Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults.

Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

Patient Attachment to Therapist Rating Scale: development and psychometric properties.

OBJECTIVE: To report on the development and initial psychometric properties of a new rating scale for patent-therapist attachment. METHOD: Seventy interviews from the Young Adult Psychotherapy Project (YAPP) were rated. RESULTS: Excellent internal consistency (Cronbach's α > .90) was observed for all four subscales (Security, Deactivation, Hyperactivation, and Disorganization). Three subscales showed good inter-rater reliability (ICC > .60), while one (Hyperactivation) had poor (ICC < .40). Correlations with measures of alliance, mental representations, and symptom distress support the construct validity of the reliable subscales. Exploratory factor analysis indicated three underlying factors explaining 82% of the variance. CONCLUSIONS: The Patient Attachment to Therapist Rating Scale is a promising approach for assessing the quality of attachment to therapist from patient narratives. Future development should focus on improving the discrimination of the insecure subscales.

Self-reported depressive symptoms and parental stress in mothers and fathers who bring their infants to an infant mental health clinic.

BACKGROUND: The parental functioning and its influence upon infant mental health development have been extensively studied but there are few clinical studies investigating less severe psychiatric problems among mothers and fathers in the same family. AIM: This study focuses on the emotional well-being of mothers and fathers who bring their infants to an Infant Mental Health Clinic. METHODS: The studied sample is comprised of 63 families with 0-47-month-old infants where the mothers completed the Center for Epidemiological Study-Depression Scale (CES-D), including 43 families in which the CES-D was completed by both parents. In 44 families, the mothers also filled in the Swedish Parental Stress Questionnaire (SPSQ), including 32 where the SPSQ was completed by both parents. The children were independently classified with the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3). RESULTS: Altogether, 54% of the mothers and 11% of the fathers reported depressive symptoms above the CES-D clinical cut-off. Self-rated depressive symptoms and parental stress were strongly related. The mothers' self-rated depressive symptoms were associated with the severity of their infant's problems, but the association was not specific to the DC 0-3 Axis I classification. The mothers' stress level was marginally related to DC 0-3 Axis II relationship classification. CONCLUSION: The results indicate that the inclusion of systematic parental self-ratings in infant mental health assessments could add clinical information facilitating the planning of family oriented interventions.

Infant Mental Health assessment: the use of DC 0-3 in an outpatient child psychiatric clinic in Scandinavia.

The study focuses on Infant Mental Health data from an outpatient psychiatric clinic using the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood" (DC 0-3) and parental questionnaires, CBCL and ITSC. In total, 138 infants (aged 0-3) went through the diagnostic procedure. Sixty-eight per cent were diagnosed within Axis I, with regulatory disorder, disorder of affect and traumatic stress disorder being the most frequent diagnoses. In addition, 48% were classified as having a relationship disorder according to Axis II, with an additional 40% being considered to be at risk of developing a relationship disorder. The mothers' and fathers' ratings of their children's externalized and sensitivity problems were in agreement with the clinicians, but the ratings of internalized problems as well as relationship problems presented a more complex pattern.