The appeal cycle in early mother-child interaction: nature and implications of a finding from developmental research

Separation Anxiety-An Unseen Cause for Development of Abnormal Oral and Paraoral Habits and Malocclusion: A Review of Literature and Report of Two Cases

A child's overall well-being depends on its mutual relationship with the caregiver and social environment. Its attachment with the caregiver forms an emotional bond at six months to two years of age. Separation anxiety refers to fear of separation from the attachment figure. In some neglected children in early age of attachment formation, symptoms of separation anxiety persist and they may show debilitating nervous behaviors during growth. It thus becomes an unseen cause of psychological problem and development of abnormal oral habits occlusal dysfunctions and further psychological problems. Oral habits being learnt patterns of muscle contraction are displayed for release of mental tension due to fear and anxiety often associated with anger, hunger, sleep, tooth eruption and fear. Pediatric dentist plays an important role in patient education through anticipatory guidance. Proper diagnosis and early interception of oral habits as a result of separation anxiety disorder can prevent occlusal disturbances in children. The present paper includes review of literature along with the management of two cases of separation anxiety as an unseen cause of development of unique socially unacceptable abnormal oral and paraoral habits and resultant malocclusion. How to cite this article: Dhote VS, Dharmadhikari PM, Bahadure RN, et al. Separation Anxiety-An Unseen Cause for Development of Abnormal Oral and Paraoral Habits and Malocclusion: A Review of Literature and Report of Two Cases. Int J Clin Pediatr Dent 2021;14(S-2):S199-S205.

Normal and pathological generosity

This contribution delineates the formal and dynamic characteristics of generosity. It traces the origins of the trait of generosity to a complex interplay of hard-wired capacities for concern and altruism with gratifying experiences of early infancy and identifications with the generative parental qualities during later childhood and adolescence. Five pathological syndromes (namely, unrelenting generosity, begrudging generosity, fluctuating generosity, controlling generosity, and beguiling generosity) seem to exist in this realm. Technical implications of the notions outlined in this paper include: (i) having and maintaining an attitude of generosity towards the patient, (ii) listening and intervening with an attitude of generosity, (iii) recognizing and accepting the patient's healthy generosity, (iv) diagnosing and interpreting the patient's pathological generosity, (v) unmasking and interpreting defenses against generosity, and (vi) discerning and utilizing the countertransference to generosity. The paper also touches briefly upon miserliness, the opposite of generosity, and upon sociocultural dimensions of the matters involved.

The appeal cycle in three cultures: an exploratory comparison of child development

Mother-child behaviors were studied in three cultural groups: Caucasian American (CA), overseas Japanese (JPN), and Chinese Vietnamese (CVN) immigrants. The children were sixteen to twenty-five months old, and the appeal cycle, with its descriptive analytic method, was the research paradigm. Group differences were found in appeal cycle occurrence and phase frequencies. CA mothers promoted independence through encouragement of decision making and toddler-initiated play, and through nonintrusive interactions. Neither JPN nor CVN mothers encouraged independence. JPN mothers were subtly directive; CVN mothers overtly so. Generally, CA toddlers played independently, evincing a beginning capacity for self-regulation. JPN and CVN toddlers reacted to separation by staying close to their mothers, and fewer were observed to play independently than in the CA group. CVN toddlers played independently more frequently than JPN toddlers, but less frequently than CA toddlers. Quantitative measures of dyadic behaviors generally support the descriptive findings, though methodological constraints did not permit comparison of phase sequencing. The findings reflect cultural differences in child development thought to influence psychic structure formation.

Parental non-compliance--a paediatric dilemma. A medical and psychodynamic perspective

Considerable resources have been directed towards the recognition and management of child physical and sexual abuse and/or neglect. However, the issue of parental non-compliance is less well defined and under recognized. While outwardly seeking advice, non-compliant parents, especially if anxious, are unable or unwilling to comply with the recommendations made. Conflicts of interest between the parent(s)' and the health professionals' perceptions regarding the best interest of the child may arise. Parental non-compliance is centred around the parents' perception of the child's current problems and its relationship to past problems. Such non-compliance may reflect ignorance or misunderstanding of the clinical situation. Ignorance may be readily addressed if the parents are receptive and trusting. However, non-compliance more commonly arises from the parents' inability to cope emotionally with the stresses surrounding the recommended treatment. Parents may be vulnerable to psychological reactions which inhibit rational thinking. Parental anxieties are best understood in terms of psychological constructs, including 'defences' such as 'denial' and 'splitting', 'repetition compulsion' and the need to 'work through' psychological barriers so that the child's best interest is served. Parental non-compliance can serve to protect the parents from overwhelming fears and anxieties, which if addressed may transform parental defensiveness to co-operation. Extreme parental non-compliance may represent a special form of child abuse where, due to parental psychopathology, parents are unable to consider the child's best interest. Clinical vignettes arising from a consultant private and hospital ambulatory setting will focus on management strategies for successful outcomes. Recommendations offered on ways to reduce the risk of parental non-compliance include building trust, eliciting the aid of a parental partner, and organizing a second opinion, thereby improving the chances of a successful outcome.

Conviction and conversion: the role of shared fantasies about analysis

This paper is an attempt to understand the origin of the analyst's conviction about both the patient's analyzability and the psychoanalytic endeavor. Clinical material will be used to illustrate the way that the intensity of the analyst's conviction is or isn't noticed or interpreted, by both patient and analyst. The primary hypothesis to be proposed is that the analyst's awareness of the transmission of conviction during conversion (or evaluation) can trigger recognition and use of a critical period for identification with an underlying mutual fantasy of intergenerational, analyst-patient conviction about analysis.

The distinction between needs and wishes: implications for psychoanalytic theory and technique

After a comprehensive survey of the literature is presented and some caveats entered, this paper delineates the concept of a psychological "need," noting that it bears a complex relation to the concept of a "wish." Need is universal, wish experience-bound. A need, unlike a wish, is not subject to repression. In addition, although a wish can be replaced by another wish, a need cannot be replaced by another need. Whereas the frustration of a wish causes dynamic shifts, the frustration of a need leads to structural disintegration. Needs and wishes can be in harmony or in opposition. The paper also identifies six basic psychological needs, which would seem to be ubiquitous, though the degree to which they are overt and the ways in which they are met vary across cultures. Their gratification seems necessary for healthy psychic development to occur, for relationships to survive, and for psychoanalytic work to take hold and to continue optimally. These needs are (1) the need for one's physical needs to be deemed legitimate; (2) the need for identity, recognition, and affirmation; (3) the need for interpersonal and intrapsychic boundaries; (4) the need for understanding the causes of events; (5) the need for optimal emotional availability of a love object; and (6) the need for a resilient responsiveness by one's love objects under special circumstances. Ordinarily these needs are met during the course of treatment with no deliberate effort by the analyst. In the treatment of some patients, however, they require more direct attention. A number of clinical vignettes are presented to elucidate these ideas.

Object relations, affect management, and psychic structure formation. The concept of object constancy

Object relations are central to contemporary structural theory. This paper first reviews the various ways in which the key concept object constancy has been used. To reconcile the apparent contradictions in definitions, the concept is viewed along a developmental continuum in which each step is defined by its functions. It is proposed that at its most mature stage, a capacity for affective self-regulation is achieved, a capacity that is central to characterological structure formation and optimal adaptation. Possible interferences with the achievement of mature object constancy are briefly explored.

"Someday ..." and "if only ..." fantasies: pathological optimism and inordinate nostalgia as related forms of idealization

Fantasies whose core is constituted by the notions of "someday" and "if only" are ubiquitous in human psyche. In severe character pathology, however, these fantasies have a particularly tenacious, defensive, and ego-depleting quality. The "someday" fantasy idealizes the future and fosters optimism, and the "if only" fantasy idealizes the past and lays the groundwork for nostalgia. The two fantasies originate in the narcissistic disequilibrium consequent upon the early mother-child separation experiences, though the oedipal conflict also contributes to them. Both can be employed as defenses against defective self and object constancy as well as later narclssistic and oedipal traumas. This paper attempts to highlight the metapsychology and behavioral consequences of these fantasies as well as their unfolding in the treatment situation. It suggests six tasks to be especially important for analytic work with such patients: (1) providing and sustaining a meaningful "holding environment"; (2) employing "affirmative interventions"; (3) helping the patient unmask these fantasies and interpreting their defensive, narcissistic and sadomasochistic aspects; (4) rupturing the patient's excessive hope, analyzing the effects of such rupture, and facilitating the resultant mourning; (5) reconstructing the early scenarios underlying the need for excessive hope; and (6) paying careful attention to countertransference feelings throughout such work.

Therapeutic process and developmental process in the restructuring of object and self constancy

This paper holds that the analytic relationship embodies both therapeutic process and developmental process, that these processes are best viewed as different and separate, and that they function in a complementary way in the revision of pathologically impaired and underdeveloped psychic structure. The focus of the paper is on the developmental formation and clinical restructuring of object and self constancy. The illustrative case material is excerpted from the case of a man who returned for additional treatment five years after the completion of an apparently successful analysis of his neurotic conflicts.