Posttraumatic Play: Towards Acceptance and Resolution

Many children who experience trauma demonstrate it through posttraumatic play (PTP). This type of play is seen by professionals as a repetitive reenactment of the traumatic event within the child’s play. Reliving the event in this way may serve to retraumatize the child and lead to other psychiatric or behavioral problems. This article examines the issues surrounding childhood trauma and PTP. It uses a case study to illustrate the phases of a play therapy approach that incorporates Ericksonian principles, in order for the child to achieve resolution and acceptance. The countertransference issues that a clinician may encounter also are discussed. Editor's Note: This article is the recipient of the Judith Mishne Memorial Award for Excellence in Clinical Social Work Theory and Practice.     

An analysis of variables affecting length of stay in foster care

The purpose of this paper was to find out whether the relationship between type of contact with agency and/or child in foster care and average number of contacts over time makes any difference in length of stay in foster care. Four types of contacts were examined: Family—Agency, Family Initiated—Agency, Social Worker—Initiated, and Family—Child. Results indicated that there were critical numbers for each contact type found to be statistically significant that would tend to reduce the length of the child's stay in foster care. The importance of contact during the first month of placement was emphasized.     

The operation was a success but the patient died: A critique of “the implementation and evaluation of a problem-solving training program for adolescents”

This critique examines George S. Tellado's account of his evaluation of a problem-solving program for adolescents in a public junior high school in Pennsylvania. The program was apparently successful (i.e., it was shown by the evaluation to improve students' problem-solving capacities), and the evaluation was, for the most part, technically sound, but the program did not survive. This critique suggests that by examining the problem-solving program as an organizational change intervention, several problems can be uncovered regarding the program's design, implementation, evaluation, and institutionalization. In particular, it appears that the school system's staff did not have sufficient ownership of the program to understand it or to wish to carry it on after the program's originator and evaluator were no longer present. This article addresses these problems in detail and recommends techniques from the field of organizational change consultation to increase the likelihood that such programs will live on into the future.     

Back to basics: child psychiatry after Cleveland

SUMMARY. In this personal view of recent developments, the author suggests that child psychiatrists were taken by surprise when they began receiving a rapid increase of referrals involving sexual abuse. Many saw their prime role as needing to adapt psychiatric techniques to determine whether abuse had occurred. Child sexual abuse was seen as being outside of normal psychiatric conditions. These responses led to major controversy within the profession. It is argued that the Cleveland Inquiry should now allow child psychiatrists to work with sexually abused children in a more traditional way, their main function being to assess and treat the whole child and its family and evaluate the significance of the abuse in a wider context     

On Becoming a Good Enough Stepmother

Studies have shown that conflict over parent–child relationships are frequently at the root of stepfamily dissolution and that the stepmother/daughter relationship is the most problematic stepfamily relationship. This paper explores the stepmother–daughter relationship in the family where the biological mother is an active parent and discusses the unique challenges and internal conflicts that the stepmother confronts on entry into the family and its web of preexisting relationships and transferences. “An internal parental stance” which underlies “good enough” stepmothering is conceptualized and the complex psychological processes which underlie this achievement are explored in this paper along with implications for clinical strategies. The term good enough stepmothering is a play on Winnicott’s concept of the good-enough mother—the maternal figure whose attunement to her child enables her to adapt appropriately to her child’s stage of life thus allowing an optimal environment for the child’s development.     

Identification of mother-child interaction patterns:: A longitudinal evaluation of early age intervention effects on early adolescents

Evidence is offered that meaningful patterns of mother-child interaction could be detected in families more than 10 years after a family-centered, early age, preventive intervention. The interactions of mother-child dyads in a situational test during the child's early adolescence were examined for three experimental conditions: a lower socioeconomic experimental group that participated in the intervention for approximately 2 years, an untreated lower socioeconomic, and an untreated upper middle socioeconomic control group.Factor analyses of family interaction measures revealed three factors, which were called Democratic-Participatory Interaction, Mixed Dominance Interaction, and Mother Controlled Interaction. Separate ANOVAS based on factor scores were performed for each factor. Both the intervention group and the middle socioeconomic comparison group were significantly higher than in the lower socioeconomic comparison group in the first factor.     

The Impact of Parent,Child, and Therapist Mental Representations on Attachment-Based Intervention with Prepubertal Children

Although attachment-based interventions with mothers and infants are beginning to flourish, guidelines for developing attachment-based intervention with prepubertal children are lacking. This article remedies this lack by discussing the potential intervention points of entry with prepubertal children based on attachment theory. In contrast to attachment-based early intervention, in which parental characteristics are targeted, attachment-based intervention with prepubertal children must include the child as well as the parents. Therapists attempting such an intervention must take into account the quality of the child’s mental representation as well as their own quality of mental representation to provide an effective clinical experience.     

An Overview of a Hospital-Based Child Advocacy Center’s Experience from Turkey

The purpose of the present study was to investigate sociodemographic variables, features of sexual abuse (SA), and first psychiatric evaluation results of abused children, and to analyze the relation of the psychiatric evaluation results to the children’s age and gender, type and duration of abuse, abuser–child relationship, and marital status of the children’s parents, at one of the most experienced Child Advocacy Centers (CACs) in Turkey. All data were obtained from reports prepared by child and adolescent psychiatrists. The sample of this study consists of 436 child sexual abuse (CSA) cases who admitted ?zmir CAC between April 2014 and November 2015. The statistical analyses yielded significant relations between psychiatric symptoms and chronic abuse, the gender of the children, and type of abuse. Suicidal ideation and behaviors due to sexual abuse (SA) were also examined. According to our results, it is fair to say that children exposed to SA benefit from immediate psychiatric help because of their vulnerability for psychiatric disorders due to abuse. In this context, CACs are very important multidisciplinary establishments to determine children’s multiple needs to ease their trauma with collaborative teamwork. Psychiatric evaluation should be part of this multidisciplinary context.     

The effects of measurement error and omitted variables when using transition matrices to measure intergenerational mobility

This paper examines the consequences of specification error when transition matrices are used to analyse patterns of intergenerational mobility. We show that classical measurement error in both the child’s and parent’s earnings can lead to biased results, with summary mobility measures biased by as much as 20% in some cases. Furthermore our results suggest that the extent of the bias is most severe in the tails of the distribution. Omitted conditioning variables appear to have a modest effect on transition matrices in our model.     

Child protection: a survey of psychiatrists' knowledge and attitudes

The aim of the study was to examine psychiatrists' knowledge of the child protection process and their attitudes toward child protection training. An anonymous questionnaire survey was sent out to all psychiatric staff in a large psychiatric hospital. The response rate was 72 per cent. Fifty‐seven per cent of respondents had never attended child protection training and 16 per cent thought that it was of no relevance to their position. Significant differences in self‐rated knowledge were identified between those who had attended training and those who had not. Variations in the availability and quality of child protection training may result in psychiatrists not attaining the core knowledge required in order to work effectively as part of the child protection process. Hospital management should work towards prioritising and disseminating local child protection policies and procedures more effectively and consider routine child protection training as part of any new staff induction. The Royal College of Psychiatrists should consider inclusion of child protection in junior staff education programmes and as part of the MRCPsych examination curriculum. Likewise, consideration should be given to enhancing the status of child protection training in continuing professional development programmes for career‐grade psychiatric staff. Copyright © 2010 John Wiley & Sons, Ltd.     

Pediatric Bipolar Disorder: The Child Psychiatrist Perspective

This study’s objectives were to gain insight into reasons for the considerable rise in pediatric bipolar disorder (PBD) and what impact the new diagnosis of disruptive mood dysregulation disorder (DMDD) may have on child psychiatric treatment. A purposive sample of 10 child psychiatrists was interviewed for this qualitative study. Interviews were transcribed and coded for themes. Participants believe that PBD is often misdiagnosed and overdiagnosed, though their understandings of the reasons behind this vary. The majority attribute it to providers trying to help children who need services but do not fit a diagnostic category, and undertrained professionals diagnosing children. Most see DMDD as positive, though opinions on how it might impact children and treatment vary. All see family as vital in the treatment process. Participants in this exploratory study support a team approach and social workers have a key role as part of this team.     

Practice Guidelines In Child Custody Evaluations for Licensed Clinical Social Workers

Child custody evaluations and decisions are often complicated and emotionally charged. The following guidelines are offered as a framework for clinical social workers who are asked by the judicial system to undertake these evaluations. The historical background of child custody and the theoretical considerations that have guided the courts are reviewed. The traditional areas of consideration and the empirical data related to these areas are examined. The guidelines present pertinent information regarding ethical considerations, parent–child relationship, parenting style, gender issues, parental conflict, parental alienation, domestic violence, race, religion, sexual preferences, geography, parental psychopathology, substance abuse, child’s preference, physical health of the child, and behavioral health of the child. A format for the evaluation process is described and includes the role of the clinician, confidentiality, fees, and review of documents, interviewing, home visits, psychological testing, and the actual written report. Making recommendations to the court regarding child custody is an area of practice that clinical social workers encounter in ever-increasing numbers. Clinical social workers are called upon to give recommendations regarding child custody in neglect or abuse cases, in termination of parental rights proceedings, and in the area divorce and of guardianship. In an effort to provide clinicians with scientifically grounded parameters for rendering these recommendations, the following guidelines are recommended. These guidelines provide a framework of scientific principles, along with established and accepted clinical practice, to enhance the practitioner’s decision making in these challenging and complicated cases. The guidelines are specifically designed for clinical social workers doing custody evaluations in cases of marital divorce and are restricted to that area of practice.     

The couch and the clinic The cultural authority of popular psychiatry and psychoanalysis

This paper examines the discourse produced by psychiatrists and psychoanalysts who wrote for non-professional audiences. As professionals who reached out beyond their professions, their writing raises questions about the authority they invoked. The two factions in this popular psychology, psychiatry and psychoanalysis, staked out cultural authority using systematically different types of appeals. The psychiatric approach involved a ‘pure’ professionalism, invoking psychiatry’s similarities to medicine. The psychoanalytic approach involved an explicit dissociation from medical authority, and claimed a difference from medical expertise as a mark of intellectual transcendence. What becomes clear is that these standpoints were constructed through discourse as types of strategic positionings. Concluding notes address the idea that Antonio Gramsci’s labels of ‘organic’ and ‘traditional’ are not only types of intellectuals; they are also stakes in the game amongst competitors for cultural authority. This insight is then applied to broader considerations regarding public intellectuals.     

Seclusion & restraint: a historical perspective

(1) The use of restraints in the care of psychiatric patients has been a topic of ethical controversy since the beginning of psychiatric medicine. (2) Enlightenment physicians regarded psychiatric illness as the loss of reason, and many advocated the use of restraints to help violent patients regain the use of reason. (3) John Conolly, a British alienist (a term used for psychiatrists) of the mid 1800s, claimed it was possible to treat psychiatric patients without the use of mechanical restraints, but he made liberal use of seclusion and physical restraint by attendants to manage violent behavior. (4) American alienists expressed misgivings about the use of mechanical and chemical restraint but most were reluctant to relinquish any usable intervention.     

KNOWING THE CHILD: AN ECOLOGICAL APPROACH TO THE TREATMENT OF CHILDREN IN FOSTER CARE

Social workers in agencies and school settings often deal with high risk, multi problem children such as those in foster care. Increasingly, there is widespread recognition that a coordinated, multifaceted approach is required to address the range of cognitive, social, and mental health problems with which they present. This article recommends utilization of an ecological treatment intervention that is specifically tailored to the needs of the child based on a formulation of the child’s experience and developmental deficits. A case example comprising the treatment of an eight-year-old boy in foster care with comorbid diagnoses of alcohol related neurodevelpomental disorder, failure to thrive, and attachment disorder, illustrates this approach. The article concludes with implications for social work practice.     

The impact of expert evidence on care proceedings

There has been an increased demand for expert child psychiatric opinion in child care cases where social services have instigated care proceedings under the Children Act 1989. However, there has been little evaluation of this work in terms of whether such a referral changes the care plan of the referring social work agency or the outcome for the child. This article examines the contribution to care proceedings of assessment reports completed by a child and adolescent forensic psychiatry team in respect of 37 consecutive child care cases. All of the assessments were presented to court and the information was collated once the proceedings were completed. Our findings indicated that the court followed the recommendations of the child psychiatric report entirely in 73% of cases. In addition, in 86% of cases the social service departments reported that they had gained confirmation of their professional opinion. In only 10% of cases did they change their care plan in response to the child psychiatric assessment. In conclusion, the results suggest that in most cases social service departments are using child psychiatry expert evidence merely to validate and/or lend support to their original care plans. Copyright © 1999 John Wiley & Sons, Ltd.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.     

Dissociation,Traumatic Attachments,and Self-Harm: Eating Disorders and Self-Mutilation

Self-harm, such as eating disorders and self-mutilation, represents dissociated compensatory attempts to serve self-regulatory functions. Self-harm develops when the child who has become attached to those who have inflicted pain and suffering maintains that attachment by inflicting pain on himself. Brain imaging studies have found that the communication pattern between parent and child shapes the way the child’s attachment system adapts to experiences with the attachment figure, literally hardwiring the child’s brain. The good news is that a safe and secure attachment is very good medicine and can rewire the brain. An attachment-based multi-phase approach to treatment is presented.

Korean American Pastors' Perceptions and Attitudes Toward Child Abuse

Abstract

More than 80 percent of Korean immigrants in the United States attend church on a regular basis. Churches, as informal community organizations, can play a very significant role in protecting children from abuse. This study examines Korean American clerics' knowledge of child abuse, their definition of child abuse, and their familiarity with mandatory child-abuse reporting laws. The study also examines how culture, demographic variables, and individual theological orientation affect their attitudes toward child abuse, mandated child abuse reporting by clergy, and preference of intervention strategies. Major findings include that more than 50 percent of respondents have seen child abuse and neglect among their church members, but the majority who have witnessed child abuse prefer to provide pastoral counseling to the family instead of reporting the case to a child protective agency.     

Maternal Life Satisfaction and Child Outcomes: Are They Related?

This paper investigates the association between maternal life satisfaction and the developmental functioning of 2-3-year-old children as well as the socio-emotional behavior of 5-6-year-old children. We use data from the German Socio-Economic Panel Study (SOEP), which allows us to control for a rich set of child and parental characteristics and to use the mother’s life satisfaction before the birth of her child as an instrument to eliminate potential reverse causality. The results indicate that the more satisfied the mother, the better her child’s verbal skills and the lower his or her socio-emotional problems. The relation is more pronounced for boys than for girls. The results are robust even when mothers’ personality or mothers’ cognitive skills are controlled for.