Parent Psychotherapy Research Articles

The effects of child maltreatment and polymorphisms of the serotonin transporter and dopamine D4 receptor genes on infant attachment and intervention efficacy

This investigation examined the extent to which polymorphisms of the serotonin transporter linked promoter region (5-HTTLPR) and the dopamine receptor D4 (DRD4) genes differentially influenced the development of attachment security and disorganization in maltreated and nonmaltreated infants at age 13 months, and the extent to which the efficacy of preventive interventions to promote attachment security were influenced by genetic variation. The sample consisted of 106 infants from maltreating families, participating in a randomized control trial evaluating the efficacy of two interventions, child-parent psychotherapy and psychoeducational parenting intervention, and 47 infants from nonmaltreating families. DNA samples were genotyped for polymorphisms of 5-HTTLPR, DRD4 exon III variable number tandem repeat, and DRD4-521. Attachment organization at age 1 and at age 2 was assessed with the Strange Situation for all participants, prior to and following the completion of the interventions. High rates of disorganized attachment were observed in the maltreatment compared to the nonmaltreatment group, and both interventions resulted in increased rates of attachment security at age 2. Genetic variation did not influence improvement in attachment organization among maltreated infants. Among maltreated infants, genetic variation had minimal effect on attachment organization. In contrast, among nonmaltreated infants, 5-HTTLPR and DRD4 polymorphisms influenced attachment security and disorganization at age 2 and the stability of attachment disorganization over time.

Psychotherapeutic options for traumatized children

This review addresses two issues. First, it updates readers on new treatments for traumatized children. Second, it examines the breadth of target problems that current evidence-based treatments for child posttraumatic stress disorder (PTSD) effectively address in the context of current diagnostic uncertainty. Specifically, changes have been proposed to the Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV) diagnostic criteria for PTSD and a proposal has been submitted to add a new developmental trauma disorder to optimally describe the range of outcomes experienced by traumatized children. Three recently completed treatment studies are described. A review of five established child trauma treatments for PTSD, child-parent psychotherapy, cognitive behavioral interventions for trauma in schools, cognitive behavioral therapy for PTSD, structured psychotherapy for adolescents responding to chronic stress, and trauma-focused cognitive behavioral therapy documents that these treatments effectively resolve problems in multiple domains beyond the current PTSD diagnostic criteria. These domains include affective dysregulation, behavioral dysregulation, cognitive dysregulation, and relational dysregulation. New treatments for children are promising for treating PTSD and some other symptoms. Current evidence-based child trauma treatments address a broad array of trauma-related difficulties.

Accessibility to a parent's psychotherapy records in custody disputes: How can the competing interests be balanced?

One of the issues that commonly arises in custody disputes is whether one parent or the court may obtain access to the records of the other parent's mental health treatment. The answer to this question varies across jurisdictions given that states do not treat the medical/psychological therapeutic privilege uniformly. These differences demonstrate the competing interests whenever a party's mental health records become an issue in a custody proceeding, and the attempt to balance the interests when the therapeutic privilege is asserted. This article will examine the balancing challenge, review the scope and function of the psychotherapist-patient privilege, discuss different states' approaches to the balancing challenge, and propose that preserving the privilege creates the most effective, long-term balance. The article concludes with strategies on addressing privilege issues in custody cases.

Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes

This study describes the implementation of three evidence-based treatments addressing traumatic stress symptoms within a wraparound foster care program in Illinois. Child–Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) were implemented with a racially diverse sample of youth ages 3–18 at six agencies. Culturally sensitive adaptations were made to treatment approaches to improve client retention and outcomes. Data analyses revealed no racial differences in retention in the program and no differences in outcomes between minority youth exposed to the intervention and other participants. All three evidence-based treatments were effective in reducing symptoms and improving functioning among minority youth. Implementation issues, including challenges and culturally competent accommodations, are discussed.

Issues in Infant—Parent Psychotherapy for Mothers with Borderline Personality Disorder

Mothers with Borderline Personality Disorder (BPD) and their infants have been largely neglected in the research literature. This is of concern, given that clinical reports indicate that mothers with BPD have difficulties with sensitive and empathic parenting and that their children are at risk of attachment disorganization. There is little available evidence on the use of interventions with this group of parents despite clinical need. This article describes our experiences in the use of an attachment-focused psychotherapy known as Watch Wait and Wonder for improving the interaction between mothers with a BPD diagnosis and their children. A case example is provided to illustrate one mother's response to the therapy and to highlight specific issues in clinical intervention for this group of parents and possible modifications of approach.

Abstracts

Abstracts

Group Psychotherapy for Parents of Patients with Schizophrenia

During a four-month period, the authors provided group psychotherapy combining psychodynamic, supportive and psycho-educational approaches. The aim was to investigate whether this approach would enable parents of patients with schizophrenia to re-establish their psychic balance and the balance of the whole family system by reducing high expressed emotion. The following tools were administered: a socio-cultural questionnaire, MMPI and PIE psychological tests and two questionnaires for group evaluation. The socio-cultural questionnaire showed that the group of parents is heterogeneous. MMPI profiles showed truthful answers and well organized thinking; there were no psychopathological symptoms. The PIE test showed increased dimensions of sociability and trust. The dimensions of fear, sorrow and anger were decreased. Combinations of primary emotions (marked sociability and high self-protection) show that the parents are cautious, responsible and tend to feel guilt. The parents evaluated the group work as interesting and helpful and the group as a place where the parents can overcome the stigma of the disease that affects them, get information, find help and friends and find a way out of their social isolation. This combined approach changes the emotional profile of parents, reduces high expressed emotions (fear, sorrow and anger) in parents and helps re-establish their psychic balance and the balance of the whole family system.

Psychotherapy for the Parents Instead of the Child

Psychotherapy for the Parents Instead of the Child

Clinical factors in group psychotherapy for parents of adolescents with disruptive behaviour disorders.

This paper describes a group treatment approach to helping parents of youth with Disruptive Behaviour Disorders. These youth have a significant negative and pervasive impact on their parents, who feel incompetent and guilty. Parents are helped to express their grief at their many losses in a safe, supportive and non-blaming group environment. They gain insight into the factors that make it difficult for them to set limits and they begin to change themselves rather than "fix" their child. Parent's hope and confidence grow as positive change becomes evident. As their sense of shame, guilt and fear lessen, parents are able to act more effectively with their youth and others. This paper delineates the clinical factors that contribute to parental effectiveness.

Disorders of excessive crying, feeding, and sleeping: The Munich Interdisciplinary Research and Intervention Program

The Munich Interdisciplinary Research and Intervention Program (MIRIP 1991) is an inter-disciplinary diagnostic and intervention service for families with regulatory disturbed infants (excessive crying, feeding/sleeping disturbances, disturbances of attachment/exploration, disturbances of autonomy/control). In addition, the systematic collection of data serve to investigate the etiology, clinical course, and possible treatments of regulatory problems in infancy. The program is based on a systemic model of early developmental psychopathology. Diagnostic procedures include a semistructured clinical interview, a developmental neuropediatric examination; behavioral diaries; questionnaires on infant temperament, the mother's psychological condition, marital satisfaction, and social support; and videotaped mother–infant interactions in age-related contexts. As is evident from the data analysis, regulatory disturbances in infancy may be associated with (1) maladaptive regulatory patterns in several domains (e.g., excessive crying and disturbed sleep-wake organization), (2) high maternal distress and multiple psychosocial risk factors, and (3) considerable distress of the early mother/parent–infant relationship and communication. Interaction-centered infant–parent psychotherapy is an interdisciplinary, multidimensional therapeutic approach for families with regulatory disturbed infants. It targets upon dysfunctional patterns of mother/parent–infant communication. Particular emphasis is put on restoring the parents' intuitive capacities. The approach has proved to be effective within short time periods and aims at preventing later developmental problems. © 1998 Michigan Association for Infant Mental Health

Psychosocial Services for Children and Adolescents With Hemophilia and Their Families: Result of a National Survey

Seventy-one providers at 53 hemophilia treatment centers were surveyed concerning their patient populations, types of problems encountered, type of psychosocial services provided, and obstacles to service delivery. Respondents, who were social workers, nurses, and psychologists, reported that they spent more time providing direct services for illness-related problems compared with general psychological problems. The most time-consuming problems included problematic child-adolescent adjustment to hemophilia (21.6%), parental adjustment to hemophilia (20.5%), child-adolescent adjustment to HIV (17.4%), and parental adjustment to HIV (14.0%). Practitioners utilized a wide range of services to address clinical problems, such as providing information and support to parents; assessment of child, parent, and family adjustment; psychotherapy for children and parents; and identification of community services and referral contracts for families. The families' distance from the center was rated as the most significant obstacle to delivery of psychosocial services. Findings have potential implications for planning for psychosocial services for children with hemophilia and their families as well as for support and education of service providers.

An outcome study of psychotherapy for patients with borderline personality disorder.

This study evaluated the effectiveness of well-defined outpatient psychotherapy for patients with borderline personality disorder. Thirty patients with borderline personality disorder diagnosed according to the DSM-III criteria were given twice weekly outpatient psychotherapy for 12 months by trainee therapists who were closely supervised. The treatment approach was based on a psychology of self (this term being used in its broad sense), and strong efforts were made to ensure that all therapists adhered to the treatment model. Outcome measures included frequency of use of drugs (both prescribed and illegal), number of visits to medical professionals, number of episodes of violence and self-harm, time away from work, number of hospital admissions, time spent as an inpatient, score on a self-report index of symptoms, and number of DSM-III criteria (weighted for frequency, severity, and duration) fulfilled. The subjects showed statistically significant improvement from the initial assessment to the end of the year of follow-up on every measure. Moreover, 30% of the subjects no longer fulfilled the DSM-III criteria for borderline personality disorder. This improvement had persisted 1 year after the cessation of therapy. The results suggest that a specific form of psychotherapy is of benefit for patients with borderline personality disorder.

Manic-depressive variant syndrome of childhood: a preliminary report

The author describes the specific diagnostic entity of manic-depressive variant syndrome of childhood and outlines the five essential diagnostic criteria (affective storms, family history of significant affective dysfunction, hyperactivity, chronically disturbed personal relationships, and absence of psychotic thought disorder) and the five secondary criteria (sleep disturbances, minimal brain dysfunction, abnormal EEG, enuresis, and neuropathology). In the four cases reported, the children, when properly diagnosed, responded well to lithium therapy. The author points out the need for further study of this syndrome. Precautions about the use of lithium in children under age 12 are crucial, as is the need for continuing psychotherapy for parents and child.

Psychopathology of the abusing parent.

Child abuse has lately reached epidemic proportions, with the most severe cases occurring in children under three years of age. Psychopathology of abusing parents and contributory factors are analyzed. Many involved families can be rehabilitated. Successful treatment includes psychotherapy for parents and temporary removal of the children from the homes.

Group psychotherapy for parents of disturbed children.

G ROUP PSYCHOTHERAPY FOR parents of emotionally disturbed children is not a new idea, but one whose value warrants continued reappraisal because it helps to clarify the psycl olynamics of family interaction. The use of group psychotherapy for parents of disturbed children is based on the hypothesis that children become sick because of their psychological environment. Parental relationships are at the center of this environment, and the child’s illness may reflect parental problems. A child is unlikely to get well and stay well unless his family environment improves. In our own hospital we found that a number of patients in the children’s unit were progressing too slowly, with too many setbacks and furlough returns. The basic J)roblem appeared to be related to parental problems. We decided to try group therapy because it is a(lapted easily to parents and to the usual time limitations of a state hospital. We decided that the group sessions could best be conducted by two therapists, a man (the author) and a woman. This would provide both a mother and a father image (to iromote optimum transference) and enable me to become familiar with the technique of a more experienced therapist. Later we found that the

COMPREHENSIVE PEDIATRICS

As a result of a 4-year experience with a preschool nursery program for children with cerebral palsy, the following conclusions have been reached. The program should include parent participation, parent education, group psychotherapy for parents and individual counseling. The services of a nursery school director, physical therapist, occupational therapist, speech therapist and graduate psychiatric social worker and a physician trained in cerebral palsy are essential to insure maximum success in treatment, delineating prognosis and directing the parents and the childern toward the future. The program, as described, has eliminated not only a great deal of financial waste but emotional waste as well. Considering the continuous searching of parents for a cure as a result of misleading and incomplete medical information, coupled with virtually no counseling, the emotional waste for such parents is obvious. No substitute has been found for facing up to and understanding the problem objectively at an early age.

Organic and organizational aspects of school adjustment problems.

The statistics of a public school system showed that 5% of the children failed in a given year. In some instances no reason could be found for the difficulty, but in general there was a preponderance of birth injuries or severe postnatal infectious disorders, such as encephalitis, or severe cerebral episodes connected with the acute exanthemas or postnatal trauma. Pediatric and psychiatric examination revealed a fairly common picture of hyperactivity, excessive pressure of speech, insecurity and anxiety, immaturity of reaction, and fright in the examining situation. Electroencephalographic and neurological evidence of brain damage was found in a large percentage of 181 children so examined. After thorough individual evaluations, a systematic study was made of the effects of treatment, which consisted of psychotherapy for both child and parents, specific speech and reading therapy, and the use of certain drugs. Rauwolfia, reserpine, certain anticonvulsants, and a placebo were used in four groups of 69, 102, 44, and 31 children respectively. The best results, under the conditions of the experiment, were obtained with Rauwolfia, which gave improvement in 63 (91 %) of the 69 children, but it is emphasized that the drug therapy alone was not responsible for the total improvement. Many children who now fail constantly in school can be saved for society if coordination can be achieved by interested parties in the community. The private physician should become a leader in undertakings of this kind.