Aus Klinik und Praxis / From Clinic and Practice. Die Erweiterung der psychotherapeutischen Perspektive durch bifokale Young Child Observation. Methodisches und Kasuistisches zur Konzeption der Vienna Parent-Toddler Group Study.

Expanding the Psychotherapeutic PerspectiveThrough Bifocal Young Child Observation. Methodological and Case-Related Considerations on the Design of the Vienna Parent-Toddler Group Study The parent-toddler group concept was developed at the Anna Freud Centre in London. Since 2021 it has also been used at the Child Guidance Clinic in Vienna.The Vienna Parent-Toddler Group (PTG) study investigates the significance of participation in such a therapeutic group for changes in children's relational experiences and developmental problems in their families. Among other research tools, the bifocal use of Young Child Observation according to the Tavistock concept is used:The children are observed as continuously as possible in their interactions and relations both in the group and at home.The article first describes the background and the design of the research project. Subsequently, with reference to accounts from the observation of a child with eating problems, it is shown in which respect this observation design provides a deeper understanding of the eating problem. Finally, the arguments for and against an early exchange of considerations between the observers and the psychotherapists are discussed.

[On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany]. / Zum Stand der Aus- undWeiterbildung in Säuglings-/Kleinkind-Eltern-Psychotherapie in Deutschland.

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

[Developmental Disturbance or Autistic Spectrum Disorder? Early Intervention in a Psychotherapeutic Parent-Toddler Group]. / Entwicklungsstörung oder Autismus-Spektrum-Störung? Frühe Intervention in einer pychotherapeutischen Eltern- Kleinkind-Gruppe.

Starting in Vienna in the 1920s, Anna Freud's first tentative attempts at observing children became a crucial component of the "double approach" which integrated direct child observation with psychoanalytic reconstruction. This enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Her identification of disturbances that were developmental rather than neurotic led to the broadening of child analysis. Interventions aimed at freeing and supporting development rather giving insight, became known as "developmental therapy".These interventions are used in the parent-toddler groups that embody Anna Freud's endeavour to link psychoanalytic theory, direct observation and clinical practice. Observations of a toddler who attended a psychotherapeutic parent-toddler group with his mother, show how intervening early in the child's life and soon after concerns were identified, contributed to preventing maladaptive affective states and ways of relating from becoming entrenched.

Father-child bonding among Japanese fathers of infants: A municipal-based study at the time of the 4-month child health checkup.

We aimed to clarify the factor structure of a bonding measure among Japanese fathers with infants and the factors associated with the subscales. Among fathers of children attending the 4-month health checkup, the Japanese version of the Mother-to-Infant Bonding Scale had a two-factor structure comprising "anger" and "lack of affection." Anger was associated with fathers' work demands and poor mental condition, and lack of affection with fathers' older age, poor mental condition, and interpersonal problems at home. Paternal parenting support needs to account for not only the fathers themselves, but also interpersonal communication at home and in the work environment.

Nos propusimos clarificar la estructura de factores de una medida de acercamiento afectivo entre los papás japoneses con infantes y los factores asociados con las subescalas. Entre los papás de niños que asistían al chequeo de salud de 4 meses, la versión japonesa de la Escala de Acercamiento Afectivo Madre a Infante tuvo una estructura de dos factores que comprende "ira" y "falta de afecto." La "Ira" se asoció con las responsabilidades del trabajo de los papás y la débil condición mental, y la "falta de afecto" con la más vieja edad de los papás, la débil condición mental y los problemas interpersonales en casa. La crianza paterna apoya las necesidades de dar cuenta no sólo de los padres mismos, sino también de la comunicación interpersonal en casa y el ambiente de trabajo.

Notre but était de clarifier la structure de facteur d'une mesure de lien entre les pères japonais de nourrissons et les facteurs liés aux sous-échelles. Parmi les pères d'enfants présents pour leur visite médicale de 4 mois la version japonaise de l'Echelle de Lien Mère-Nourrisson était une structure de deux facteurs comprenant "la colère" et "le manque d'affection". "La colère" était liée aux exigences du travail des pères et à une condition mentale moins élevée, et "le manque d'attention" était lié à l'âge plus élevés des pères, à une condition mentale moins élevée et à des problèmes relationnels à la maison. Le soutien de parentage paternel a besoin d'être pris en compte non seulement pour ce qui concerne les pères eux-mêmes mais aussi la communication relationnelle à la maison et l'environnement au travail.

[The Importance of Adaptive Treatment Strategies for Treatment Outcome in fSKEPT]. / Die Bedeutung adaptiver Behandlungsstrategien für den Therapieerfolg in der fokussierten psychodynamischen Säugling-/Kleinkind-Eltern-Psychotherapie.

The manualized focused infant/toddler-parent psychotherapy fSKEPT is a psychodynamic focal treatment of early childhood regulatory disorders, in which either a conflict-related or a personality functioning-related treatment focus is carried out. The aim of the study is to review the effectiveness of fSKEPT depending on two different therapeutic treatment focuses. For this purpose, n = 81 families who received fSKEPT were examined as part of secondary analyzes of a randomized controlled study. The therapeutic treatment focus did not predict the effectiveness for any of the examined target criteria (maternal psychological stress F(1,70) = 0.71, p = .401, maternal depression F(1,70) = 0.18, p = .678, infant regulatory symptoms F(1,70) = 0.11, p = .753, maternal self-efficacy F(1,70) = 0.038, p = .847, maternal reflective functioning F(1,50) = 0.56, p = .458). In a subsample of n = 33 families (40 % of the total sample) we tested whether the therapeutic interventions used in the therapy correspond to the treatment focus of the therapists. No significant difference was found between personality functioning-specific interventions (t(28) = 1.71, p = .099) and unspecific interventions (t(28) = 1.77, p = .087) when comparing the two treatment focus groups. In the conflict focus group significantly more conflict-specific interventions were used (t(28) = 2,71, p = .011). The results demonstrate the effectiveness of the focus concept of the fSKEPT treatment. The focus and the flexible individual adaptation of the interventions in the course of the treatment may help offering parents with different psychological vulnerabilities and ressources an equally effective treatment. In addition, the relevance of unspecific interventions and relationship-promoting aspects of the treatment are discussed.

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child-parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers' behavior and affect (free play) and toddlers' self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.

Los primeros años de la niñez son un período sensible en el desarrollo de la auto-regulación, un grupo de habilidades adaptables que son fundamentales para la salud mental y a las que en parte les da forma la crianza. Es sabido que el dormir bien es esencial para la auto-regulación y, aun así, el nivel al que el sueño del niño altera los procesos interactivos entre progenitor y niño permanece poco estudiado. Este estudio examina las asociaciones entre la crianza observada y la auto-regulación del niño pequeño, tomando como moderador de tal asociación el proceso de dormir del niño pequeño. Se grabó en video a niños pequeños de familias de bajos ingresos (N=171) y sus madres durante una sesión de juego libre y una tarea de auto-regulación que suponía un reto; los videos fueron codificados en cuanto al comportamiento y afecto de las madres (juego libre) y la auto-regulación de los niños pequeños (tarea que suponía reto). Las madres reportaron acerca del sueño nocturno de sus niños por medio de un cuestionario. Los resultados revelaron interacciones significativas en cuanto al dormir y el negativo afecto materno, así como el dormir y el negativo control materno. Los niños que no experimentaron una crianza negativa tenían una buena auto-regulación independientemente de la duración de su sueño nocturno. En el caso de los niños que experimentaron una crianza negativa, la auto-regulación quedó intacta en aquellos que lograban más tiempo nocturno de dormir, pero fue significativamente más pobre en los niños que tenían menos tiempo de sueño nocturno. Por tanto, en el caso de los niños indicados en el reporte con menos tiempo de dormir nocturno, se dieron asociaciones más robustas entre la crianza negativa y una más pobre auto-regulación que entre los niños pequeños indicados en el reporte con más tiempo de dormir.

La petite enfance est une période sensible dans le développement de l'auto-régulation, un ensemble de compétences qui sont fondamentales pour la santé mentale et en partie formées par le parentage. L'on sait qu'un sommeil sain est critique pour l'auto-régulation et pourtant la mesure dans laquelle le sommeil de l'enfant altère les processus interactifs enfant-parent demeure peu étudiée. Cette étude examine les liens entre le parentage observé et l'auto-régulation du petit enfant, le sommeil de l'enfant ayant un effet modérateur dans ce lien. Des jeunes enfants de familles issues de milieux défavorisés (N=171) et leurs mères ont été filmés durant un jeu libre et un exercice de défi d'auto-régulation. Les vidéos ont été codées pour le comportement des mères et l'affect (jeu libre) et l'auto-régulation des jeunes enfants (exercice de défi). Les mères ont fait état de la durée de sommeil nocturne de leur enfant au moyen d'un questionnaire. Les résultats ont révélé que : sommeil significatif x l'affect négatif maternel et le sommeil x négatif maternel contrôle les interactions. Les enfants qui n'avaient pas fait l'expérience d'un parentage négatif avaient une bonne auto-régulation quelle qu'ait été la durée du sommeil nocturne. Pour les enfants ayant fait l'expérience d'une parentage négatif, l'auto-régulation était intacte chez ceux ayant plus dormi, mais bien moindre chez les enfants qui avaient moins dormi. Donc, chez les enfants ayant moins de sommeil nocturne les liens bien plus robustes ont été découverts entre le parentage négatif et une moindre auto-régulation que chez les petits enfants dormant plus durant la nuit.

DEVELOPMENT OF THE PARENT-CHILD PLAY SCALE FOR USE IN CHILDREN WITH FEEDING DISORDERS.

The Parent-Child Play Scale was developed as a scale that complements the Parent-Child Feeding Scale, created by I. Chatoor et al. (1997), to evaluate mother-infant/toddler interactions in two different caregiving contexts of a young child's everyday life, specifically play and feeding. This Play Scale can be used with infants and toddlers ranging in age from 1 month to 3 years and provides reliable global ratings of mother-child interactions during 10 min of videotaped free-play in a laboratory setting. The scale consists of 32 mother and infant/toddler interactive behaviors which are rated by trained observers from videotaped observations. Four subscales are derived: Dyadic Reciprocity, Maternal Unresponsiveness to Infant's/Toddler's Cues, Dyadic Conflict, and Maternal Intrusiveness. Construct validity and interrater and test-retest reliability of the Play Scale have been demonstrated. This Play Scale discriminates between children with and without feeding disorders as well as between children with different subtypes of feeding disorders as defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0-3R) (Feeding Disorder of State Regulation, Feeding Disorder of Caregiver-Infant Reciprocity, and Infantile Anorexia). It can be used for research or clinical practice in the diagnosis and treatment of early feeding problems, to assess the pervasiveness of mother-infant/toddler difficulties and to monitor changes following therapy.

[Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders]. / Elterliche Mentalisierungsfähigkeit und der Zusammenhang mit elterlicher Belastung bei frühkindlichen Regulationsstörungen.

Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders Parents' capacity to reflect on their child as a mental agent, is defined as an important competence for the early parent-infant relationship. One way to operationalize this is parental reflective functioning (PRF) that distinguishes between mentalizing and non-mentalizing modes of reflection. Until today PRF has not been investigated in samples of infants/toddlers with early regulatory disorders. Goal of the present study is to investigate PRF by comparing a clinical group with parents of infants/toddlers with early regulatory disorders (N = 98) with a healthy control group (N = 27) and testing if PRF is related to parenting stress, past mental illness of the mother, and stress factors related to pregnancy and birth. A semi-structured clinical interview, the Parenting Stress Index, the Symptom-Check-List-90R-S, the Parental Reflective Functioning Questionnaire, and an anamnestic questionnaire were used. Compared to the control group, mothers of infants/toddlers with early regulatory disorders reported significant more prementalizing. Prementalizing in the total sample was significantly predicted by parenting stress, accounting for 16.3 % of the variance. None of the other independent variables significantly predicted prementalizing. Results are discussed in relation to early regulatory disorders and implications for clinical practice.

OBSERVING TODDLERS' INDIVIDUAL EXPERIENCES IN CLASSROOMS: INITIAL USE OF THE PARENTING INTERACTIONS WITH CHILDREN: CHECKLIST OF OBSERVATIONS LINKED TO OUTCOMES.

This study investigated using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO; Roggman, Cook, Innocenti, Norman, & Christiansen, 2013a) measure to assess teacher-child interactions experienced by individual toddlers within their childcare classrooms. Forty toddlers were observed, each during three 10-min cycles, and all their interactions with adults in the classroom were coded using the PICCOLO. Results, in terms of psychometric properties, indicate promise for using this measure to observe toddlers' individual experiences of teacher-child interactions in group settings. Furthermore, certain individual teacher-toddler interactions were associated with toddlers' problem behavior. Implications for use of the PICCOLO in early childhood classroom research and particular findings related to toddlers' behavior are discussed.

Observation: its role in Anna Freud's developmental approach and therapeutic parent-toddler groups.

Starting in Vienna in the 1920s, Anna Freud's first tentative attempts at observing children became a crucial component of the 'double approach' which integrated direct child observation with psychoanalytic reconstruction. This enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Her identification of disturbances that were developmental rather than neurotic led to the broadening of child analysis. Interventions aimed at freeing and supporting development rather than giving insight, became known as 'developmental therapy'. These interventions are used in the parent-toddler groups that embody Anna Freud's endeavour to link psychoanalytic theory, direct observation and clinical practice. Observations of a toddler, who attended a parent-toddler group with his mother, show how intervening early in the child's life and soon after concerns were identified, contributed to preventing maladaptive affective states and ways of relating from becoming entrenched.

Débutant à Vienne vers 1920, les premiers essais d'Anna Freud dans l'observation des petits enfants devinrent une composante déterminante de la « double approche ¼ qui intègre l'observation directe de l'enfant avec la reconstruction psychanalytique. Ceci a permis l'étude détaillée des processus du développement pendant leur déroulement et la construction d'une théorie normative ainsi que pathologique du développement de l'enfant. Le repérage qu'elle fit des troubles propres au développement et non pas névrotiques a permis l'expansion de l'analyse des enfants. Les interventions visant à libérer et à soutenir le développement plutôt qu'à donner des éclairages (insight) devinrent connues sous le nom de « thérapie développementale ¼. Ces interventions sont utilisées dans les groupes parent-bébé qui incarnent la tentative d'Anna Freud pour relier la théorie psychanalytique, l'observation directe et la pratique clinique. Les observations d'un petit enfant participant avec sa mère à un groupe parent-bébé montrent comment intervenir tôt dans la vie de l'enfant, peu après que des inquiétudes soient apparues, contribue à éviter que des états affectifs et des liens mal adaptés deviennent établis.

Comenzando en Viena, en los años 20, los primeros intentos de observación de niños de Anna Freud se tornaron en un componente crucial del 'abordaje doble', el cual integraba la observación directa del niño con la reconstrucción psicoanalítica. Esto permitió el estudio detallado del despliegue de los procesos de desarrollo y la construcción de una teoría normativa tanto como patológica del desarrollo del niño. Su identificación de trastornos que más que neuróticos pertenecían al desarrollo condujo a la expansión del análisis de niños. Las intervenciones destinadas a liberar y ofrecer apoyo en el desarrollo en vez de ofrecer insight, fueron conocidas como 'terapia del desarrollo'. Estas intervenciones son utilizadas en los grupos de madres/padres-niños que encarnan la tarea de Anna Freud de relacionar la teoría psicoanalítica, la observación directa y la práctica clínica. Las observaciones de un niño que asistía a un grupo con su madre muestran como la intervención temprana en la vida de un niño, poco después de la identificación del problema contribuyó a prevenir estados afectivos de inadaptación y el enquistamiento de modos de relacionamiento.

Apoio e acolhimento à mulher que se torna mãe: uma escuta psicanalítica / Giving support to women who become mothers: Psychoanalytic listening / Support et accueil de femmes qui deviennent mères: une écoute psychanalytique / Apoyo y recepción a las mujeres que se convierten madres: una escucha psicoanalítica / Unterstüetzung und Beratung für werdende Müetter: psychoanalytisches Zuhören

A proposta deste artigo é apresentar um modelo de escuta endereçado a questões que envolvem a maternidade. Para construir esse espaço de escuta psicanalítica no âmbito institucional, foi preciso, inicialmente, ampliar a compreensão das vicissitudes do processo que envolve o ser mãe. Um método respaldado no amparo e no acolhimento foi o modelo utilizado no atendimento de mulheres que estavam com os seus bebês internados na Unidade de Terapia Intensiva Neonatal (UTIN). A partir do caso exposto, foi possível apresentar um modelo de escuta que se fundamenta no referencial psicanalítico, mas que, ao mesmo tempo, amplia o modelo tradicional da psicanálise.

The purpose of this paper is to present a listening model for issues involving motherhood. In order to establish this psychoanalytical listening place within an institutional scope, it was initially necessary to broaden the understanding of the vicissitudes inherent to being a mother. A method based on support was used to offer care to women whose babies were hospitalized in a Neonatal Intensive Care Unit (NICU). Based on this case, it was possible to present a listening model that is based on psychoanalytical references, but which, at the same time, expands the traditional psychoanalysis model.

Le but de cet article est de présenter un modèle d’écoute par rapport aux questions liées à la maternité. Pour établir cet espace institutionnel d’écoute psychanalytique, il s’est avéré nécessaire, initialement, d’élargir la compréhension des vicissitudes du processus qui entraîne être mère. Une méthode basée sur le support et l’accueil des mères dont les nouveau-nés étaient internés dans l’Unité de Thérapie Intensive Néo-natale (UTIN) à été utilisée. C’est sur la base de cette étude qu’il fut possible de modéliser l’écoute sous l’angle psychanalytique, tout en élargissant le modèle traditionnel de la psychanalyse.

La propuesta de este artículo es presentar un modelo de escucha dirigido a las cuestiones relacionadas a la maternidad. Para construir este espacio de escucha psicoanalítica en el ámbito institucional, fue necesario inicialmente ampliar la comprensión de las vicisitudes implicadas en el proceso de ser madre. Un método respaldado en el amparo y en el acogimiento fue el modelo utilizado para atender a las mujeres que tenían a sus bebés internados en la Unidad de Cuidados Intensivos Neonatales (UCIN). A partir del caso expuesto, fue posible presentar un modelo de escucha que se fundamenta en el referencial psicoanalítico, pero que, al mismo tiempo, amplía el modelo tradicional del psicoanálisis.

Dieser Artikels stellt ein Modell des Zuhörens in Bezug auf Fragen zur Mutterschaft vor. Um diesen psychoanalitischen Raum des Zuhörens im institutionellen Bereich aufzubauen war es anfangs nötig, das Verständnis zu den Einzelheiten des Prozesses der Mutterschaft zu erweitern. Eine Methode, die auf Unterstützung und Aufnahme gegründet ist, wurde als Modell benutzt, um Frauen, deren Kinder in der Intensivstation für Neugeborene hospitalisiert waren, zu betreuen. Der dargelegte Fall erlaubte es uns, ein Hörmodell vorzustellen, das auf psychoanalytische Referenzen basiert, das aber gleichzeitig über das traditionelle Modell der Psychoanalyse hinausgeht.