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Children who have experienced complex trauma in early life often fail to develop robust ego functions, such as frustration tolerance and emotion regulation capacities. Often, impairments in these capacities persistently characterise these children’s social and emotional development and, as such, prove extremely challenging to the adults who care for them. This paper aims to illustrate different ways in which therapists working with these children in psychodynamic therapy have to find a precarious balance between the need to support developing ego functions, and opportunities to conduct more exploratory work. This balance resembles walking a tightrope. We illustrate this ‘balancing act’ with case excerpts from the treatment of nine-year-old Laura, growing up in foster care after a range of complex traumatic experiences. This case study seeks to illustrate that psychotherapy with children who have a history of complex trauma may be most conducive to developmental recovery, if the therapist is able and willing to almost unabatingly walk the tightrope between ego-supportive and exploratory work with the child.

BACKGROUND The peripartum period, defined as the period from the beginning of the gestation until one year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one’s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy induced hypertension (PIH). OBJECTIVE The aim of this study is to explore and describe changes in intrapersonal factors in patients at risk for PIH. METHODS An explorative design is used in which three questionnaires were sent by email to 110 participants the day following inclusion in the Pregnancy Remote Monitoring (PREMOM) program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the PREMOM project (mostly at 14 weeks of gestation), and after 32 weeks of gestational age (GA). The Generalized Anxiety Disorder scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and depression; an adaptation of the Pain Catastrophizing Scale (PCS) was used to measure trait pain catastrophizing. RESULTS Scores were significantly higher at 32 weeks of GA, compared to the moment of inclusion (GAD-7: 7 (4-11) vs. 5 (3-8), P = .01; and PHQ-9: 6 (4-10) vs. 4 (2-7), P < .01). The subscale scores of the PCS were all lower at 32 weeks of GA compared with 14 weeks of GA (Rumination: 4 (1 – 6) vs. 5 (2 – 9.5), P = .11; Magnification: 3 (1 – 5.5) vs. 4 (3 – 7), P = .04; and Helplessnes: 5 (2-9) vs. 6 (3.5 – 12), p = .06). The proportion of women with a risk for depression (GAD-7 > 10) was 13.3% at inclusion and had increased to 35.6% at 32 weeks of GA. CONCLUSIONS This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA, compared to the moment of inclusion. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH to manage feelings of stress and anxiety. CLINICALTRIAL The study was also registered at clinicaltrails.gov (NCT03246737)

Background The lifetime risk of suicide is significantly higher in patients with schizophrenia than in the general population. It has been suggested that insight is an important risk factor for suicidality in schizophrenia, but only in the presence of feelings of hopelessness and demoralization more generally. Methods This study set out to investigate these assumptions in a sample of patients diagnosed with schizophrenia (n = 81) with the Structured Clinical Interview for DSM-IV Axis I. We hypothesized that there would be a positive association between insight in schizophrenia, measured by the Insight Scale for Psychosis, and suicidality among these patients, measured by the Beck Scale for Suicide Ideation. Furthermore, we expected demoralization, measured by the Demoralization Scale, to mediate the association between insight and suicidality. Results With regard to the association between insight and suicidality, only the dimension awareness of illness was significantly positively associated with suicidality (r = .34, p ≤ .01**). Demoralization fully mediated the relationship between awareness of illness and suicidality (Sobel test z = 1.93, p Limitations This was a cross-sectional study in a relatively small sample, based on self-report questionnaires only. Conclusions This study emphasizes the importance of recognizing and treating demoralization features in schizophrenia.

In dit artikel bepleiten de auteurs de waarde van Narratieve Story Stem Technieken (NSST) voor het instrumentarium van de psychotherapeut. Zij beschrijven en illustreren aan de hand van vignetten eerst wat de techniek inhoudt en hoe deze, door de aanspraak op zowel verbale als non-verbale registers van het kind, bij uitstek een inkijk biedt op de belevingswereld van kinderen. Vervolgens bieden de auteurs de psychotherapeut handvatten omtrent het kader waarbinnen een NSST zinvol aangewend kan worden, evenals een model om naar het verkregen narratief materiaal te kijken. Binnen een dergelijk perspectief beargumenteren zij tot slot hoe deze methodiek – op het kruispunt van het diagnostische en psychotherapeutische proces – een hulpmiddel kan zijn om met kinderen aan de slag te gaan met cruciale thema’s die ze in hun leven ontmoeten, en met de manier waarop ze deze ervaren en beleven, en in relatie brengen.

The capacity for reflective functioning (RF) or mentalizing of adoptive parents is hypothesized to play an important role in fostering socio-emotional development in adopted children. This paper reports on the development and preliminary validation of the Adoption Expectations Interview (AEI), a semi-structured interview to assess RF in prospective adoptive parents. The AEI was developed based on the Pregnancy Interview, Parent Development Interview, and Working Model of the Child Interview, three interviews that have been used to assess RF in biological parents, to capture RF before child arrival in prospective adoptive parents. In a sample of 96 prospective adoptive parents, the Reflective Functioning Scale, as applied to the AEI (AEI-RFS) showed good reliability, with strong correlations between the different demand items, high internal consistency, and good to excellent inter-rater reliability. A principal component analysis yielded one component, suggesting that the items measured a unidimensional factor. Preliminary evidence for the construct validity of the AEIRFS was demonstrated by significant associations between the AEI-RFS and well-validated measures of mentalizing, attachment dimensions, and interpersonal functioning. ispartof: Plos One vol:16 issue:1 pages:1-16 ispartof: location:United States status: published

BACKGROUND Pregnancy-induced hypertension (PIH) is associated with high levels of morbidity and mortality in mothers, fetuses, and newborns. New technologies, such as remote monitoring (RM), were introduced in 2015 into the care of patients at risk of PIH in Ziekenhuis Oost-Limburg (Genk, Belgium) to improve both maternal and neonatal outcomes. In developing new strategies for obstetric care in pregnant women, including RM, it is important to understand the psychosocial characteristics associated with adherence to RM to optimize care. OBJECTIVE The aim of this study was to explore the role of patients’ psychosocial characteristics (severity of depression or anxiety, cognitive factors, attachment styles, and personality traits) in their adherence to RM. METHODS Questionnaires were sent by email to 108 mothers the day after they entered an RM program for pregnant women at risk of PIH. The Generalized Anxiety Disorder Assessment-7 and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and the severity of depression, respectively; an adaptation of the Pain Catastrophizing Scale was used to assess cognitive factors; and attachment and personality were measured with the Experiences in Close Relationships-Revised Scale, the Depressive Experiences Questionnaire, and the Multidimensional Perfectionism Scale, respectively. RESULTS The moderate adherence group showed significantly higher levels of anxiety and depression, negative cognitions, and insecure attachment styles, especially compared with the over adherence group. The low adherence group scored significantly higher than the other groups on other-oriented perfectionism. There were no significant differences between the good and over adherence groups. Single linear regression showed that the answers on the PHQ-9 and ECR-R questionnaires were significantly related to the adherence rate. CONCLUSIONS This study demonstrates the relationships between adherence to RM and patient characteristics in women at risk of PIH. Alertness toward the group of women who show less than optimal adherence is essential. These findings call for further research on the management of PIH and the importance of individual tailoring of RM in this patient group. CLINICALTRIAL ClinicalTrials.gov NCT03509272; https://clinicaltrials.gov/ct2/show/NCT03509272

This study aimed to investigate associations among the parental personality dimensions of self-criticism and dependency, parental relationship stress, and child development from a stress generation perspective. Data from 79 first-time parents and their children aged 8–13 months, who were followed up in a two-wave, 1-year longitudinal study, were analysed within a multilevel structural equation modelling framework in order to account for within-couple interdependence. Results revealed that, as hypothesised, both parental self-criticism and dependency were associated with increased levels of relationship stress, which in turn were negatively related to child development. Hence, parental personality features in combination with relationship stress may be an important target in couple and family-based interventions. Implications for further research on family dynamics and interventions are discussed. Copyright © 2015 John Wiley & Sons, Ltd.

There is increasing research evidence supporting the assumption that transactional associations between parent and child characteristics need to be taken into account in order to more fully understand the dynamics within emergent parent-child relationships. This study focuses on transactional associations among parental self-criticism and dependency, parenting stress, child temperament, and emotional availability. Data from a two-wave, 1-year longitudinal study in a community sample of 79 first-time parents and their children, followed-up from infancy to toddlerhood, were analyzed within a multilevel moderated mediation framework. Results showed that parental self-criticism and dependency assessed in infancy predicted emotional availability in toddlerhood. Stress generation processes associated with self-criticism and dependency played a central role in these associations. In addition, findings suggested that child extraversion and orienting/regulation capacities may buffer against the negative impact of ...

This prospective longitudinal study investigated the role of the personality dimensions of dependency and self-criticism in the course of depressive symptoms in a sample of inpatient severely postpartum depressed mothers (n = 55). Depressive symptoms and personality were measured during hospitalization and on average 3 1/2 years later. In line with previous research, a considerable subgroup of mothers (39%) reported moderate to severe symptoms of depression at time 2. In addition, although these mothers did not exhibit more depressive episodes during follow-up period compared with mothers with a less chronic course of depression, their depressive episodes were considerably longer, and they had higher levels of severity of depression as well as of dependency and self-criticism at Time 1. Finally, self-criticism, but not dependency, assessed at Time 1, predicted both depression diagnosis and levels of depression at follow-up, supporting a vulnerability model positing that self-criticism confers vulnerability for depression over time.