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Objective: Attachment style and social support networks (SSN) are associated with suicide ideation (SI) and suicide attempt (SA). How these two factors interact is important to understanding the mechanisms of risk for suicidal behaviors and identifying interventions., Method: Using the Army Study to Assess Risk and Resilience in Servicemembers New Soldier Study ( N  = 38,507 soldiers), we examined how three attachment styles (preoccupied, fearful, and secure) and SSN (smaller vs larger) were associated with lifetime SI, SA, and SA among soldiers with SI. The interaction of each attachment style by SSN was examined., Results: All three attachment styles were associated with SI and SA in the total sample (for SA: preoccupied OR = 2.82, fearful OR = 2.84, and secure OR = 0.76). Preoccupied and fearful attachment were associated with SA among suicide ideators. Smaller SSN was associated with a higher risk for all three outcomes (range of ORs = 1.23-1.52). The association of SSN with SI and with SA among suicide ideators was significantly modified by the presence or absence of preoccupied attachment style. Among soldiers without preoccupied attachment, larger SSN was associated with lower risk of SI. Among suicide ideators with preoccupied attachment, a larger SSN was associated with lower risk of SA., Conclusion: This study highlights the need for increased understanding of the role of attachment style and social networks in suicide risk, in particular preoccupied attachment among soldiers with SI. A critical next step is to explore these relationships prospectively to guide intervention development.

Objective: The present study aimed at investigating whether gay fathers' coherence of mind within the Adult Attachment Interview (AAI) moderated the influence of parental disclosure on children's exploration of their surrogacy origins during middle childhood and early adolescence., Background: Once children of gay fathers are disclosed to about their surrogacy conception, they may start exploring the meanings and implications of their conception. Very little is known about the factors that may enhance such exploration in gay father families., Method: A home-visit study was conducted with 60 White, cisgender, gay fathers and their 30 children born through gestational surrogacy, all residing in Italy and with medium to high socioeconomic status. At time 1, when children were aged 6-12 years ( M  = 8.31, SD = 1.68), fathers were rated for AAI coherence of mind and interviewed about their disclosure of the surrogacy origins to their child. At time 2, approximately 18 months later ( M  = 9.87, SD = 1.69), children were interviewed about their exploration of their surrogacy origins., Results: In the context of more information disclosed about the child conception, only children whose fathers showed greater AAI coherence of mind explored their surrogacy origins in more depth., Conclusion: Gay fathers' ability to show an internally consistent, but not emotionally overwrought, state of mind regarding their own attachment experiences impacted the extent to which their children felt safe and legitimated in sharing their curiosity about their conception.

Introduction: Prior research has identified associations between pregnancy intendedness and maternal-foetal bonding, but no studies have examined the potential mediation of pregnancy happiness on the development of the maternal-infant relationship., Methods: In 2017-2018, a clinic-based pregnancy cohort of 177 low-income and racially diverse women in a South-Central U.S. state participated in a study examining their pregnancy intentions, attitudes and behaviours. Pregnancy intentions and happiness and demographic characteristics were measured during the first trimester assessment, and maternal-foetal bonding was measured with the Prenatal Attachment Inventory (PAI) during the second trimester. Structural equation modelling was used to examine the associations between intendedness, happiness and bonding., Results: Findings indicate positive associations between intended pregnancies and pregnancy happiness and pregnancy happiness to bonding. The direct effect from intended pregnancy to maternal-foetal bonding was not significant, providing evidence for full mediation. We did not find any associations between pregnancies that were unintended or ambivalent with pregnancy happiness or maternal-foetal bonding., Conclusions: Pregnancy happiness provides one potential explanation for the association between intended pregnancies and maternal-foetal bonding. These findings have implications for research and practice, as inquiring about mothers' pregnancy attitudes (e.g. how happy they are about their pregnancy) may be more important for maternal psychological health outcomes, such as the maternal-child relationship, than whether or not their pregnancies were intended.

Objective: This study aimed to explore factors influencing functioning in psychiatric outpatients, both separately and in combination. The primary objectives were to determine predictors of functioning, assess their significance in a combined analysis, and quantify their collective predictive power., Method: A sample of 137 psychiatric outpatients diagnosed with bipolar disorder, borderline personality disorder, or attention deficit hyperactivity disorder (ADHD) participated in this cross-sectional study, undergoing semi-structured diagnostic interviews for psychiatric and personality disorders. Participants also completed assessments of current functioning, personality traits (temperament and character), attachment style, and childhood trauma. Linear regression models were employed to analyse the relationships between these factors and level of functioning., Results: The majority of temperament and character traits and attachment dimensions, as well as having a personality disorder, predicted impaired functioning, but comorbidity and childhood trauma did not. When all variables were taken into account in a multiple regression analysis, only the temperament and character traits Harm Avoidance and Self-directedness remained significantly predictive ( p  = .006 and .003, respectively). These two factors explain about one-third of the variance., Conclusions: Personality traits-more specifically, the temperament trait Harm Avoidance and the character trait Self-directedness-are strong predictors of functioning among psychiatric outpatients. Interestingly, when accounting for these factors, traditionally associated variables, such as attachment, comorbidity, and childhood trauma, lost their significance as predictors. These findings underscore the pivotal role of specific personality traits in understanding and predicting the functioning of psychiatric patients.

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Background: Whereas the maternal 'blues' has been widely researched, comparatively less is known about the "highs" following childbirth, and the relation between mothers and fathers' mood in this early period. We aimed to investigate the association between maternal 'blues' and 'highs' with paternal postpartum mood (here described as 'lows' and 'highs') in the early postpartum and their associations with the quality of child bonding., Methods: Women and their cohabitating male partners, fathers of the index child (N = 98 couples), attending an obstetric hospital unit completed questionnaires on mood, bonding and socio-demographics between the 3rd and the 5th postpartum day. We used generalised estimating equations to analyse the data., Results: The 'blues' scores were higher in mothers, whereas 'highs' and bonding were higher in fathers. Maternal 'blues' were significantly correlated with paternal 'lows' ( r s  = .23, p < .05) and maternal 'highs' were also associated with paternal 'highs' ( r s  = .22, p  < .05). Parental 'highs' were significantly associated with better baby bonding (B = .13, p = .02)., Conclusions: Our study demonstrates moderate associations between both 'blues/lows' and 'highs' in mothers and fathers shortly after the birth of the child. Associations between mood, particularly 'highs', and bonding were similar for mothers and fathers. Greater consideration of 'blues/lows' and 'highs' in both parents is needed to promote adjustment in the postpartum period.

Background: Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women's psychological health in pregnancy subsequent to loss., Objective: This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss., Method: Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress., Results: Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious)., Conclusions: Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy - and in grief.

Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive ( r  = -.39, p  = .018), but not negative ( r  = .06, p  = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [-0.021, -0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [-0.397, -0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness ( p  > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.

Background: The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase., Methods: Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4., Results: Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R 2 =0.12)., Discussion: The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.

Purpose: Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking., Methods: The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant., Results: The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model., Conclusion: Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.

Objectives: To determine the effect of self-evaluation of foetal movement and position tracking on prenatal attachment and distress., Methods: The study was a randomised controlled study . The study included women who came to the Kahramanmaraş Maternity and Children's Hospital for prenatal examination. The data were collected using a questionnaire form, the prenatal attachment inventory (PAI), and the Tilburg pregnancy distress scale (TPDS). The pregnant women in the intervention group were trained to count the foetal movements and track the position of the foetus. Data were evaluated using paired samples t -test, independent samples t -test, chi-square test, Pearson correlation analysis, and linear regression analysis. This trial was registered at ClinicalTrials.gov under the process NCT05313113., Results: Although the mean PAI pre-test scores were similar in the intervention and control groups (t = -0.811; p = 0.420), a significant difference was observed in the mean post-test scores between the two groups (t = 6.404; p < 0.001). The mean TPDS pre-test scores were similar in both groups (t = 0.933; p = 0.453), but a significant difference was observed in the mean post-test scores (t = -3.345; p < 0.001)., Conclusion: Thus, self-evaluation of foetal movement and foetal position tracking increased the prenatal attachment.

Objective: This study examined the intra- and inter-rater reliability of the Recorded Interaction Task (RIT); a novel tool to assess mother-infant bonding via observational methods., Background: Mother-infant bonding describes the reciprocal early emotional connection between mother and infant. Whilst various tools exist to assess mother-infant bonding, many incorrectly confuse this construct with mother-infant attachment. Further, available tools are limited to those that employ self-report methods, thus may reflect perceived behaviour, rather than actual behaviour. The RIT is a novel tool for observational assessment of mother-infant bonding. A standard interaction between mother and infant is recorded, and later assessed against specified bonding-related behaviours. Before its use in research, reliability testing must be undertaken to ensure the RIT may be used consistently., Methods: The RIT was administered to 15 mother-infant dyads. Participant recordings were assessed by three trained raters at two time points, using the RIT observation scoring sheet. Intra-rater reliability was determined by comparing scores at each time point for each rater. Inter-rater reliability was determined by assessing reliability of scores at the first time point., Results: Strong intra-rater reliability (ICC >0.86) and fair inter-rater reliability (ICC = 0.55) were observed., Conclusion: The current findings support the RIT's potential to reliably assess mother-infant bonding.

Purpose: Experiencing spinal cord injury (SCI) can be life-changing for individuals and their families. Previous reviews have focused on coping and psychological adjustment, sexual function and sexuality, or factors facilitating or impeding interpersonal relationships after SCI. However, there is a very little synthesis of research focusing on changes to adult attachment and emotional intimacy post-SCI. This review aims to examine the mechanisms of change in adult attachment and intimacy in romantic relationships following SCI., Materials and Methods: Four online databases (Psycinfo, Medline, CINAHL, and Scopus) were searched for qualitative papers concerning romantic relationships, attachments, and intimacy post-SCI. Sixteen of the 692 papers met the inclusion criteria. These were quality assessed and analysed using meta-ethnography., Results: Three main themes emerged from the analysis: (a) strengthening and maintaining adult attachment; (b) changes in roles; and (c) changing views of intimacy., Conclusion: Many couples face significant changes to adult attachment and intimacy following SCI. Systematic ethnographic analysis of their negotiations enabled the identification of underlying relational processes and adaptation strategies associated with changes to inter-dependence, communication, role revision, and re-definition of intimacy. The findings indicate that healthcare providers should assess and respond to challenges faced by couples post-SCI using evidence consistent with adult attachment theory.

Objective: This study aimed to identify and inform recommendation of self-report and interview-based instruments that are feasible, reliable and valid to evaluate the quality of the maternal-fetal relationship (MFR)., Background: Several constructs predicting parent-infant interaction and later infant adjustment are used to assess mothers' thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation, and fetal attachment. As yet, there is no existing review comparing the quality and accessibility of instruments across each of these constructs., Methods: A systematic literature review was undertaken to synthesise psychometric information on measures reporting on the MFR. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD checklist was used to assess study quality., Results:  Of 669 studies identified, 28 met inclusion criteria. Thirteen different instruments were identified for evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use., Conclusion: Suggestions for research and clinical practice include further evaluation of the psychometric properties of tools, particularly for self-report measures of reflective functioning, use of interviews to scaffold reflexivity, and development of clinical policies and procedures to clarify care pathways for expectant mothers needing further support.

Introduction: Despite the emerging body of literature on mother-to-infant bonding and the associated variables, there are various definitions of bonding construct. Also, there is a lack of a comprehensive conceptual framework of antecedents and consequences of bonding that would guide empirical work., Objective: Aim of the study was to provide a systematic review and synthesis of concept analysis studies on maternal-foetal, mother-infant, or father-infant bonding., Method: A systematic search was performed in PubMed, EBSCOHost (including PsycINFO), ProQuest, and CINAHL. In addition, a hand search was conducted. Papers were eligible for inclusion if they conducted concept analyses on mother or father to foetus/infant bonding. A qualitative meta-synthesis was applied to synthesise the findings., Results: Eight papers on concept analyses were eligible for inclusion. In meta-synthesis, six aspects of parent-to-(unborn) child bonding emerged, including direction, domain, process, timing, endurance, and parental gender. Defining attributes are (i) a close relationship, (ii) filled with positive parental affection, (iii) manifested during pregnancy as monitoring foetal development and behaviour and after childbirth in proximity and interaction. Antecedents, affecting factors, and consequences of the parent-child bonding have been summarised., Conclusion: Parent-infant bonding refers to an emotional, behavioural, cognitive, and neurobiological tie of the parent to the (unborn) child, as a process from intention to have a child throughout infancy. This is a parental-driven process which can continue to evolve throughout child's and parent's life, characterised as enduring, committed, and engaged. Based on meta-synthesis, a conceptual structure of parent-infant bonding has been provided, which needs further empirical testing.

Background: Effective and appropriate care and treatment for children in order to decrease the psychosocial problems that arose after experiencing child abuse and neglect (CAN) is of vital importance, given the severity of symptomatology that may develop. Objective: The purpose of the present study was to examine whether attachment style and core cluster Posttraumatic Stress Disorder symptoms acted as moderators for treatment outcomes of a new integrative treatment model for trauma and attachment. In this treatment model, family therapy is combined with EMDR and obstacles for trauma processing are tackled first. Method: we included children, ages 6-12 years, with a history of CAN, who did not respond to evidence-based trauma treatment. Target treatment outcomes were problems in attachment, posttraumatic stress symptoms, behaviour, and emotion regulation. We conducted a multiple-baseline ABC Single-Case Experimental Design (SCED). We categorized 12 participants into four groups of attachment style and core cluster PTSD symptoms: (1) non-disorganized & re-experiencing; (2) non-disorganized & avoidance/hyperarousal; (3) disorganized & re-experiencing; & (4) disorganized & avoidance/hyperarousal. We compared the four groups with each other and across time, and the interaction between groups and effect over time. We conducted non-parametric permutation tests and estimated q -values for false discovery rate control. Results: Children with a disorganized attachment style had more severe symptomatology in general, except for posttraumatic stress symptoms. The treatment appeared more effective in targeting and successfully treating children with a non-disorganized attachment style, and specifically children with a non-disorganized attachment style and re-experiencing as core cluster PTSD symptoms. Conclusion: Our study underlines the complexity of treating children who developed a complicated combination of symptomatology after CAN and calls for the continuous development of innovative interventions.

Background: Upon arrival in the host country, refugees and asylum seekers (RAS) experience a range of post-migration living difficulties (PMLD), which are often linked to psychological symptoms such as post-traumatic stress (PTS). Initial research suggests that attachment insecurity partly explains the association between PMLD and psychological symptoms in RAS. However, the mechanisms through which attachment insecurity may act as a mediator are not well understood, though emotion dysregulation is one of the potential candidates. Objectives: This study investigated (1) whether attachment insecurity (i.e. anxiety and avoidance) mediate the association between PMLD and PTS, and (2) whether this mediation model can be extended to emotion dysregulation. Methods: 134 treatment-seeking RAS living in Switzerland completed questionnaires assessing PMLD, attachment insecurity, emotion dysregulation, and PTS. Two models were tested: (1) a parallel mediation analysis with attachment anxiety and avoidance as mediators, and (2) a serial mediation analysis with attachment anxiety as the first and emotion dysregulation as the second mediator. Results: First, PMLD was indirectly associated with PTS through attachment anxiety but not avoidance. Second, the association between PMLD and PTS was further explained by a pathway through attachment anxiety and emotion dysregulation. Conclusions: Although this study is limited by its cross-sectional design, we identified attachment anxiety and emotion dysregulation as potential mechanisms explaining how PMLD affects symptoms of PTS in RAS. Systematically assessing attachment style and addressing emotion regulation may therefore help improve treatment of refugee and asylum-seeking patients.

Background: Research on post-disaster mental health shows that people have unique resources to undergo positive changes like posttraumatic growth (PTG) after facing adversities. Objective: This study aimed to investigate the relationship between attachment styles and PTG in COVID-19 survivors, with a focus on exploring the mediating role of coping strategies. Through examining these dynamics, the study seeks to contribute to deeper understanding of the psychological processes underlying growth in individuals recovering from the pandemic. Method: A total of 210 participants were enrolled from the hospitals in Tabriz, Iran, in January 2021, and completed self-report questionnaires. PTG, attachment styles, and coping strategies were assessed using Posttraumatic Growth Inventory (PTGI), Revised Adult Attachment Scale (RAAS), and Coping Inventory for Stressful Situations (CISS). Structural equation modelling (SEM) was used to assess the mediation models. Results: The direct effects of secure (β = 0.22, p  < .001), and ambivalent-anxious attachment (β = -0.22, p  < .001) on PTG were significant. Also, task-oriented coping significantly predicted PTG (β = .60, p  < .001). The direct path from secure (β = 0.16, p  < .05) and ambivalent-anxious attachment (β = -0.38, p  < .001) to task-oriented coping was significant, as was direct impact of secure (β = -0.18, p  < .01) and ambivalent-anxious attachment (β = 0.37, p  < .001) to emotion-oriented coping. The association between secure attachment and PTG is significantly mediated by task-oriented coping (β = 0.1, (95% CI: 0.01-0.18)). Also, task-oriented coping was a significant negative mediator between ambivalent-anxious attachment and PTG (β = -0.24, (95% CI: -0.33 - -0.15)). Conclusions: Results support the mediating role of coping strategies in the relationship between attachment styles and PTG. It emphasizes the importance of interventions for improving coping resources in individuals with life-threatening illnesses, focusing on improving problem-focused coping and reducing maladaptive strategies.

Background: The alarming prevalence of teen mothers' exposure to perinatal intimate partner violence (IPV, 8.3-67%) and attachment disorders (ADs) among their children is a global concern, especially in sub-Saharan Africa with high teenage pregnancy rates. This study, therefore, aimed to examine the link between teen IPV and AD in their offspring. We sought also to explore the mediating roles of postpartum depression symptoms, maternal sensitivity, parenting stress, and perceived social support in the relationship between perinatal IPV and children's ADs. Method: This cross-sectional study selected a random sample of 309 teen mothers from Nyanza district. This sample size was determined using Yamane's formula, with random sampling. Various instruments were used for data collection, including questionnaires on intimate partner violence, social support, maternal sensitivity, postpartum depression symptoms and parenting stress and early trauma-related disorders. The data was analysed using SPSS, with mediation analyses performed using the PROCESS macro (version 4.1). Results: IPV was found to be significantly associated with attachment disorders. Simple mediation models showed that parenting stress completely mediated these relationships, while postpartum depression, perceived social support, and maternal sensitivity partially mediated the relationship between IPV and children's ADs. In parallel mediation model, the combined roles of all mediators fully mediated the associations between IPV and ADs. Conclusion: These findings offer valuable insights in designing or strengthening the appropriate interventions to prevent and mitigate the perinatal intimate partner violence and its detrimental impact on children's attachment disorders. Combating intimate partner violence in post-conflict situations is challenging in teen mothers, however, our results suggest that efforts to address maternal mental health and parenting practices may protect children from attachment disorders.

Freud's publication of The Ego and the Id sparked a diverging set of psychoanalytic models - ego psychology, structural conflict theory, Kleinianism, object relations theories, Lacanianism, etc. - each of which attempted to deal with the clinical limitations of his first topography in regard to unconscious guilt, negative therapeutic reactions and primitive character organizations. This paper attempts to look back on these developments from the perspective of contemporary, post-Freudian psychoanalytic theories.

The present paper attempts to define "time" in clinical-psychoanalytic terms. After brief remarks on time, on timelessness, on times, and on Nachträglichkeit, the treatment of a breakdown state is described. The breakdown from the earliest period of the patient's life first manifested itself in an autistoid perversion. It finally occurred in the transference in a presence moment and could become conceivable as a thought for the patient in a turbulent process. Here two time dimensions became apparent: The timeless state of breakdown unfolds in the treatment in such a way that preforms of temporal experiences precede the event of time in presence moment, from which then the times past, future and present can become. In the presence moment and its sublation in the presentational symbol, not only did the breakdown become psychically real, but time, times, and space emerged, albeit dynamically very differently in the analyst and the analysand: for the analyst, past and place emerged with the presentational symbol, while for the patient, temporal location did not occur in the time "past," but in the place where the perversion was practiced. Past is the place where it happened. For the discovery and use of times, it is necessary for the patient to distinguish the absent object from the retraumatizing one. Then the present absent object becomes the object that was there in the past understanding and will be there in the future. The assurance of this figure of thought is obtained in the use of the object.

This paper examines two major issues related to the concept of identity. The first of these concerns the place of this concept in psychoanalytic theory and practice, particularly taking note of its limited presence in the psychoanalytic literature of the British School of psychoanalysis. My argument is that the concept and phenomena of identification has been preferred to that of identity in the discourse of British Object Relations and considers why that might be the case. The second issue concerns the salience of the concept of identity in contemporary political and cultural debate, as this has come to denote differences of a socially-constructed kind such as those of race, gender, ethnicity, and religion. In this context, the idea of identity has become an important point of reference in much recent psychoanalytic thinking. The significance of this development will be considered in its relevance for psychoanalytic and wider social practices.

Karl Abraham, one of Melanie Klein's analysts, undoubtedly influenced Klein in her clinical and theoretical thinking. Abraham was arguably the first analyst to focus on character, as well as the relationship between bodily experience and object relationships-central to the concept of projective identification. His writing on mourning (like Klein's, intensely personal) described identificatory processes with the lost object. In a lesser known essay, Abraham applied some of these ideas to the Jewish Day of Atonement, Yom Kippur. Through examination of this lesser known paper, this article describes how Abraham initiated ideas around the concept of projective identification, and then extends Abraham's early ideas to a more contemporary understanding of the concept. This extension represents a contemporary elaboration of a psychoanalytic contribution to a study of ritual, which was of great interest to many early psychoanalysts-among them, Abraham.

The impact of intergenerational transmissions of trauma and the dissociative states of mind that cross from parents to their children has become an important expansion of psychoanalytic theory. Clinical material will be discussed showing how an early death of a mother haunted the lives of many generations of mothers and daughters. Considerations of attachment rupture, trauma, envy, deadly and deadening aggression and shame are discussed as part of transgenerational transmission phenomena and how they are worked on in the analytic relationship. Envious attacks, though painful to tolerate, nonetheless need to be processed in order to transform transmissions from the past.

Objective: To examine the psychometric properties of the Maternal and Paternal Attachment Scales (MAAS/PAAS) in a Polish sample of expectant couples., Background: A parental prenatal bond is important for the psychological and health outcomes of children and parents. The MAAS/PAAS is one of the well-established measures for parental prenatal bonding. However, there is a lack of Polish investigations of the factor structure and construct validity of these scales., Methods: The sample consisted of 341 Polish expectant couples who were surveyed about their prenatal bond, closeness with their unborn child, relationship satisfaction, and gender-role attitudes towards parenthood. The reliability and construct validity of the MAAS/PAAS were evaluated. A Confirmatory Factor Analysis (CFA) and a Principal Axis Factoring (PAF) were conducted., Results: The obtained results did not confirm the original factor structures of the MAAS/PAAS. However, in the proposed  single 11-item version for the MAAS/PAAS, two factors equivalent to the original structure were extracted. The scale reliability for the brief MAAS/PAAS version was good. The construct validity was confirmed., Conclusion: The single Polish brief version for the MAAS/PAAS is a reliable and valid measure to use in Polish context. The obtained results support the importance of couple functioning for the MAAS/PAAS.

In this paper, I am concerned with the question of relationship between internal personality integration and external integration in the community within the context of voluntary migration. Migration always includes a loss of all that one has left behind. Both internal and external integration in the new community thus involve a mourning process that involves a working through of depressive position anxieties. Only then can the migrant turn towards the new object, the new community and initiate a process of integration. This process is particularly difficult for patients with an entrenched system of narcissistic defences, in which they have turned away from the helpful object, also the helpful object of the community around them and the helpful object of the analyst. These are often patients who have used the migration as a kind of psychic retreat. The difficult process of integration is illustrated in this paper with the treatment of Mr B.

Purpose: To explore the relational and emotional components of the surgeon-patient relationship from the perspective of practicing pediatric neurosurgeons in the field., Materials and Methods: The study utilized the Grounded Theory Method of data collection and analysis. 26 pediatric neurosurgeons from 12 countries were interviewed using video-conferencing technology., Results: Pediatric neurosurgeons find meaning, joy and pleasure in the relationships they form with their patients and their families, while also experiencing difficult and painful emotions when these patients do not do well. Four themes emerged from the analysis that include having a relational attachment to patients, forming bonds with the parents/caregivers of these patients, dealing with patient suffering, death and complications, and communicating bad news to parents., Conclusions: Pediatric neurosurgeons develop deep and enduring bonds with their patients and their families. These relationships are an integral part of what brings meaning and joy to their work, and simultaneously, are one of the most significant emotional challenges of their careers. . Training neurosurgical fellows should include pedagogical modules about the relational and emotional dimensions of their work, with a specific and dedicated focus on communicating bad news.

Background: Although social support has been consistently associated with recovery from psychological trauma and prevention of posttraumatic stress disorder (PTSD), individual differences in seeking or benefitting from social support in trauma survivors are not well understood. Factors associated with negative internal working models of self and others, emotion dysregulation, and interrupted bonds with an individual's social support groups such as vulnerable attachment and rejection sensitivity could contribute to lower experienced social support and higher levels of PTSD., Objective: The objective of this study was to test a theoretically informed model and investigate how psychosocial variables such as vulnerable attachment styles, rejection sensitivity, and social support are associated with PTSD., Method: Using a cross-sectional survey and path analyses in 141 survivors of trauma (aged 18-69, M = 25.20), the relationship between vulnerable attachment style, rejection sensitivity, and PTSD were investigated., Results: Higher vulnerable attachment, rejection sensitivity, and lower social support were found to be significant predictors of PTSD symptoms ( f 2  = 0.75). The relationships from vulnerable attachment to PTSD were mediated by rejection sensitivity and perceived social support. The results supported and extend theoretical models of PTSD that posit a role for predisposing factors in the development and maintenance of the disorder., Conclusion: The findings suggest a potential benefit of identifying vulnerable groups that could benefit from a refinement of existing PTSD interventions by targeting the maladaptive effects of vulnerable attachment and rejection sensitivity, thus allowing the individual to draw effectively on social support networks., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objective : The aim of this research was to explore mothers' lived experience of early bonding with their twins. Background : Research has suggested that the process of bonding with twins may differ from that of bonding with singletons. However, there is limited research exploring this experience from the mother's perspective. Method : An IPA study involved six participants in semi-structured interviews. Results : Two superordinate themes emerged; 'Twin guilt and shame' and 'I missed out … they miss out'. Results suggested the experience of bonding with two infants simultaneously generated guilt for the mothers, who at points felt that they and their infants had missed out and had had to adapt. Conclusion : The experience of bonding with twins can be complex and take longer than anticipated, with mothers reporting the experience as being different from their expectations. Having a greater understanding and information about the complexities of bonding with twins would be beneficial for both mothers and professionals working with them.

Objective: To develop and evaluate Baby CHAT, a single-session psychoeducational intervention for expectant parents. Baby CHAT aims to improve parental reflective functioning (RF) and bonding., Background: The early years of a child's life, including pregnancy, are vital for healthy physical and emotional development. Caregivers who provide responsive parenting, enhanced through strong bonds and good RF, can aid healthy development.. However, limited interventions exist to enhance RF and bonding in expectant parents., Methods: Feasibility of Baby CHAT was assessed using a mixed methods randomised controlled trial design. It evaluated uptake and retention of participants, effect size calculations, and acceptability and satisfaction with Baby CHAT., Results: Participants (N = 20) were aged 30-39 years (n = 17) in their third trimester of pregnancy (n = 12). Nine males and 11 females were recruited. Content analysis of qualitative feedback after the intervention resulted in four themes; positive group aspects, group improvements, 4D scan footage and relating content to my baby., Conclusions: Baby CHAT can help expectant parents think about their baby as a separate person and has potential to improve prenatal RF and bonding. However, further research is required to assess the effectiveness of Baby CHAT to improve bonding and RF.

Background: Political violence and constraints on liberty of movement can have consequences for health and well-being but affect individuals differently., Objective: In three Palestinian samples, we sought to examine the relationship between key environmental and psychological factors and general and mental health, including the previously unexplored roles of constraints to liberty of movement and attachment orientation., Method: Participants ( N = 519) in the Occupied Palestinian Territories and Jordan completed questionnaires on constraints to liberty of movement, attachment insecurity, resource loss, experience of political violence , demographics, general healthdepression, and anxiety. All measures were translated from English to Arabic and back-translated into English., Results: Findings from regression and mediation analyses indicated that (1) differences in general and mental health among Palestinians in the Occupied Palestinian Territories and the diaspora in Jordan can be explained by the assessed constructs; (2) constraints to liberty of movement, attachment avoidance, and resource loss significantly accounted for poor general health; (3) constraints to liberty of movement, attachment anxiety, and resource loss significantly explained general anxiety symptoms; and (4) attachment anxiety, resource loss, and experience of political violence significantly explained depression symptoms., Conclusion: The findings have theory-building implications for psychological models of human flourishing and suffering, suggesting that they are incomplete without consideration of liberty as a context, as well as implications for policymakers and champions of global health initiatives, as they highlight the psychological effects of constraints to liberty of movement on health., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Although past research shows hoarding to be associated with stressful life events involving loss and/or deprivation, the temporal relationship between the onset of symptoms and these events is not completely clear., Objectives: In a cross-sectional online study, we examined the relationship between the number of events involving loss or deprivation before/simultaneously vs. after the onset of hoarding and various hoarding-related beliefs, such as emotional attachment to possessions, and symptom severity. Further, we examined whether perceived social support moderated the influence of these events on emotional attachment to objects., Methods: One hundred seventeen subjects with hoarding problems responded to a series of instruments to assess the history and timing of traumatic and stressful loss and/or deprivation in relation to the onset of hoarding, and self-report tools evaluating the severity of hoarding, beliefs/motivations, depression, anxiety, general distress, and perceived social support., Results: The number of events involving loss or deprivation occurring before hoarding was related to increased emotional attachment to possessions, whereas events happening after the onset of hoarding were related to increased concerns about memory as drivers of hoarding symptoms. Events happening before hoarding did not interact with perceived social support to influence emotional attachment to objects., Conclusions: The timing of traumatic and stressful life events related to loss and deprivation is associated with different hoarding phenotypes, including beliefs/motivations for hoarding. If confirmed by longitudinal studies, these findings may be relevant for therapeutic and preventive measures., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

A large and significant portion of contemporary psychoanalytic theory has given up on the drives. The shift toward object relations in the 1940s and 50s, the scepticism about metapsychology in the latter half of the twentieth century, and a general confusion about the coherence of Freud's drive theory have all contributed to their slow decline in prominence. There are legitimate criticisms of the drives that deserve attention but the drives themselves require a careful examination before any successful defence of their place in the metapsychology may be mounted. The current paper provides an account of the drives informed by the intellectual history of German and English thought related to the drives and instincts as they came to Freud. This history allows us to clearly distinguish between "drive" (or Trieb ) and its conceptual neighbour "instinct" (or Instinkt ).

The author reflects on the ethical status of psychoanalysis. He argues that the ethical specificity of psychoanalysis is determined by its method. He distinguishes between concepts tied to the analytic frame - the protocol, technique and method. The method is the main guarantee of the ethical engagement between analyst and patient - in particular through the transference. The conditions of opening up the transference are maintained by a particular aspect of the analytic method, namely stating the fundamental rule of free association, which turns the setting into a process. The author illustrates his remarks by discussing Sophie's psychoanalytic treatment in which a passionate transference emerges. A chance external event brings about a rupture in the transitional space of the session's psychic reality, and thereby makes the specific status of the transference fall away and compromises the analytic work. Consequently, the analyst is deprived of his ethical status as object of the patient's psychic reality, and as the recipient of the transference, and becomes an ordinary object in the field of everyday objectality. He simply becomes the person he is in external reality, with his various physical attributes.

Background: Social capital is often cited as shaping impacts of participatory arts, although the concept has not been systematically mapped in arts, health and wellbeing contexts. In wider health inequalities research, complex, differential, and sometimes negative impacts of social capital have been recognised., Methods: This paper maps of social capital concepts in qualitative research as part of the UK What Works for Wellbeing evidence review programme on culture, sport and wellbeing., Results: Studies often cite positive impacts of bonding and, to a lesser extent, bridging social capital. However, reported challenges suggest the need for a critical approach. Forms of linking social capital, such as reframing and political engagement to address social divisions, are less often cited but may be important in participatory arts and wellbeing., Conclusions: Future research should further specify dimensions of social capital as well as their nuanced effects in arts, and wellbeing contexts.

Objective : Individuals with mental illnesses severe enough to require psychiatric hospitalization often have significant trauma histories, have developed maladaptive attachment styles, and experience comorbid somatic distress. Gaining an understanding about the interaction of such factors may lead to prioritizing interventions that target factors that mediate the relationship between trauma and adverse somatic distress. Prior research has examined various mediation models, but results have been mixed and conducted only on outpatient samples. Method : Participants (47.7% female) in a large sample ( N = 2702) with a mean age of 34.62 ( SD  = 14.7) were enrolled in a specialist inpatient program and completed self-report measures pertaining to demographics, attachment insecurity, lifetime trauma exposure, and somatic distress within 72 hours of admission. The dimensions of attachment insecurity (i.e., attachment anxiety and attachment avoidance) were tested as parallel mediators in the relationship between lifetime trauma exposure and somatic distress. Results : The mediation analyses revealed that attachment anxiety and avoidance partially mediated the relationship between lifetime trauma exposure and somatic distress. Conclusions : These results are the first to date to implicate both attachment anxiety and avoidance as mediators between trauma exposure and somatic distress in a high acuity sample. Although the results do not imply causality, they do call attention to social-cognitive factors related to somatic distress and highlight the importance of considering attachment styles as a possible contributor to comorbid physical symptoms in patients with trauma exposure.

Background : Child maltreatment is embedded in a complex system of familial, societal and cultural influences. However, the microsystemic framework in which child maltreatment occurs has not been sufficiently accounted for in previous measures of trauma history. In order to include this relational context, a novel survey method, the Childhood Attachment and Relational Trauma Screen (CARTS), was developed, focusing specifically on the familial environment and childhood attachment relationships. Prior validation studies of the English and Italian versions of the CARTS have tended to support its use. Objective : The current study aims at evaluating the psychometric properties of the German version of the CARTS as well as conducting cross-cultural comparison analyses. It is part of an international research project of the Global Collaboration on Traumatic Stress which was initiated by the International Society for Traumatic Stress Studies (ISTSS). Method : The sample consisted of n = 140 participants from the German general population aged 18 or older. Further trauma specific measures (GPS, BSI-18, CTQ-SF, ECR-R, PBI) were included for validation. Cross-cultural comparisons were conducted with a German subsample of students in reference to Italian- and English-speaking student samples. Results : Most CARTS subscales showed acceptable internal consistency. Statistically significant relationships were observed with other measures of childhood trauma exposure and parental bonding, as well as PTSD- and other distress-related outcomes. Comparing the German-speaking sample with Italian- and English-speaking samples indicated significant differences with regard to childhood attachment and child maltreatment. Conclusion : The present findings are consistent with previous results concerning the CARTS and advance the validation of this novel survey method within German-speaking samples. Further, the CARTS appears to be sensitive to cross-sample differences in childhood attachment and child maltreatment. Further psychometric evaluations of the CARTS in other languages and within further German-speaking samples are needed., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)