Early Parenting and Prevention of Disorder: Psychoanalytic Research at Interdisciplinary Frontiers

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This book provides insight and findings from leading psychoanalysts who are involved in early prevention research and clinical work. Advances in the sciences of early development have brought a heightened awareness to the crucial importance of early experiences for health and development as well as building strong foundations for education and preventing disorder. New approaches are applied in home visitation, working with immigrant families, and those stressed by trauma, conflicts and economic disadvantage. Examples of clinical application and the implementation of promising programs in an "outreach psychoanalysis" are also provided.

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CHAPTER ONE The prevention sciences of early development and challenging opportunities for psychoanalysis

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CHAPTER ONE

The prevention sciences of early development and challenging opportunities for psychoanalysis

Robert N. Emde

T

he sciences of early development, disorder prevention, and health have recently undergone momentous advances (see the reviews in American Academy of Pediatrics, 2012; Beardslee, Chien and

Bell, 2011; Emde, 2012; Mercy & Saul, 2009; Rutter, 2011; Shonkoff, 2012).

New knowledge and methods have generated new ways of thinking.

Correspondingly, a greater awareness of science, suffering and the adverse effects of unattended early risk have all combined to energise preventive interventions. Such work, converting knowledge into practice, is necessarily interdisciplinary and collaborative, and leads both to exciting opportunities and challenges. As the reader of this volume will find, psychoanalysts have much to contribute and have vigorously joined in preventive work. This chapter provides an introduction for the perspectives and programmes of empirical research in the chapters that follow.

 

Chapter One: The Prevention Sciences of Early Development and Challenging Opportunities for Psychoanalysis

ePub

Robert N. Emde

The sciences of early development, disorder prevention, and health have recently undergone momentous advances (see the reviews in American Academy of Pediatrics, 2012; Beardslee, Chien and Bell, 2011; Emde, 2012; Mercy & Saul, 2009; Rutter, 2011; Shonkoff, 2012). New knowledge and methods have generated new ways of thinking. Correspondingly, a greater awareness of science, suffering and the adverse effects of unattended early risk have all combined to energise preventive interventions. Such work, converting knowledge into practice, is necessarily interdisciplinary and collaborative, and leads both to exciting opportunities and challenges. As the reader of this volume will find, psychoanalysts have much to contribute and have vigorously joined in preventive work. This chapter provides an introduction for the perspectives and programmes of empirical research in the chapters that follow.

After reviewing some basic prevention concepts, including trials and the emerging field of implementation science, I will discuss my perspective on prevention principles that lead to psychoanalytic opportunities. A view of current science will then serve to introduce the chapters of the book that provide overviews of research in some remarkably creative prevention programmes. I believe the reader will be rewarded by experiences of sharing in the accounts of engaged psychoanalysts as they describe their working and their promising early results.

 

Chapter Two: “Out-Reaching Psychoanalysis”: A Contribution to Early Prevention for “Children-at-Risk”?

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Marianne Leuzinger-Bohleber 1

This chapter supplements the overview from the prevention sciences provided in chapter one with a perspective from clinical psychoanalysts in Germany, bringing their knowledge to “children-at-risk” outside their “normal” treatment settings. We refer to this as “Out-reaching psychoanalysis”. It is an engagement which takes up a well-known tradition of psychoanalytical pedagogics (e.g., Anna Freud, Bruno Bettelheim, August Aichhorn and many others) and tries to adjust it to new challenges for a psychoanalytical oriented prevention in Western countries.

Introduction: early prevention as a societal responsibility

In its report the OECD deplores…“that migrants in almost no other country have such a bad level of education as in Germany” (Klingholz, 2010, p. 1299). Every fourth child with a background of migration leaves school without a certificate. Many of them become unemployed as are their parents and lead a life on the fringe of society. The societal disparity between them and other children in Germany, who have never had it better, becomes greater and greater. Early deprivation, violence and the increase of psychosomatic and mental illness such as depression and addiction are among the consequences. Seventy per cent of violent criminals have themselves been abused as children. Twenty to thirty per cent of their children, in turn, become violent criminals (e.g., Egle, Hoffmann & Joraschky, 2000).

 

CHAPTER TWO “Out-reaching psychoanalysis”: a contribution to early prevention for “children-at-risk”?

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CHAPTER TWO

“Out-reaching psychoanalysis”: a contribution to early prevention for “children-at-risk”?

Marianne Leuzinger-Bohleber1

T

his chapter supplements the overview from the prevention sciences provided in chapter one with a perspective from clinical psychoanalysts in Germany, bringing their knowledge to

“children-at-risk” outside their “normal” treatment settings. We refer to this as “Out-reaching psychoanalysis”. It is an engagement which takes up a well-known tradition of psychoanalytical pedagogics (e.g., Anna

Freud, Bruno Bettelheim, August Aichhorn and many others) and tries to adjust it to new challenges for a psychoanalytical oriented prevention in Western countries.

Introduction: early prevention as a societal responsibility

In its report the OECD deplores … “that migrants in almost no other country have such a bad level of education as in Germany” (Klingholz,

2010, p. 1299). Every fourth child with a background of migration leaves school without a certificate. Many of them become unemployed as are their parents and lead a life on the fringe of society. The societal disparity between them and other children in Germany, who have never had it better, becomes greater and greater. Early deprivation, violence and the increase of psychosomatic and mental illness such as depression

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CHAPTER THREE Minds shaped through relationships: the emerging neurobiology of parenting

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CHAPTER THREE

Minds shaped through relationships: the emerging neurobiology of parenting

Helena J. V. Rutherford and Linda C. Mayes

I

do not believe it is possible to understand the functioning of the mother at the very beginning of the infant’s life without seeing that she must be able to reach this state of heightened sensitivity, almost an illness, and to recover from it” (Winnicott, 1956 [1975], p. 302). When

Winnicott made his observations of a special shift in the mental economy of adults recently becoming new parents, he was calling attention to a critical adult developmental stage that has implications not only for the parent but also for the infant (Winnicott, 1956 [1975]). For Winnicott, the adult’s experience of a preoccupied mental state was essential not only for the new parent’s coming to understand their infant but also for creating a “transitional space” in which the infant’s self slowly differentiates.

Key to Winnicott’s observations is that both parent and infant are engaged in a critical developmental period with each shaping and influencing the other. Indeed, the onset of parenthood represents a significant transitional period in the lives of many adults, requiring a host of psychological and neurobiological changes to facilitate adaptive and responsive caregiving to the needs of the infant. Across disciplines, there has been decades of research addressing how parental care impacts child development; however, there has been far less consideration of

 

Chapter Three: Minds Shaped through Relationships: The Emerging Neurobiology of Parenting

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Helena J. V. Rutherford and Linda C. Mayes

“I do not believe it is possible to understand the functioning of the mother at the very beginning of the infant's life without seeing that she must be able to reach this state of heightened sensitivity, almost an illness, and to recover from it” (Winnicott, 1956 [1975], p. 302). When Winnicott made his observations of a special shift in the mental economy of adults recently becoming new parents, he was calling attention to a critical adult developmental stage that has implications not only for the parent but also for the infant (Winnicott, 1956 [1975]). For Winnicott, the adult's experience of a preoccupied mental state was essential not only for the new parent's coming to understand their infant but also for creating a “transitional space” in which the infant's self slowly differentiates.

Key to Winnicott's observations is that both parent and infant are engaged in a critical developmental period with each shaping and influencing the other. Indeed, the onset of parenthood represents a significant transitional period in the lives of many adults, requiring a host of psychological and neurobiological changes to facilitate adaptive and responsive caregiving to the needs of the infant. Across disciplines, there has been decades of research addressing how parental care impacts child development; however, there has been far less consideration of how adults transition to their parenting role and the psychological and neurobiological changes that accompany this period. As Winnicott observed, the onset of parenthood is characterised by heightened sensitivity and involvement to one's child (Winnicott, 1956 [1975]), but the neurobiological mechanisms that underscore these changes have only recently been of interest to researchers (Leckman et al., 1999; Mayes, Swain, & Leckman, 2005; Swain, Lorberbaum, Kose, & Strathearn, 2007). Here we review recent neurobiological studies of mothers and fathers that have begun to unpack how their minds may be shaped through the emerging relationship with their child and vice versa.

 

Chapter Four: Fraiberg in Paris—Early Prevention through a Mental Health Programme for vulnerable Families: Preliminary Findings and what we have Learned in Conducting the French CAPEDP Study

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Antoine Guedeney, Nicole Guedeney, Susana Tereno, Romain Dugravier, Thomas Saias, Florence Tubach, Jaqueline Wendland, Bertrand Welniarz, Alain Haddad, and Tim Greacen

Along with the advisors of the scientific committee of the CAPEDP Study Professor Bruno Falissard, MD PhD, and Professor Richard E. Tremblay, PhD

The author thanks the 440 families who accepted to participate in the study, the members of the home-visiting team and of the home-based assessment team, without whom this project would have been impossible: Joan Augier, Amel Bouchouchi, Anna Dufour, Cécile Glaude, Audrey Hauchecorne, Gaëlle Hoisnard, Virginie Hok, Alexandra Jouve, Anne Legge, Céline Ménard, Marion Milliex, Alice Tabareau. The authors particularly thank the members of the supervision team: Laure Angladette, Drina Candilis, Judith Fine, Alain Haddad, Joana Matos, Anne-Sophie Mintz, Marie-Odile Pérouse de Montclos, Diane Purper-Ouakil, Françoise Soupre, Susana Tereno, and Jaqueline Wendland, under the leadership of Bertrand Welniarz.

 

CHAPTER FOUR Fraiberg in Paris—early prevention through a mental health programme for vulnerable families: preliminary findings and what we have learned in conducting the French CAPEDP study

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CHAPTER FOUR

Fraiberg in Paris—early prevention through a mental health programme for vulnerable families: preliminary findings and what we have learned in conducting the French CAPEDP study

Antoine Guedeney, Nicole Guedeney, Susana Tereno,

Romain Dugravier, Thomas Saias, Florence Tubach,

Jaqueline Wendland, Bertrand Welniarz, Alain Haddad, and Tim Greacen

Along with the advisors of the scientific committee of the CAPEDP Study

Professor Bruno Falissard, MD PhD, and Professor Richard E. Tremblay, PhD

T

he author thanks the 440 families who accepted to participate in the study, the members of the home-visiting team and of the home-based assessment team, without whom this project would have been impossible: Joan Augier, Amel Bouchouchi, Anna Dufour,

Cécile Glaude, Audrey Hauchecorne, Gaëlle Hoisnard, Virginie Hok,

Alexandra Jouve, Anne Legge, Céline Ménard, Marion Milliex, Alice

Tabareau. The authors particularly thank the members of the supervision team: Laure Angladette, Drina Candilis, Judith Fine, Alain Haddad,

 

CHAPTER FIVE Understanding how traumatised mothers process their toddlers’ affective communication under stress: towards preventive intervention for families at high risk for intergenerational violence

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CHAPTER FIVE

Understanding how traumatised mothers process their toddlers’ affective communication under stress: towards preventive intervention for families at high risk for intergenerational violence*

Daniel S. Schechter and Sandra Rusconi Serpa

W

ithin the context of infant–parent attachment, primary caregivers provide multiple, complex, and often “hidden” regulatory functions. These functions are akin to individual coloured threads that then when woven together, compose a brilliant, unique, and clearly recognisable pattern, itself the focus of the artful tapestry that is the individual infant’s relationship to his primary caregivers (Hofer, 1984). One form of “hidden” regulation of critical importance to the child’s capacity to form healthy relationships with others and to learn, is that of emotion regulation (Cassidy, 1994). The term “mutual regulation,” as first used by (Tronick & Gianino, 1986), refers to a bidirectional, albeit asymmetric, process of emotion regulation between the adult caregiver and the infant.

 

Chapter Five: Understanding how Traumatised Mothers Process their Toddlers’ Affective Communication under Stress: Towards Preventive Intervention for Families at High Risk for Intergenerational Violence

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Daniel S. Schechter and Sandra Rusconi Serpa

Within the context of infant–parent attachment, primary caregivers provide multiple, complex, and often “hidden” regulatory functions. These functions are akin to individual coloured threads that then when woven together, compose a brilliant, unique, and clearly recognisable pattern, itself the focus of the artful tapestry that is the individual infant's relationship to his primary caregivers (Hofer, 1984). One form of “hidden” regulation of critical importance to the child's capacity to form healthy relationships with others and to learn, is that of emotion regulation (Cassidy, 1994). The term “mutual regulation,” as first used by (Tronick & Gianino, 1986), refers to a bidirectional, albeit asymmetric, process of emotion regulation between the adult caregiver and the infant.

Focus of our study

Our studies both in New York and in Geneva are interested in understanding the interplay of factors that disrupt and facilitate mutual emotion regulation. It is well known that maternal psychopathology (e.g., depression (Tronick & Gianino, 1986) or anxiety (Moore, Whaley, & Sigman, 2004)) disrupts mutual regulation. It is clearly established in our field that maternal history of attachment security and parental reflective functioning as its robust marker (Fonagy, Steele, Steele, Moran, & Higgitt, 1991; Slade, Grienenberger, Bernbach, Levy & Locker, 2005) are robust predictors of maternal caregiving sensitivity, disrupted parent–infant communication, and thus maternal ability to engage in and be supportive of mutual emotion regulation with her child.

 

CHAPTER SIX The triadic perspective for parenting and early child development: from research to prevention and therapy

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CHAPTER SIX

The triadic perspective for parenting and early child development: from research to prevention and therapy

Kai von Klitzing

A

triadic perspective in the context of parenthood takes into account the capacity for triadic relationships, or what we have called “triadic capacity” in mothers and fathers. It involves the capacity of each parent to develop an intense relationship with her or his child (whether in internal representations or in reality) without excluding either themselves or their partners from the relationship with the infant. Such a capacity also means that the intimate relationship between the parents can develop further, even when the child is integrated as a third member of the family. A mother with high triadic capacity is able to recognise that the father also has an important relationship to the child, without being overwhelmed by her fear of being excluded. A father with high triadic capacity recognises the mother’s significance, without excluding himself from the relationship between mother and child. As the child grows older, triadic capacity also indicates the ability of parents to accept that the child enters into meaningful relationships with significant others.

 

Chapter Six: The Triadic Perspective for Parenting and Early Child Development: From Research to Prevention and Therapy

ePub

Kai von Klitzing

Atriadic perspective in the context of parenthood takes into account the capacity for triadic relationships, or what we have called “triadic capacity” in mothers and fathers. It involves the capacity of each parent to develop an intense relationship with her or his child (whether in internal representations or in reality) without excluding either themselves or their partners from the relationship with the infant. Such a capacity also means that the intimate relationship between the parents can develop further, even when the child is integrated as a third member of the family. A mother with high triadic capacity is able to recognise that the father also has an important relationship to the child, without being overwhelmed by her fear of being excluded. A father with high triadic capacity recognises the mother's significance, without excluding himself from the relationship between mother and child. As the child grows older, triadic capacity also indicates the ability of parents to accept that the child enters into meaningful relationships with significant others.

 

CHAPTER SEVEN Transition to parenthood: studies of intersubjectivity in mothers and fathers

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CHAPTER SEVEN

Transition to parenthood: studies of intersubjectivity in mothers and fathers

Massimo Ammaniti, Cristina Trentini, Francesca Menozzi, and Renata Tambelli

Introduction

Recent developments in different areas of research, psychoanalysis, infant research, cognitive neuroscience, and developmental science, highlight the dynamic, intersubjective sense of personality organised in term of “self-with-other” (Ammaniti & Trentini, 2009).

The evolution of the human species attuned human mothers, both psychologically and neurobiologically, to the smell and the sounds of the baby, and to his expressions and behaviours; in this way, mothers can immediately understand when they need to intervene to protect or feed the baby, who is immature and helpless. At the same time, babies with higher ability in tuning and understanding others have been favoured by natural selection, gaining a better chance of survival. For this reason, human infants are very social from their birth and develop that human-specific ability to read intentions and participate in collaborative activities defined by shared goals and intentions (Tomasello,

 

Chapter Seven: Transition to Parenthood: Studies of Intersubjectivity in Mothers and Fathers

ePub

Massimo Ammaniti, Cristina Trentini, Francesca Menozzi, and Renata Tambelli

Introduction

Recent developments in different areas of research, psychoanalysis, infant research, cognitive neuroscience, and developmental science, highlight the dynamic, intersubjective sense of personality organised in term of “self-with-other” (Ammaniti & Trentini, 2009).

The evolution of the human species attuned human mothers, both psychologically and neurobiologically, to the smell and the sounds of the baby, and to his expressions and behaviours; in this way, mothers can immediately understand when they need to intervene to protect or feed the baby, who is immature and helpless. At the same time, babies with higher ability in tuning and understanding others have been favoured by natural selection, gaining a better chance of survival. For this reason, human infants are very social from their birth and develop that human-specific ability to read intentions and participate in collaborative activities defined by shared goals and intentions (Tomasello, 1999; Tomasello, Carpenter, Call, Behne & Moll, 2005).

 

CHAPTER EIGHT The First Steps: a culture-sensitive preventive developmental guidance for immigrant parents and infants

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CHAPTER EIGHT

The First Steps: a culture-sensitive preventive developmental guidance for immigrant parents and infants

Patrick Meurs

M

any children that are currently participating in preventive developmental guidance programmes in the major towns of the Western world are growing up in cultural or subcultural environments that differ substantially from those of white middle class families. In that perspective, the ability of the prevention worker to take into account very different cultural practices and scripts involving child development and parenting is of great importance (Emde & Spicer,

2000). This ability, referred to as “cultural sensitivity”, has been worked out systematically in the Belgian prevention project we have called The

First Steps. After describing the history of that project as well as the specific ports of entry we have in the target group of socially disadvantaged immigrant families, we will provide a section on culture-sensitive adaptations of psychoanalytic concepts and methods. This will be followed by a description of our empirical research, indicating how our studies on vulnerable developmental lines in immigrant children have shown effects of a targeted preventive intervention on their developmental profiles.

 

Chapter Eight: The First Steps: A Culture-Sensitive Preventive Developmental Guidance for Immigrant Parents and Infants

ePub

Patrick Meurs

Many children that are currently participating in preventive developmental guidance programmes in the major towns of the Western world are growing up in cultural or subcultural environments that differ substantially from those of white middle class families. In that perspective, the ability of the prevention worker to take into account very different cultural practices and scripts involving child development and parenting is of great importance (Emde & Spicer, 2000). This ability, referred to as “cultural sensitivity”, has been worked out systematically in the Belgian prevention project we have called The First Steps. After describing the history of that project as well as the specific ports of entry we have in the target group of socially disadvantaged immigrant families, we will provide a section on culture-sensitive adaptations of psychoanalytic concepts and methods. This will be followed by a description of our empirical research, indicating how our studies on vulnerable developmental lines in immigrant children have shown effects of a targeted preventive intervention on their developmental profiles.

 

Chapter Nine: The Evolution of an Early Parenting Education Programme, its Follow-Up, and its Implications

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Henri Parens

This chapter describes our psychoanalytically informed early parenting intervention project, which began in 1970, and its follow-up after nineteen, thirty-two and thirty-seven years. The intervention, involving ten mothers and sixteen children, began in infancy with twice a week two hour session and continued for five years. Longitudinal observations and reflections, as well as personal conclusions of the author are presented.

In 1969 the team of the Early Child Development Program in the department of Psychiatry at the Medical College of PA/Eastern Pennsylvania Psychiatric Institute (EPPI) developed a project to observe mothers and their newborn infants for the purpose of a longitudinal research project. We had developed procedures and a protocol to record1 and to film2 relevant mother–infant interactional observational data to test the hypothesis that qualitative aspects of the mother–child relationship would correspond qualitatively with the development of specified adaptive ego functions in their child, assuming average-expectable neonatal endowment in the child. The staff committed to two hour observation sessions, twice a week, and a once weekly conference to discuss procedures, observations, and eventually inferences to which these led.

 

CHAPTER NINE The evolution of an early parenting education programme, its follow-up, and its implications

PDF

CHAPTER NINE

The evolution of an early parenting education programme, its follow-up, and its implications

Henri Parens

T

his chapter describes our psychoanalytically informed early parenting intervention project, which began in 1970, and its follow-up after nineteen, thirty-two and thirty-seven years.

The intervention, involving ten mothers and sixteen children, began in infancy with twice a week two hour session and continued for five years. Longitudinal observations and reflections, as well as personal conclusions of the author are presented.

In 1969 the team of the Early Child Development Program in the department of Psychiatry at the Medical College of PA/Eastern

Pennsylvania Psychiatric Institute (EPPI) developed a project to observe mothers and their newborn infants for the purpose of a longitudinal research project. We had developed procedures and a protocol to record1 and to film2 relevant mother–infant interactional observational data to test the hypothesis that qualitative aspects of the mother–child relationship would correspond qualitatively with the development of specified adaptive ego functions in their child, assuming averageexpectable neonatal endowment in the child. The staff committed to two hour observation sessions, twice a week, and a once weekly conference to discuss procedures, observations, and eventually inferences to which these led.

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