George S. Moran

The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment

Epidemiologists and psychoanalysts have been equally concerned about the intergenera-tional concordance of disturbed patterns of attachment. Mary Mains introduction of the Adult Attachment Interview (AAI) has provided the field with an empirical tool for examining the concordance of parental and infant attachment patterns. In the context of a prospective study of the influence of parental patterns of attachment assessed before the birth of the first child upon the childs pattern of attachment to that parent at 1 year and at 18 months, the Anna Freud Centre—University College London Parent-Child Project reported a significant level of concordance between parental security and the infants security with that parent. In the context of this study, a new measure, aiming to assess the parents capacity for understanding mental states, was developed and is reported on in this paper. The rating of Reflective-Self Function, based upon AAI transcripts, correlated significantly with infant security classification based on Strange Situation assessments. The philosophical background and clinical importance of the measure are discussed.

The roles of mental representations and mental processes in therapeutic action.

In this paper we describe two models of the psychoanalytic treatment of mental disturbance. The first describes the mechanism by which the patient is helped to recover threatening ideas and feelings which have been repudiated or distorted as a result of conflict and defense. The second points to the therapeutic effects of engaging previously inhibited mental processes within the psychoanalytic encounter. The two forms of therapeutic action imply two distinct means available to the individual to deal with psychological conflict. They highlight different aspects of the psychoanalytic process and technique in child and adult psychoanalysis.

A Controlled Study of the Psychoanalytic Treatment of Brittle Diabetes

The study compared two equivalent groups of 11 diabetic children with grossly abnormal blood glucose profiles necessitating repeated admissions to a hospital. Patients in the treatment group were offered an intensive inpatient treatment program including psychoanalytic psychotherapy three to four times a week, which took place on the hospital ward and lasted an average of 15 weeks. The intervention was highly effective in improving the diabetic control of the children, and this was maintained at a 1 year follow-up. Patients in the comparison group, who were offered only inpatient medical intervention, returned to their prehospitalization level of metabolic control within a period of 3 months from discharge.

Psychological adjustment and diabetic control.

Glycosylated haemoglobin concentrations, C peptide secretion, insulin dose, psychiatric state, intellectual functioning, and the extent to which the implementation of the diabetic regimen was shared between parent and child were studied in a cross sectional study of 50 children with diabetes aged 6-16. Indications of psychological disturbance in the children and their parents predicted low glycosylated haemoglobin concentrations in the children, and accounted for 44% of variance in blood glucose control. The childs early and independent participation in the implementation of the diabetic regimen was associated with poor control.

Studies on the efficacy of child psychoanalysis.

This article summarizes 3 studies that evaluated the psychoanalytic psychotherapeutic treatment of diabetic children and adolescents with grossly abnormal blood glucose profiles necessitating repeated admissions to hospital. Study 1 used time series analysis to demonstrate that improvements in control were predicted by unconscious themes emerging in the analytic material. Study 2 compared the effect of psychotherapeutic treatment with that of minimal psychological intervention in two well-matched groups (n = 11). Patients in the treatment group were offered psychoanalytic psychotherapy 3-4 times per week on the hospital ward. The intervention was highly effective in improving the diabetic control of the children, and this improvement was maintained at 1-year follow-up. Study 3 used single-case experimental design to demonstrate the marked effect of psychotherapeutic help on growth in diabetic children with short stature.

Reflections on the aim of child analysis.

Childhood disturbances can best be studied in a developmental frame of reference. Following Anna Freud, the authors distinguish between outcome aims and intermediary aims. They present the analyses of a child and an adolescent to demonstrate how these aims affect the nature and progression of treatment.