Donor sibling relations among adult offspring conceived via insemination by lesbian parents.

STUDY QUESTION: How do adult offspring in planned lesbian-parent families feel about and relate to their donor (half) sibling(s) (DS)? SUMMARY ANSWER: A majority of offspring had found DS and maintained good ongoing relationships, and all offspring (regardless of whether a DS had been identified) were satisfied with their knowledge of and contact level with the DS. WHAT IS KNOWN ALREADY: The first generation of donor insemination offspring of intended lesbian-parent families is now in their 30s. Coincident with this is an increased use of DNA testing and genetic ancestry websites, facilitating the discovery of donor siblings from a common sperm donor. Few studies of offspring and their DS include sexual minority parent (SMP) families, and only sparse data separately analyze the offspring of SMP families or extend the analyses to established adult offspring. STUDY DESIGN, SIZE, DURATION: This cohort study included 75 adult offspring, longitudinally followed since conception in lesbian-parent families. Quantitative analyses were performed from online surveys of the offspring in the seventh wave of the 36-year study, with a 90% family retention rate. The data were collected from March 2021 to November 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were 30- to 33-year-old donor insemination offspring whose lesbian parents enrolled in a US prospective longitudinal study when these offspring were conceived. Offspring who knew of a DS were asked about their numbers found, characteristics or motivations for meeting, DS terminology, relationship quality and maintenance, and impact of the DS contact on others. All offspring (with or without known DS) were asked about the importance of knowing if they have DS and their terminology, satisfaction with information about DS, and feelings about future contact. MAIN RESULTS AND THE ROLE OF CHANCE: Of offspring, 53% (n = 40) had found DS in modest numbers, via a DS or sperm bank registry in 45% of cases, and most of these offspring had made contact. The offspring had their meeting motivations fulfilled, viewed the DS as acquaintances more often than siblings or friends, and maintained good relationships via meetings, social media, and cell phone communication. They disclosed their DS meetings to most relatives with neutral impact. The offspring, whether with known or unknown DS, felt neutral about the importance of knowing if they had DS, were satisfied with what they knew (or did not know) of the DS, and were satisfied with their current level of DS contact. This study is the largest, longest-running longitudinal study of intended lesbian-parent families and their offspring, and due to its prospective nature, is not biased by over-sampling offspring who were already satisfied with their DS. LIMITATIONS, REASONS FOR CAUTION: The sample was from the USA, and mostly White, highly educated individuals, not representative of the diversity of donor insemination offspring of lesbian-parent families. WIDER IMPLICATIONS OF THE FINDINGS: While about half of the offspring found out about DS, the other half did not. Regardless of knowing of a DS, these adult offspring of lesbian parents were satisfied with their level of DS contact. Early disclosure and identity formation about being donor-conceived in a lesbian-parent family may distinguish these study participants from donor insemination offspring and adoptees in the general population, who may be more compelled to seek genetic relatives. The study participants who sought DS mostly found a modest number of them, in contrast to reports in studies that have found large numbers of DS. This may be because one-third of study offspring had donors known to the families since conception, who may have been less likely to participate in commercial sperm banking or internet donation sites, where quotas are difficult to enforce or nonexistent. The study results have implications for anyone considering gamete donation, gamete donors, donor-conceived offspring, and/or gamete banks, as well as the medical and public policy professionals who advise them. STUDY FUNDING/COMPETING INTEREST(S): No funding was provided for this project. The authors have no competing interests. TRIAL REGISTRATION NUMBER: N/A.

The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning.

The present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. The study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). All families lived in Italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). The AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. Similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. Mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. The results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood.

European gay fathers via surrogacy: Parenting, social support, anti-gay microaggressions, and child behavior problems.

The present study investigated child behavior problems, parenting styles, coparenting, and couple relationship satisfaction in 67 European gay father families via surrogacy and 67 European heterosexual parent families via unassisted conception, all with children aged 1.5-10 years (M = 3.57 years, SD = 2.09). The two family groups were matched for child age and gender. In the gay father group only, the associations between family anti-gay microaggressions, family/friend support, and other main variables also were explored. Children of gay fathers had fewer externalizing and internalizing problems compared to children of heterosexual parents. Also, gay fathers reported more effective parenting styles, greater coparenting quality, and higher couple relationship satisfaction compared to heterosexual parents. Overall, child externalizing problems (i.e., aggression, rule-breaking) and internalizing problems (i.e., anxiety, depression) were more strongly associated with being raised in a heterosexual parent family, more authoritarian parenting, and lower positive coparenting. Specific to the gay father sample, anti-gay microaggressions experienced by family members were associated with more child internalizing problems, lower positive coparenting, and lower social support from family and friends. These results refute concerns about possible detrimental effects on child development of surrogacy conception or of being raised by gay fathers. The results further suggest that family therapists treating child behavior problems should focus mainly on improving the coparenting relationship, reducing authoritarian/punitive parenting styles, and (for gay father families specifically) coping with anti-gay microaggressions and lack of social support outside the nuclear family.

Patient personality dimensions, relational patterns and therapeutic alliance in clinical practice: An empirical investigation.

INTRODUCTION: Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. METHODS: A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler-Westen Assessment Procedure-200 (SWAP-200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI-T) to evaluate quality of therapeutic alliance. RESULTS: Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician-patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. CONCLUSIONS: Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes.

Sperm donor relations among adult offspring conceived via insemination by lesbian parents.

AIM: The present study examined how adult offspring of lesbian parents relate to their anonymous, open-identity, or known donors. DESIGN: An online survey of 75 donor-conceived offspring of lesbian parents, aged 30-33 years, participating in Wave 7 of a U.S. 36-year longitudinal study of planned lesbian-parent families was conducted. Offspring were asked about donor type, motivations for contacting the donor, terminology for the donor, relationship quality, means of relationship maintenance, impact of donor contact on offspring's other family members, and their feelings about the donor. RESULTS: Twenty offspring with anonymous donors and 15 with open-identity donors whom they had not contacted felt comfortable not knowing their donors. Forty offspring knew their donors - anonymous, contacted through an online registry (n = 7), open-identity, contacted (n = 9), or known since childhood (n = 24). Offspring who had contacted their donor since age 18 had their motivations fulfilled after contact, got along well with him, did not view him as a relative, and had told most family members about their contact, without detriment. Whether the donor was unknown or known at this stage of their lives, most offspring were satisfied with their contact level. CONCLUSION: This cohort of donor-conceived offspring of lesbian parents was among the first to reach adulthood during a time of technological advances in DNA testing, giving access to anonymous donors via online registries. The results inform donors, families, mental health providers, medical providers and public policymakers, on whether, how, and to what degree donor-conceived offspring optimally make donor contact.

Parenting, dyadic coping, and child emotion regulation in lesbian, gay, and heterosexual parent families through assisted reproduction.

AIMS: The present study examined the associations between family structure, parenting, and dyadic coping and children's emotion regulation in lesbian, gay, and heterosexual parent families through assisted reproduction. It also explored differences in parenting dimensions and dyadic coping, based on parents' sexual orientation. METHODS: Participants were 60 lesbian mothers through donor insemination, 50 gay fathers through surrogacy, and 42 heterosexual parents through gamete donation, all with a child aged 6-12 years (M = 8.67; SD = 2.16; 48.68% females) and residing in Italy. In each family, both parents reported parenting stress, parent - child relational self-efficacy, parental control, dyadic coping, and their perception of the child's emotion regulation. RESULTS: Mixed models indicated no significant differences between family types in parenting stress and use of a controlling parenting style. However, lesbian mothers reported higher parent - child relational self-efficacy than heterosexual parents, and higher dyadic coping strategies than gay fathers. Also, children of gay fathers showed greater emotion regulation than children of heterosexual parents. Across family types, higher levels of parenting stress and dyadic coping, and lower levels of parent - child relational self-efficacy were associated with lower child emotion regulation. CONCLUSION: Given that in middle childhood, across family types, better emotional regulation was associated with lower parenting stress and dyadic coping, and greater effectiveness in the parent - child relationship clinical work should focus on the parent's and couple's ability to cooperatively manage stressors while maintaining a balanced focus on their children's resources and autonomy.

Disclosure and child exploration of surrogacy origins in gay father families: Fathers' Adult Attachment Interview coherence of mind matters.

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.

Examining Differences in Alcohol and Smoking Behaviors between Parenting and Nonparenting Lesbian Women.

BACKGROUND: The transition to parenthood is a significant life event that has implications for health behaviors and health. Few studies have examined alcohol use and smoking by parenthood status (nonparent vs. parent) among women who identify as lesbian. METHODS: This study used data from two longitudinal studies, the Chicago Health and Life Experiences of Women Study (n = 135) and the U.S. National Longitudinal Lesbian Family Study (n = 116), to compare problem drinking and cigarette smoking trajectories among lesbian-identified women by parenthood status. We used mixed models to investigate differences in problem drinking and cigarette smoking in three waves of data in each study. RESULTS: Lesbian parents reported significantly less problem drinking, but not cigarette smoking, than nonparent lesbian women. When considering the interaction between parental status and time, problem drinking was significantly higher among nonparents than parents at each time interval. CONCLUSIONS: Parenthood was associated with positive changes in drinking among lesbian women; however, more research is needed to understand how to support smoking cessation among parenting lesbian women.

Peer Microaggressions and Social Skills among School-Age Children of Sexual Minority Parents through Assisted Reproduction: Moderation via the Child-Teacher Relationship.

The impact of peer microaggressions and the child-teacher relationship on the social skills of children with sexual minority parents has received little attention. The current study used a mixed-method, multi-informant, two-wave longitudinal design to address this research gap. Thirty-seven children of lesbian mothers through donor insemination and 33 children of gay fathers though surrogacy (wave 1: Mage = 8.3 years, SD = 1.6; 51.4% female; wave 2: Mage = 9.9 years, SD = 1.7), all school-aged and residing in Italy, participated together with their 140 parents and 55 teachers. Approximately two-thirds of the children reported at least one peer microaggression and, on average, microaggressions were of a low intensity. Child-teacher relationships were of high quality (i.e., characterized by high safe haven-seeking and secure base use, and low conflict). Both parents and teachers reported high levels of child social skills. However, more intense W1 microaggressions predicted lower W2 social skills among children reporting a lower W1 child-teacher relationship quality, and greater W2 social skills among those reporting a higher W1 child-teacher relationship quality. These results support the child-teacher relationship as a potentially secure context in which children can "mentalize" negative experiences such as microaggressions and improve their social skills. In this vein, considering microaggression, attachment, and developmental intergroup theories, teachers must attune to the school experiences of children with sexual minority parents and cultivate caring classroom environments that are sensitive to family diversity.

Father-child bonding and mental health in gay fathers using cross-border surrogacy during the COVID-19 pandemic.

RESEARCH QUESTION: What are the psychological implications of the COVID-19 pandemic for father-child bonding and mental health among Italian gay fathers pursuing surrogacy in the USA or Canada? DESIGN: Between 20 March and 29 July 2020, this cross-sectional case-control study collected data on father-child bonding quality, depression, anxiety and somatization in 30 Italian gay fathers (n=15 families) who were having or successfully had a child through cross-border surrogacy during the COVID-19 pandemic. These fathers were compared with a sociodemographically similar group of 50 Italian gay fathers (n=25 families) who had children through cross-border surrogacy prior to the pandemic. RESULTS: Although father-child bonding quality and the mental health symptoms of fathers scored below the clinical cut-off points in both groups, fathers who had or were having a child during the COVID-19 pandemic reported poorer father-child bonding (estimate 3.04, SE 1.47, P=0.044) and more depressive (estimate -1.47, SE 0.49, P=0.005), anxious (estimate -1.96, SE 0.55, P<0.001) and somatic symptoms (estimate -2.48, SE 0.52, P<0.001). CONCLUSIONS: The findings call for the development of international guidelines for cross-border surrogacy and underline the need for tailored and ongoing psychological and legal support for intended gay fathers to ease their strain and anxiety related to having a child through cross-border surrogacy during the COVID-19 pandemic.

Effect of a parenting intervention on decreasing adolescents' behavioral problems via reduction in attachment insecurity: A longitudinal, multicenter, randomized controlled trial.

INTRODUCTION: Secure attachment in adolescence, related to caregiving quality, is a robust predictor of positive behavioral adjustment in early adulthood and beyond. Nevertheless, few attempts have been made to develop treatments to promote parent-adolescent attachment security. METHODS: Using a longitudinal, multicenter, randomized controlled trial design, two questionnaire-based studies were run in Italy (Study 1: n = 100 mothers of adolescents, 60% boys, Mage = 14.89, SD = 1.58; Study 2: n = 40 mothers and 40 adolescents, 60% boys, Mage = 14.90, SD = 1.91) to test the effectiveness of an attachment-based parenting intervention (i.e., Connect) in reducing adolescents' behavioral problems and attachment insecurity 2 weeks post-intervention (t2) and at a 4-month follow-up (t3). It was further investigated whether a decrease in avoidant and anxious attachment at t2 would account for changes in externalizing and internalizing problems, respectively, at t3. All adolescents belonged to two-parent intact families. RESULTS: Mothers who completed Connect reported significantly fewer adolescent behavioral problems and lower adolescent attachment insecurity, compared to mothers in the waitlist group, at both t2 and t3 (Study 1). These findings were confirmed in a second subsample (Study 2), considering both mothers' and adolescents' reports. Controlling for pre-intervention behavioral problems, reductions in internalizing and externalizing problems were observed in both studies at t3 via a decrease in anxious and avoidant attachment, respectively, at t2. CONCLUSIONS: The findings point to the malleability of attachment security in adolescence and highlight the importance of targeting parenting quality to promote adolescent behavioral adjustment.

Childhood abuse and neglect experiences, Hostile-Helpless attachment, and reflective functioning in mentally ill filicidal mothers.

The present study represents the first empirical investigation of the mechanisms - a Hostile-Helpless (HH) attachment and reflective functioning (RF) - through which childhood abuse and neglect (CA&N) experiences may impact a mother's likelihood to commit filicide. The sample was comprised of 46 mentally ill mothers. Differences in attachment-derived risk variables between filicidal mothers (FM) and non-filicidal mothers (NFM) were also examined. FM (n = 23) reported lower RF, higher HH attachment, and a more severe history of CA&N, compared to NFM (n = 23), but did not differ on the severity of childhood experiences of loss of and/or separation from attachment figures. Bayesian analysis indicated that the mediated effect of more severe CA&N on the likelihood of committing filicide through higher HH attachment was significantly amplified by lower RF. A developmental interpretation of filicide is proposed and clinical implications for prevention and attachment-based interventions with at-risk mother-child dyads are discussed.

Enhancing food habits via sensitivity in rural low-SES mothers of children aged 1-3 living in Colombia: a randomized controlled trial using video-feedback intervention.

In a randomized controlled trial with 25 Colombian rural low-SES mothers and their children (aged 1-3 years), the effectiveness of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) in enhancing maternal sensitivity and food habits was tested pre-intervention, post-intervention, and at a 6-month follow-up. The study further verified whether maternal sensitivity represented a mechanism of change for food habits. Mixed models indicated that the VIPP-SD did promote higher maternal sensitivity and better food habits. Moreover, increased maternal sensitivity following the VIPP-SD predicted improved maternal food habits, both post-intervention and at the follow-up. The findings suggest that interventions aimed at preventing early inadequate parental food habits in low-SES communities should promote sensitive parenting during daily mother-child interactions, in addition to offering nutritional advice.

Long-Term Effects of Homophobic Stigmatization During Adolescence on Problem Behavior in Emerging Adult Offspring of Lesbian Parents.

The long-term impact of homophobic stigmatization on adolescents with lesbian parents has not been explored. This longitudinal study investigated the effects of homophobia experienced during adolescence on problem behavior among emerging adult offspring of lesbian parents. The 72 offspring (37 females and 35 males; all cisgender and 25 years old) were predominantly White, heterosexual, and highly educated. As 17-year-old adolescents, 40.3% (n = 29) reported that they had been treated unfairly because of having lesbian parents. Experienced homophobia during adolescence was indirectly associated with internalizing problems during emerging adulthood through psychological problems during adolescence and meaning in life in emerging adulthood. Adolescent experiences of homophobia were also indirectly related to externalizing problems during emerging adulthood through adolescent psychological problems, but not through meaning in life in emerging adulthood. These findings indicate that long-term effects of homophobic stigmatization during adolescence persist into adulthood. School and community interventions should include all types of families in their diversity appreciation programs.

Child attachment security in gay father surrogacy families: Parents as safe havens and secure bases during middle childhood.

Child attachment security and utilization of parents as safe havens and secure bases were compared in 33 surrogacy children with gay fathers and 37 donor-conceived children with lesbian mothers during middle childhood. Assessments included data coded from parent-child interactions, interviews, and questionnaires administered to children and both parents. Findings indicated that children of gay fathers perceived high attachment security and their scores did not differ from those of children with lesbian mothers or from normative scores of children with heterosexual parents. Children's greater attachment security was associated with higher levels of parental warmth, responsiveness, and willingness to serve as an attachment figure; lower levels of parental negative control and rejection; and the child's younger age. Finally, children used the primary attachment figure more as a safe haven and the secondary attachment more as a secure base, though they reported high levels of both types of support from both parents.

Support for discriminatory behaviours against immigrants in Italy: Perceived threat and positive beliefs mediate the effect of contact with immigrants.

The present study aimed at investigating whether the effects of intergroup contact on support for discriminatory behaviours against immigrants was mediated by perceived threat from immigrants and positive beliefs toward immigrants. Using data from the Italian national survey on "Discrimination by Gender, Sexual Orientation and Ethnic Origin," which followed a multi-stage stratified cluster sampling procedure, a representative sample of 5509 Italian residents (53.4% women), aged 18 to 74 years, participated. Findings showed that contact with immigrants was negatively related to perceived threat, and positively related to positive beliefs toward immigrants. Mediational analysis conducted by structural equation modelling, indicated that support for discriminatory behaviours was positively associated with perceived threat, and negatively associated with positive beliefs toward immigrants. Both variables together mediated the relationship between contact with immigrants and support for discriminatory behaviours against immigrants; individually, indirect relationships were also significant. To promote interaction between natives and immigrants by reducing the perceived threat and strengthening positive beliefs toward immigrants might lessen support for discriminatory behaviours against immigrants.

Surrogacy families headed by gay men: relationships with surrogates and egg donors, fathers' decisions over disclosure and children's views on their surrogacy origins.

STUDY QUESTION: How do gay father families experience surrogacy in terms of their relationships with surrogates and egg donors, fathers' disclosure decisions and children's views on their surrogacy origins? SUMMARY ANSWER: More families had a relationship with the surrogate than the egg donor, and almost all had started to disclose to their children, the majority of whom expressed limited interest in their surrogacy conception. WHAT IS KNOWN ALREADY: Gay fathers tend to report greater contact with the surrogate than the egg donor and to disclose only the use of a surrogate (omitting discussion of the egg donor and the respective fathers' genetic relatedness). Children's views on their surrogacy conception to gay fathers are not known. STUDY DESIGN, SIZE, DURATION: Thirty-one children and 80 fathers were interviewed as part of a larger in-depth investigation of 40 Italian gay father surrogacy families. Multiple strategies were used to recruit participants. PARTICIPANTS/MATERIALS, SETTING, METHODS: Children were aged 6-12 years and had been born to gay fathers through gestational surrogacy. Semi-structured interviews were conducted in participants' homes with each family member, separately. Fathers' interviews were presented from the perspective of the father who identified as being most involved with the child on a day-to-day basis. Qualitative content analysis was performed and quotations illustrating the findings were reported. Where appropriate, comparisons were conducted using χ2 or Fisher's exact tests. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 31 children in 24 families were interviewed. Most families reported a harmonious relationship with the surrogate (n = 20, 57.1%) and a distant relationship with the donor (n = 10, 66.7%) (χ2(1) = 23.33, P < 0.001). Before the child was aged 4 years, almost all families (n = 34, 85%) had started to disclose their use of a surrogate, with 16 families (n = 16, 40%) also disclosing their use of a donated egg, and only 4 (10%) disclosing which father's sperm had been used. Of the 31 children interviewed, most (n = 17, 54.8%) showed a clear understanding of their conception. About 19 (61.3%) expressed limited interest in their conception, 11 (35.5%) felt positive and 1 child (3.2%) was unsure how he felt. Children differed in their feelings towards their surrogate and egg donor (Fisher's exact test, P = 0.002). Of the 31 children who were aware of the surrogate, the majority felt grateful towards her (n = 22, 71%), while of the 25 children who were also aware of the egg donation, 11 (44%) showed limited interest in their donor. LIMITATIONS, REASONS FOR CAUTION: The sample's convenience nature and the gay father families' high income limited the representativeness of the findings. Further, some children belonged to the same family, and this could have biased the results, as these children may have had similar experiences. WIDER IMPLICATIONS OF THE FINDINGS: Prior to this study, the voice of children conceived by gay fathers through surrogacy had not been heard. Future research on factors influencing children's desired contact with-or interest in-the surrogate and/or egg donor and their feelings when contact is not possible will be important in preparing families for such events. STUDY FUNDING/COMPETING INTEREST(S): Support was obtained from a Sapienza Starting Grant for Research to the first author (grant number AR11715C77EB56B2). None of the authors has any conflict of interest.

Do therapists' subjective variables impact on psychodynamic psychotherapy outcomes? A systematic literature review.

BACKGROUND: Despite growing attention to the general therapist effects in a wide range of clinical settings, little is known about the individual, cross-situational, and therapy-nonspecific variables that impact on the differential effectiveness of clinicians. The current study is a systematic review of the evidence relating to the influence of therapist's subjective characteristics on outcomes of psychodynamic psychotherapies. METHOD: A multistage and systematic search of articles published between 1987 and 2017 identified 30 relevant studies, which were organized into 6 areas according to the specific therapist's variable considered. RESULTS: Therapists' interpersonal functioning and skills showed the strongest evidence of a direct effect on treatment outcomes. Furthermore, there were preliminary evidence that therapists' attachment styles, their interpersonal history with caregivers, and their self-concept might affect outcomes through interaction effects with other constructs, such as technical interventions, patient's pathology, and therapeutic alliance. The high variability between studies on therapists' overall reflective or introspective abilities and personality characteristics suggested the need for more systematic research in these areas, whereas therapists' values and attitudes showed small effects on therapeutic outcome. CONCLUSIONS: The present review clarifies how a deep examination of the contribution of therapists' subjective characteristics can help elucidate the complex association between relational and technical factors related to the outcome of psychodynamic treatments.