Mentalizing in first-time fathers: reflective functioning as a mediator between attachment representation and sensitivity.

Sensitivity in parent-child interaction is essential for child development. Since fathers are increasingly involved in childrearing, identifying factors leading to paternal sensitivity is crucial. We examined the relation between attachment representation and reflective functioning (RF) as factors influencing paternal sensitivity in a longitudinal study including N = 40 first-time fathers (Mage = 33) and their 6-month-old children. We used the Adult Attachment Interview during pregnancy to assess paternal attachment representation and general RF, the Parental Development Interview to assess fathers' parental RF, and the Emotional Availability Scale to measure sensitivity at child's age of 6 month. Data show that secure paternal attachment representation, high general and parental RF are associated with higher levels of paternal sensitivity. Further, parental RF mediates the association between attachment representation and paternal sensitivity. These findings contribute to the identification of a causal interplay in that they suggest an explanatory effect of RF on the association between fathers' attachment representation, and sensitivity.

The Therapeutic Relationship in EMDR Therapy.

The history of EMDR Therapy goes back to 1987, when it was introduced as EMD, a novel treatment for PTSD by Francine Shapiro. Over the course of time EMD developed into the comprehensive therapy approach named EMDR Therapy. The development of the "Adaptive Information Processing (AIP) Model", the model of pathogenesis and change of EMDR Therapy, was a milestone in this development from technique to psychotherapy approach. Up to date EMDR Therapy offers not only a model of pathogenesis and change, but also a variety of treatment plans and techniques to treat patients of various diagnosis far beyond PTSD. What seems to be missing is a specific description of the therapeutic relationship in EMDR Therapy. The therapeutic relationship should be described as a core element of EMDR Therapy, and seems be related to the structure of EMDR Therapy. As attachment theory offers a view on the development of interpersonal relationships in general, an attachment theory based perspective of the therapeutic relationship seems advisable. A description of the therapeutic relationship in EMDR Therapy is necessary at this point of the development of EMDR Therapy to a psychotherapeutic approach and therefore we try to describe the therapeutic relationship in this article and point out parallels between the therapeutic relationship and the development and core features of an attachment based relationship. We propose to describe EMDR Therapy as a sensitive psychotherapy. Implications for treatment, training and research will be discussed.

Examining Ecological Constraints on the Intergenerational Transmission of Attachment Via Individual Participant Data Meta-analysis.

Parents' attachment representations and child-parent attachment have been shown to be associated, but these associations vary across populations (Verhage et al., 2016). The current study examined whether ecological factors may explain variability in the strength of intergenerational transmission of attachment, using individual participant data (IPD) meta-analysis. Analyses on 4,396 parent-child dyads (58 studies, child age 11-96 months) revealed a combined effect size of r = .29. IPD meta-analyses revealed that effect sizes for the transmission of autonomous-secure representations to secure attachments were weaker under risk conditions and weaker in adolescent parent-child dyads, whereas transmission was stronger for older children. Findings support the ecological constraints hypothesis on attachment transmission. Implications for attachment theory and the use of IPD meta-analysis are discussed.

[Attachment and Adoption: Diagnostics, Psychopathology, and Therapy]. / Bindung und Adoption: Diagnostik, Psychopathologie und Therapie.

This presentation describes the development of attachment between adopted children and their adoptive parents with a focus on the particular issues seen in international adoptions. The questions of settling in, trauma in the country of origin, and the motivations of the adoptive parents will be discussed. Diagnosis and various psychopathological manifestations will be examined, as will outpatient and inpatient modes of therapy. The treatment of children of various ages will be covered along with the necessity for intensive counseling and psychotherapy for the adoptive parents. This will enable the parents to work through early trauma, which will give them and their adopted child the basis for developing healthy attachment patterns. This in turn will enable the child to mature and integrate into society. Possibilities of prevention are discussed. Many of the approaches discussed here regarding attachment and adoption may be applied to foster children and their foster parents.

Prospective randomised multicentre trial with the birth trainer EPI-NO for the prevention of perineal trauma.

BACKGROUND: In several non-randomised trials training with EPI-NO increased the rate of intact perineum and decreased episiotomy rates, shortened the second stage of labour and lowered use of pain killers. AIMS: To verify the preliminary results with EPI-NO in a prospective randomised trial. METHODS: Randomised, single-blind multicentre trial in four university hospitals in Germany including 276 primigravidae. RESULTS: After training with EPI-NO we observed a significant increase in the incidence of intact perineum (37.4% vs 25.7%; P = 0.05) and a tendency towards lower episiotomy rates (41.9% vs 50.5%; P = 0.11). We found no significant differences between the two groups regarding incidence of perineal tears, duration of second stage of labour, use of pain relief and rate of vaginal infection. CONCLUSIONS: Training with EPI-NO increases significantly the likelihood of having an intact perineum and reduces the episiotomy rate.

[Anxiety and coping strategies of pregnant women and infant development in the context of prenatal ultrasound diagnostics]. / Angst und Bewältigungsformen von Schwangeren und kindliche Entwicklung bei pränataler Ultraschall-Diagnostik.

Ultrasound is a widespread non-invasive method of prenatal diagnosis. The detection of fetal abnormalities can provoke anxiety, which needs coping. Anxiety and the coping process of pregnant women with different risk conditions for fetal abnormality were studied in a longitudinal design and compared with a non-risk control group of women with healthy uncomplicated pregnancies. The level of anxiety and the coping strategies of women (N = 664) during the second trimester were assessed with questionnaires. Data were collected at three points in time: immediately before the ultrasound scanning for fetal malformation, 5-6 and 10-12 weeks after the prenatal ultrasound examination. Questionnaires were also used to collect information about sociodemographic data, pregnancy data and personality. The level of anxiety showed a correlation with the coping strategies. The analysis of the coping strategies of women with high-risk pregnancies (n = 497) and as well of these with no-risk conditions in the control group (n = 167) revealed three different factors of coping: Factor I: positive emotional attitude/distance, Factor II: negative emotional attitude/disapproval and Factor II: active coping. At all three points in time, Factor I correlated significantly with anxiety decrease, Factor II with increase and Factor III did not correlate with anxiety at all. Women with risk-pregnancies experienced high levels of anxiety before ultrasound scanning and used coping strategies similar to those women in the control group. Different spectrums of coping strategies corresponded significantly to increasing or decreasing anxiety. These women with high levels of anxiety should be offered psychotherapeutic counselling, as their coping processes did not lead to successful coping in the form of a reduction in anxiety. The possible impact of these results on fetal and infant development is discussed.

[The importance of early traumatic experiences for the development of the infant's brain]. / Psychisch kranke Kinder wurden häufig als Säuglinge "traumatisiert". Wie Sie elterliches Fehlverhalten erkennen und vorbeugen.

Learning and social and emotional experiences have an impact on gene activity, and modify the growth and function of nerve cells. As a result, and depending on the interactive experiences within relationships, motoric, cognitive and emotional skills, as well as behavior of the infant are influenced. If the child fails to experience a dependable relationship, the symptoms of mental disturbance often develop (e.g. ADHD, among others). Further factors that impact on brain development and lead to posttraumatic stress disorder (PTSD) are deprivation, physical violence and sexual abuse in early childhood.

The influence of prematurity, maternal anxiety, and infants' neurobiological risk on mother-infant interactions.

In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother-infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full-term sample (n = 35) showed mother-infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction. Additionally, higher levels of maternal anxiety were associated with preterm infants being less facially responsive in interaction with their mother. While neurobiological risk of the infant played a part in this association, with higher risk infants also being less facially responsive, the relationship with maternal anxiety and the mother-child interaction was stronger. How these findings may influence therapeutic interventions is discussed.

Early preventive attachment-oriented psychotherapeutic intervention program with parents of a very low birthweight premature infant: results of attachment and neurological development.

The birth of a very small preterm infant (< or = 1500 grams) can be a traumatizing experience for many parents. A developmental risk model is presented that is the background to an early attachment-oriented preventive psychotherapeutic intervention. This comprehensive parent-centered intervention program is composed of supportive group psychotherapy, attachment-oriented focal individual psychotherapy, a home visit and video-based sensitivity training. The intervention aims at improving parental coping, the process of attachment and parent-infant interaction. In a prospective longitudinal design mothers were randomly assigned to a control (N = 44) and an intervention group (N = 43) after preterm delivery. Results show that the percentage of secure (control vs. intervention group: 77.8% vs. 59.4%) and insecure (control vs. intervention group: 8.3% vs. 31.3% avoidant, 13.9% vs. 9.4% ambivalent) attachment quality in high-risk preterm infants is comparable to results from studies with term infants. There was no significant statistical difference in terms of quality of attachment of the preterm infants between the control group and the intervention group. However, only in the control group, impaired neurological development corresponded significantly with an insecure quality of attachment, but not in the intervention group, although there were significantly more neurologically impaired infants in the intervention group. This result is discussed as an effect of the intervention program.