The nature of love.

Infant monkeys were reared with the aid of a laboratory constructed mother-substitute. "We produced a perfectly proportioned streamlined body stripped of unnecessary bulges and appendices. Redundancy in the surrogate mother's system was avoided by reducing the number of breasts from two to one and placing this unibreast in an upper-thoracic, sagittal position, thus maximizing the natural and known perceptual-motor capabilities of the infant operator. The surrogate was made from a block of wood, covered with sponge rubber, and sheathed in tan cotton terry cloth. A light bulb behind her radiated heat. The result was a mother, soft, warm, and tender, a mother with infinite patience, a mother available twenty-four hours a day, a mother that never scolded her infant and never struck or bit her baby in anger." The data obtained "make it obvious that contact comfort is a variable of overwhelming importance in the development of affectional responses, whereas lactation is a variable of negligible importance." It is suggested that the primary function of nursing "is that of insuring frequent and intimate body contact of infant with mother." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Countertransference in psychotherapy with children and adolescents.

Reviews the book, Countertransference in psychotherapy with children and adolescents edited by Jerrold R. Brandell (see record 1992-97833-000). Books on child analytic work are rare, and books on countertransference in child treatment are basically nonexistent, despite the proliferation of writing on countertransference in work with adults. Thus, Jerrold Brandell's edited volume is a welcome and long-overdue addition to the literature. Although the book is not strictly about analysis, it is analytically informed. Brandell's stated goal is to advance the principle that "countertransference is a ubiquitous factor in child and adolescent treatment, and that its recognition, understanding, and management are essential to effective psychotherapy." This is indeed a worthy if not essential undertaking, and the collection of articles in Brandell's book advances this goal. Brandell prefaced the chapters with his own thorough historical literature review of countertransference in both adult and child work. He then subdivided the book into two sections, with the first containing two classic articles an countertransference and the bulk of the book devoted to the following "scientific situations" in child psychotherapy: racial and cultural issues, depressed and suicidal children and adolescents, infant-family treatment, severely disturbed adolescents, eating disorders, abused children and adolescents, parent loss and divorce, borderline children and adolescents, life-threatening illness, and substance-abusing adolescents. This book is a very good resource for child analysts and therapists, especially those who espouse a more relational or intersubjective point of view. It is suitable both for inexperienced analysts and as a reminder to more seasoned ones of the importance and pervasiveness of countertransference issues in our work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reattachment therapy: Intervention with the very young physically abused child.

Describes the role of disruption of the parent–infant attachment in the etiology of child abuse in very young children. A treatment model is presented, using the case of a 4-yr-old female victim of child abuse to illustrate the treatment's 2 overlapping phases. First, a substitute bond between the therapist and child is established in order to ameliorate developmental lesions spurred by the abuse and to restore normal growth processes. The child's behavior and appearance are then shaped to make him/her a more attractive attachment object, thereby stimulating reattachment with the original caretaker and inhibiting aggression by the parent. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of maternal social skills in multiproblem families: Effects on the mother-child relationship.

Tested a two-step infant preventive intervention model: Step 1 was for the mother to improve her interpersonal competence with other adults; Step 2 was for her to learn more optimal parenting behavior. Ss were 147 multiproblem mothers and their infants. Assessed the mothers' adult social skills pre- and posttreatment. Measured the percentage of treatment goals attained during treatment, and mother–child interactive quality posttreatment. Data partially supported the model: For women who began the program with low social skills, the attainment of treatment goals was positively related to posttreatment social skills (Step 1), which, in turn, were positively related to the quality of mother–child interaction (Step 2). For those women who began with high social skills, the treatment was unrelated to posttreatment social skills or to mother–child interaction. Additional analyses explored the factors associated with individual differences in delivery of services and response to treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of the dilemmas involved in work with schizophrenic patients.

Discusses some of the difficulties involved in transference and its handling with schizophrenic patients, using the treatment of a 22-yr-old chronic schizophrenic male as an illustration. Two major findings have emerged since Freud's contention that the schizophrenic could not form a transference relationship: The schizophrenic can form a transference relationship to the therapist, although (1) it may be of a different kind than that of the neurotic, and (2) for some therapists it is no longer the major tool of therapy. As the nature of the relationship changes from that of one whole person relating to another to that of a mother relating to a child, there is a shift in therapeutic technique. Whereas, in the former relationship, interpretation of the transference is primary, in the latter, the context or the setting for that interpretation becomes primary. The therapist must create a safe environment for schizophrenics as they regress to dependence. The therapist must be willing and able to merge with the patient, to be mother to the infant patient. This stance requires the utmost from the therapist, and thus countertransference acquires major importance in this work. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The enigmatic dimension of sexual experience: the "otherness" of sexuality and primal seduction

Sexual experience has an "otherness" about it that distinguishes it from daily, habitual modes of experiencing and relating. This paper attempts to use Freud's and Laplanche's theories of primal seduction by the mother, who sends an "enigmatic signifier" or message of her sexuality to the child whom she nurtures. A tension arc is created between bodily sensations and the enigmatic other carrying over into adult life and constituting a bedrock for the sense of enigma and unfathomableness and the sense of the profound revelation that sometimes accompanies sexual experience. The author articulates links with transference and countertransference forms and offers new possibilities of understanding some clinical phenomena.     

Identity of two: The phenomenology of shame in borderline development and treatment.

Describes the identity of borderline individuals as being shame-based. Shame underlies anger as the major affective state, and shame creates an "identity of 2": bad self and good mother. Shame brings into focal awareness both the self and the other, with the imagery that the other rejects the self. The factors in the mother–child relationship that favor shame as the interactive matrix are discussed. Shame represents a complete mother–child system. It disallows firm boundaries between mother and child because the image of the self cannot be detached from the image of the other. There is no stable sense of self, defined by secure boundaries, and no ability to trust perceptions of self and the world. The therapist must provide the route out of shame by providing a new paradigm of nurturance that includes insistence on separation and forgiveness, as well as the identification of the system of shame. The therapist must be vigilant about his or her own shame and must be able to forgive the client's parents for the damage they have caused. The therapist's avoidance of shame, particularly as evidenced in the routine substitution of guilt as the problematic phenomenon, serves to protect him or her from powerful, painful feelings but acts as a disservice to the client who profoundly suffers shame. The goal for borderline clients is not to become shame-free, but to live lives undetermined by shame. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vertical transmission of cytomegalovirus, most probably by breast milk, to an infant with Wiskott-Aldrich syndrome with fatal outcome

A 4-month-old boy with prenatally diagnosed Wiskott-Aldrich syndrome became ill with a severe cytomegalovirus (CMV) infection, the outcome of which was fatal. The parents had isolated the infant from other children and adhered to standards of hygiene in order to avoid CMV infection because their first child had died of Wiskott-Aldrich syndrome and CMV infection. The mother breast-fed her child although she was CMV IgG positive. The source of infection was most probably breast milk, which contained CMV at the time the infant developed the generalized CMV infection. Conclusion: In infants with immunodeficiency syndromes, CMV infection may have a fatal outcome. Since the virus can be transmitted by breast milk, the advantages and disadvantages of breast-feeding should, therefore, be weighed in newborn infants with an immunodeficiency syndrome whose mother is a CMV carrier.     

The aminolysis of beta-phenylglycide esters. 3. Chemical structure proof

Peptic ulcer in pregnancy and its complications, though rare, can be life-threatening to mother and fetus. Perforated peptic ulcer in pregnancy is extremely rare; when this occurs survival of both mother and child is unusual. Only five cases of maternal survival following perforation of a peptic ulcer have previously been recorded and, of these, only three were associated with survival of both mother and infant. The authors report an additional case of perforated ulcer in pregnancy with survival of mother and infant, and review the relevant literature. Early surgical diagnosis and treatment followed by vaginal delivery of the fetus offers the best hope for survival of mother and child.     

Behavioral disposition of child and caretaker-child interaction.

To assess relations between behaviors in a particular circumscribed caretaker–child interaction setting and child behavioral dispositions assessed by more extensive observation, caretaker–child interaction data collected across several days in a nursery school free-play setting were related to child behavioral disposition data collected across 4 wks of nursery school attendance. For 20 boys and 20 girls, child behavioral disposition variables describing out-of-control and disruptive behaviors were positively related to level of caretaker-initiated interaction in the caretaker–child interaction situation. For boys, child behavioral disposition variables describing impatience, excitement, and outgoingness and, for girls, child behavioral disposition variables describing nonaggressiveness and fear were positively related to level of child-initiated interaction in the caretaker–child interaction situation. The caretaker's initiations are interpreted as responses to what are traditionally viewed by adults as "problem" behaviors. The child's initiations are interpreted as reflecting the child's own need for comfort and nurturance, there being a sex difference in the causes of such a need: high intensity activities for males and low intensity activities for females. Results are also discussed in terms of the isomorphism of relations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When do infants need additional inspired oxygen? A review of the current literature

A previously healthy 8-month-old infant experienced a dramatic change in affect, motor patterns, and appetite after a brief (4-day) separation from her parents. She went from being a happy, interactive, and engaging child to being withdrawn, with limited vocalization, spontaneous motor activity, or interest in her environment. For the first 3 days after her parents returned home, she refused solid food and most of the formula or water she was offered. Over the following week, her appetite increased minimally. Her parents were concerned about her apathy, excessive quietness, and lack of interest in food, toys, or their own attempts to engage her in play. At the pediatrician's office, she was significantly less interactive and playful compared with previous visits. Her temperature, heart rate, and respiratory rate were normal. Although there were no objective signs of dehydration, her weight was 8 ounces less than the previous recorded weight 1 month ago. Results of the physical examination were normal, with the exception of neurological and behavioral findings. She had mild, generalized decreased tone and strength, with normal deep tendon reflexes, a sad facial appearance with sustained furrowing of the lines in her forehead, difficulty in eliciting a social smile, and limited spontaneous sounds. There was an absence of focal neurological findings, a flat open anterior fontanel, and a head circumference measurement consistent with previous recorded results. There were no cutaneous bruises, and findings of her funduscopic examination did not reveal retinal hemorrhage. Before the 4-day holiday, child care was provided almost exclusively by her mother at home. On only two previous occasions, at 4 and 6 months of age, this first child of 20-year-old high school graduate parents was cared for by a neighbor when the parents went out to a movie theater. She cried for about 10 minutes when the parents left on these occasions. Her mother stated that she felt anxious about leaving the child for several days, but she and her husband decided that they needed a break and planned the 4-day vacation. Child care was provided by the neighbor, who did not notice any unusual behavior or refusal to feed while in her care during the parents' absence.     

Munchausen syndrome by proxy: a different kind of child abuse

Munchausen syndrome by proxy (MSBP) continues to mystify health care professionals, law enforcement officials and the judicial system. Even though the first cases were described in 1977, it remains puzzling why a parent would want to induce fictitious symptoms and illnesses in a child. Many professionals do not consider MSBP as a diagnosis because the parent, usually the mother, is so convincing that she is a "good" mother, cares about and wants the best for her child. This article is offered to further educate physicians that MSBP exists, can present in the form of anything and should be considered as a diagnosis in cases that do not make medical sense. Case examples are provided, along with common and not so common presentations. MSBP is a form of severe child abuse that must be reported to Child Protection Service when a child is endangered. Physicians play a critical role in identifying these children and recommending the best course of action to the rest of the system.     

Review of Countertransference in the treatment of PTSD.

Reviews the book, Countertransference in the treatment of PTSD, edited by John P. Wilson and Jacob D. Lindy (see record 1994-98036-000). This book purports to be the first to examine systematically the unique role of countertransference in working with victims of trauma. To help systematize clinical work with trauma victims, the contributors produced a theoretical model that attempts "to identify the core elements and dimensions of countertransference and their relationship to PSTD." The unique status of this book claimed by the editors is predicated on an assumption unexamined by the editors; namely, that the contributors have uncovered a new clinical phenomenon—countertransference to PSTD. This assumption rests on a second important and unquestioned assumption that the victims of PSTD suffer differently and more horribly than do other sufferers of the human condition. Haven't clinicians learned by now that suffering is suffering regardless of the external event that may have precipitated the hurt? If suffering is suffering, regardless of its provocation, then countertransference is countertransference regardless of the external events to which the clinician is responding. While this volume, by carefully delineating and systematizing a host of therapist responses to patient inductions, contributes to a better understanding of countertransference, it hasn't discovered a new clinical phenomenon. The value of this book resides in the thoughtful ways the contributors discuss monitoring one's countertransference and their compassionate and efficacious responses to the suffering of their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social organization, physical environment, and infant–caretaker interaction.

Examined the relationships of the infant–caretaker interaction with the home's social organization and physical environment in rural Malay and Chinese families living in Malaysia. 12 families in each group were observed every 4–6 wks until the target infant's 1st birthday. Most infant–caretaker interaction in the nuclear Malay family occurred in areas physically separate from work and cooking facilities, which were compatible with infant crawling and exploration. The extended family in the Chinese home interacted with the infant in a large room that contained cooking, storage, and work areas. These differences in the social and the physical environments paralleled differences in infant–caretaker interaction between Malays and Chinese, including the role of alternate caretakers in the management of infant crying, the distribution and context of physical contact, and the proximity regulation between infant and mother. Findings are discussed in terms of the integration of behavioral characteristics, patterns of social organization, and arrangement of the physical environment that constitutes a culture's caretaking practices. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The replacement of the fantasied oedipal child: A disruptive effect of sibling loss on the mother-infant relationship.

Presents the case of a 30-yr-old woman whose sibling had died during adolescence and who experienced her own child, almost 2 decades later, as a replacement for the lost sibling. This process was facilitated by the oedipal meaning of her sibling and by the interference in her family's ability to mourn the death of the child. The case illustrates the manner in which these conflicts were activated during the patient's pregnancy and how they subsequently interfered in the developing mother–infant relationship prior to intervention. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mother-child hospitalization

The authors think, that psychological perturbations in women during the period immediately preceding and following childbirth brings about deepseated personality changes that will determine the future relationship between the mother and her child and all subsequent children. Hospitalization of the mother and child together is resorted to in three types of case: for the classic post-partum psychosis, for psychotic mothers showing serious personality troubles, and for early deviations in the mother-child relationship. For most children the alternative is being taken into care, or being placed in the hands of a series of mother-substitutes. Joint hospitalization allows a relationship to be established in a satisfactory environment, allows the mother-child relationship to be maintained, or a means of separation arranged if it should prove necessary. This practice opens new horizons in research into the psychology of mothers and the child's development in the earliest time of life. It should be possible to organize hospitalization of this type within the structure of the general hospital, and include it in the long-term treatment both of the mother and the child.     

Drug delivery during pregnancy: evaluation in vitro of new drugs

Indications for the treatment of the pregnant woman fall into three general categories: mother and infant require treatment, only the mother should be treated, or only the infant. Directing therapy towards the affected subject is an important aspect of good care, although it is not the only one. It is argued that a rational selection of the appropriate drug can be made without endangering mother or infant, with the aid of select laboratory investigations, including placental perfusion, and a knowledge of placental physiology. Examples are presented to support this contention. The intra-amniotic administration of drugs is briefly discussed. A plea is made to develop drugs that are designed specifically for use during pregnancy.     

Intonation contours as signals in maternal speech to prelinguistic infants.

The utterances of 6 mothers to their 2-, 4-, and 6-mo-old infants were analyzed to determine the type of grammatical sentence, the pitch contour of the utterance, and whether the infant was gazing and smiling at the mother at the time of her utterance. Two contours were context specific for all mothers: Rising contours were used when the infant was not visually attending and the mother "wanted" eye contact; sinusoidal and bell-shaped contours were used when the infant was gazing and smiling at the mother and she wanted to maintain the infant's positive affect and gaze. Different mothers used different contours to elicit smiling when the infant was gazing but not smiling at her. Mothers also used specific pitch contours for specific types of sentences. Yes–no questions had rise contours, and "wh" questions and commands generally had fall contours. Declarative sentences had sinusoidal–bell contours rather than the fall contours. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing a mother's response to her child's disclosure of incest.

The nonoffending parent of an incest victim, in many cases the mother, occupies a pivotal position when incest is disclosed. The response of the mother may further or hinder the future mental and emotional health and well-being of the child victim. Many factors appear to be involved in determining the reactions of the mother, and it is imperative that psychologists give thought to the dynamics involved in being in this unique position. Accurate assessment and effective intervention with the nonoffending mother may serve to preserve or facilitate the parental support the child victim clearly needs at the time of disclosure, thus reducing the likelihood of severe repercussions from the abuse and disclosure experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)