11-17 years) showed more conduct problems than younger children (4-10 years). The differences between the types of assessment was significant for conduct problems., Conclusion: Single-parenting and parental cancer as a double burden don't increase the risk for mental health problems and low QoL of children. The results for conduct problems will be discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

The psychological distress of men with underage children, whose female partners have cancer, was examined using the Hospital Anxiety and Depression Scale (HADS). The sample (N=141) was compared with the partners who have cancer and a comparison group of men from the general population (N=154). The male partners of cancer patients were psychological strongly distressed. About half of the partners showed increased scores in anxiety and one third of the partners had a high level of depression. There was a high correlation within the couple. The male partners of cancer patients were significantly more distressed than the comparison group of men with underage children from the general population. It is very important to assess psychosocial support needs of partners of cancer patients and to provide adequate options of possible psychosocial treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Children exposed to parental cancer have an increased risk of mental health problems. However, the parental illness itself and its features do not predict children's psychological adjustment. Parent- and family-related factors are more predictive for children's well-being and the incidence of psychopathological symptoms, respectively. This study focuses on parental ways of coping with illness from both, the ill and healthy parent's perspective, and the relationship with family functioning and children's adjustment. Results show a significant impact of parental coping styles on children's health-related quality of life and psychopathological symptoms and, furthermore, that this relationship is mediated by aspects of family functioning. This study support the importance of family systems approaches. Implications for further studies and practical issues are discussed.

Parents of infants and young children, who have been diagnosed with cancer wish to protect their child from the emotional strains of their illness. They wonder, what the child can understand about the illness and how it is able to process or assimilate the experience of the illness. In fact, infants and young children are particularly sensitive to the degree of emotional burden and the mental state of their parents and will experience varying degrees of insecurity due to even small changes in their relationship with their parents. On the basis of psychological development parameters specific to this age group as well as scientific findings on risk and protection factors an integrated interaction based counseling approach was developed. Within this approach, support for the communication between parent and child in view of the specific strains of their illness, both non-verbal and in the child's early stages of verbal communication, is central. In the present article the counselling concept is described and illustrated by case studies. Application and limits are discussed.

Adolescent mothers and their children received much scientific attention in the past. Some studies also looked at characteristics of the interaction between mother and child. However, little is known about the interaction between children of adolescent mothers and their fathers, as research to date has focussed on paternal psychosocial aspects. The present study examines 19 partners of adolescent mothers in the interaction with their four-months-old infants. Results indicate that fathers of this sample--despite a sufficiently large intuitive repertoire--mainly relate to their infants with tactile stimulation and behaviours that facilitate eye contact. Most fathers succeed in adjusting their behaviour to their child's state. Fathers who are able to adjust their behaviour to their child's state show a larger repertoire of intuitive capacity. The infant's readiness to interact is associated with successful paternal adjustment. We discuss implications for involving fathers in the clinical work with children of adolescent mothers.

A randomized controlled trial (RCT) was conducted to assess the effectiveness of the home visiting program "Pro Kind". A total of 755 primiparae with multiple risk factors were recruited through the end of 2009 in three German federal states (Lower Saxony, Bremen, Saxony) and were randomized into one of two research groups. All participants had access to standard community service; women in the treatment group also received a program of home visitation over a period of 2.5 years. Primary objectives were improvement of maternal health behavior during pregnancy and birth of a healthy child. Long-term objectives are better outcomes of child health and development. To date, significant group differences in the primary objective variables are not detectable. Interim analyses at the ages of 6 and 12 months showed a tendency for a positive treatment effect on cognitive development. Methodological and practical limitations are critically discussed.

Adolescent pregnancy usually leads to notification and involvement of a broad array of sources of support. It is then important to assess risk factors and resources with regard unique to the young woman, as well as to protect the (as yet unborn) child. However, due to the complexity of such cases, helpers often lose sight of other family members whose lives undergo a radical change, such as, for example, the child's father. What action should be taken in order to generate and promote previously inadequate parenting capacities, for example with the assistance of institutions? Which relationships within the family, but also with persons outside the family, require consideration, protection and support? By means of a case study, this paper aims to demonstrate and discuss difficulties and possibilities connected with assisting a very young family.

The Basel clinic for parents with infants and toddlers is a special interdisciplinary service. The authors present the concept and practice of treatment. Further they show the results of documentation and evaluation. In most cases regulation and sleeping disorders are treated. Temperament ratings made by the mothers of the treated children exhibit more difficult behaviour in comparison to a normal sample. These ratings had no correlation with the mothers' depression scores which rank much higher than the control group. The outcome ratings by the psychotherapists show that despite the short duration of the treatment and severe cases therapeutical success could be achieved. This outlines the importance of such specialized services for early infant crying and other disturbances of the early childhood.

In the field of developmental research, there is a long tradition of using story completion tasks with play figures for preschoool children. In contrast, story completion tasks are not often used in the clinical assessments of young children. In this paper we will present the MacArthur Story Stem Battery (MSSB), a typical story completion task, which is useful in clinical as well as in research settings. We will give two clinical case examples in order to demonstrate how compelling this method is for young children because they can continue the stories with the help of play figures. In this way the instrument can help to open a window into the inner world of young children.

The early development of the infant and of the infant-parent relationship contains complex processes. These processes are built on the relational competency of the infant and of the parents and are characterized by fast changes and affective integration. The developmental process can easily be disturbed. Early disturbances can have severe consequences for further development. The process of early diagnostic in infant psychiatry faces many difficulties: the fast changes during early development, the strong connection between individual and interactional processes, and the uncertainty of differentiating between normality and pathology during this early age. The operationalized psychodynamic diagnostic can better deal with this developmental phase than traditional classification systems, which only address the individual phenomenology, because in the OPD there is a special axis for the relational level. Modern theories and research results on early development and on the early parent-infant triad offer a favorable background for such a classification of relations.

Operationalization of relations is tried out following an interpersonal circular model (SASB) using observation and description of behavior in dyadic and triadic relationship configurations. On a vertical and on a horizontal axis the amount of loving kindness versus hostile aggressivity and of independence versus control is determined. Different dyadic and triadic relationship configurations (e.g. child to mother or researcher to child) and also the emotional resonance of the investigating person will be rated according to anamnestic data, observed and videotaped sequences of interaction, play episodes or symbolic relationships in projective tests. Such ratings can be performed in a module like form and will be used not only in clinical practice but also in settings of scientific research. The minimal standard for a clinical examination consists of the evaluation of the child with his parents.

The development of a child or a adolescent and it's (psycho-)pathological manifestations call often for a multidisciplinary approach. The specialist for child and adolescent psychiatry has in such situations a coordinating and integrating function with direct involvement. His goal is therefore--be it during diagnostic or therapeutic procedures--to guarantee an attunement of biological, medical, psychological, psychiatric, pedagogical and social perspectives, to favor reflective conceptualisation and the cooperation of all the involved persons and institutions.

In an prospective longitudinal study of family development, 39 healthy couples were examined by the Giessen-Test 1-3 months before and 1 month and 1 year after the birth of their first child. The self-assessment and the assessment of the other spouse were recorded from both partners. By this procedure information relating to intrapsychic and interpersonal dynamics of the couple was obtained. It was evident, that during the transition from the preto the postnatal period the assessments at the personal as well as at the couples' level remained very stable. Our sample showed considerable differences compared to a representative couple sample. These differences decreased by the time of the third survey one year after the birth of the child. Although pregnancy and the birth of the first child seem to cause specific, but transitory changes in the parents self-images and in the dynamics of their relationship, our results support the notion of a high stability during the transition to parenthood with regard to the self-concepts of mother and father and especially to the structure of the parental dyad.

Objective: In a longitudinal prospective study on 38 couples and their first child, we examined the influence of prenatally assessed psychological factors of the parents on somatic and psychic aspects of birth, the quality of the newly established parent-child relationship and the early development of the baby., Methods: Half-standardized psychoanalytic interviews with the couple (pre- and postnatally conducted, video-recorded), the Giessen test for couples, an evaluation of the parents' birth narratives and a parent questionnaire about functional symptoms of the baby were used., Results: We found a high continuity between the pre- and the postnatal measurements of the partnership and the emotional experiences of the parents. Somatic complications of the birth event were not correlated with prenatally assessed psychological factors. But there exists a highly significant correlation between the mental representations and the relationships of the parents and the emotional experiences of birth, the early relationship between the parents and their baby and manifestations of functional disorders of the newborn., Conclusions: Relevant psychological and psychosocial aspects should be included in the medical care of pregnant women. One should listen to the imaginations and expectations of the parents about the future parentship, including ambivalent feelings. The father should also be seen for psychological assessment.

The indications for and effectiveness of intensive psychoanalytic psychotherapy of children with early emotional deprivation is discussed based on the case of an 8-year-old boy. Not only is it important to evaluate the symptomatology but also to identify well-functioning "ego islands", which serve as the point of departure for all therapeutic activities. A prerequisite for this type of treatment is a supportive, therapeutic educational environment. Psychoanalytic work seems to be particularly effective in an inpatient psychiatric setting, but it should be continued after the child has been discharged.

Adolescence is a phase of human development which is marked by a high vulnerability due to the ongoing psycho-physiological transformations. The regulation of the self-esteem is especially in danger in youngsters who went into adolescence with a marked burden of conflicts or who lived in families with disturbed intrafamilial dynamics. To be present as a partner and not to find the solutions for the adolescents' conflicts, to accept their questioning of what is established and to recognize their movements of reconciliation are the quite complex demands put on to the world of the adults. Adolescents urge us to a review of our own adolescence, to a balancing of hate and love, openness and rigidity, and to dialectic movements between disintegration and reintegration as well as between the generations. Any help, be it on the physical, the social or the psychic level, should be directed toward a restitution of the intrapsychic, intrafamilial or intergenerational balance; sociocultural factors have also always to be respected. The helpers--especially in a culture with rapid change--are often confronted with their own adolescence, which took place a generation before and mostly under totally different conditions.

The impact of psychological factors of pregnancy on the development of the child are discussed in context with first results of a research project. Furthermore some psychological psychological aspects of the course of pregnancy are shown. As a method of prevention we suggest a special form of psychosocial care during pregnancy, which gives adequate room for rejected parts of the relationship and especially for the experience of rage and fear, which can then be integrated.