From Ego to “We-Go”: Neurobiology and Questions for Psychoanalysis: Commentary on Papers by Trevarthen, Gallese, and Ammaniti & Trentini

Stockholm preterm interaction-based intervention (SPIBI) - study protocol for an RCT of a 12-month parallel-group post-discharge program for extremely preterm infants and their parents

BACKGROUND

Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.

METHODS

The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant's next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.

DISCUSSION

If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.

TRIAL REGISTRATION

The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).

MOMENTS OF MEETING: THE RELEVANCE OF LOU SANDER'S AND DAN STERN'S CONCEPTUAL FRAMEWORK FOR UNDERSTANDING THE DEVELOPMENT OF PATHOLOGICAL SOCIAL RELATEDNESS

Lou Sander and Dan Stern made seminal contributions to our understanding of early child development, particularly in regard to the moment-to-moment intersubjective exchanges and mutual sensitivity that are at the core of the caregiver-infant relationship. Although their own studies focused primarily on the ways in which children's intersubjective experiences of mutual attunement lead to adaptive social relatedness and validate a healthy sense of self, this article focuses on the applicability of their theoretical conceptions to the development of pathological social relations. It explores the premise that the emotional validation derived from recurrent intersubjective experiences of mutual attunement involving negative affects can be as emotionally compelling from the child's standpoint as that derived from positive exchanges. Children's needs to recreate unhealthy, but affectively meaningful, moments with their caregivers can lead to ingrained, automatically operating pathological patterns of social behavior and affective expression that can take on a life of their own and strongly shape the child's subsequent socioemotional functioning. Following an overview of Sander's and Stern's conceptual thinking, developmental research and clinical case material will be utilized to illustrate how their work can enrich our understanding of developmental processes that can contribute to a number of emotion-specific, early relational disturbances.

The Value of Reflective: Functioning within an Academic Therapeutic Nursery

The self begins as a social self and is dependent on the other and the self-other relationship. Furthermore, shortly after birth, the intersubjective self is nurtured and sustained by the reciprocal interactions with the significant other. Recent research suggests that the significant other's reciprocity depends on his or her capacity for mentalization, and this reflective functioning capacity influences not only the child's developing sense of I, other, and we, but also his or her developing attachment pattern. Several studies have demonstrated that parental reflective functioning can be improved with intervention, and enhancing parental reflective functioning can lead to a more secure attachment pattern and better outcomes for the child and parent. Therefore, intervention with toddlers and their families requires us to consider this dynamic two-person psychology. In this paper, we describe an academic parent-child nursery program aimed at enhancing parental reflective functioning. A clinical example from the collaborative treatment of a mother and her two-year-old will demonstrate how reflective functioning can be enhanced in the parent-child dyad and lead to a more secure parent-child relationship. We will also discuss the value of reflective functioning to the interdisciplinary team and how we dealt with countertransference issues that arose during the treatment.

Child Psychotherapy, Child Analysis, and Medication: A Flexible, Integrative Approach

For children with moderate to severe emotional or behavioral problems, the current approach in child psychiatry is to make an assessment for the use of both psychotherapy and medication. This paper describes integration of antidepressants and stimulants with psychoanalytically oriented techniques.

The concepts of vínculo and dialectical spiral: a bridge between intra- and intersubjectivity

The authors explore the psychoanalytic concepts of vínculo and dialectical spiral within the context of a historical review of the development of psychoanalysis in the Río de la Plata region of Uruguay and Argentina. In particular, they discuss the work of Enrique Pichon-Rivière, Madeleine and Willy Baranger, and José Bleger. Illustrative clinical material is included from a case described by Bleger. Convergences and divergences are noted between the theoretical and clinical approaches of these authors, on the one hand, and those of more traditionally Freudian, Kleinian, and other schools of analysis, on the other. Also, the authors underline some questions about the nature of vínculo that are currently under discussion in the Río de la Plata.