Loredana Laghezza

The circle of security parenting and parental conflict: a single case study

The Circle of Security Parenting (COS-P) is an early attachment based intervention that can be used with groups, dyads, and individuals. Created in the USA and now used in many countries, COS-P is a visually based approach that demonstrates its central principles through videos of parent/child interactions. The core purpose of the COS-P is to provide an opportunity for caregivers to reflect on their childs needs and on the challenges each parent faces in meeting those needs. Even though there is a wide range of clinical settings in which child/parent attachment is an important component of assessment there is limited empirical data on when and how attachment based interventions are appropriate for specific clinical profiles and contexts. The aim of this paper is to present a clinical application of COS-P in order to explore and reflect on some specific therapeutic tasks where it works and on some clinical indicators and contexts appropriate for its application. A single case study of a father, “M.” (43 years old) in conflict for the custody of his 5 years old daughter is reported. The Adult Attachment Projective Picture System (AAP), the Parenting Stress Index, the Strengths and Difficulties Questionnaire, and the Parental Alliance Measure, were administered pre- and post-intervention. The clinical significance analysis method revealed that numerous changes occurred in the father. The AAP showed improvements in the level of agency of self. M. made gains in his capacity to use internal resources and to increase his agency of self. M. was classified as recovered in his perception of the childs functioning and as improved in his parenting stress and parenting alliance with the mother. Considerations on specific contexts and clinical indicators for the application of COS-P are proposed.

Antecedents and consequences of fear of childbirth in nulliparous and parous women.

The study aimed to explore the differences in the role of specific personal and interpersonal risk factors in predicting fear of childbirth (FOC) and to examine whether FOC predicts postnatal maternal adaptation in nulliparous and parous women. A prospective correlational design with two time periods (pre- and postnatal) was carried out with 158 women, 85 nulliparous and 73 parous. Women at Week 32 of gestation completed a demographic questionnaire, the Wijma Delivery Expectancy Questionnaire (K.Wijma, B. Wijma, & M. Zar, 1998), the State-Trait Anxiety Inventory (C.D. Spielberger, R.L. Gorsuch, & R.E. Lushene, 1970), the Symptom Checklist-90-Revised (L.R. Derogatis, 1983), the Dyadic Adjustment Scale (G.B. Spanier, 1976), and the Reciprocal Attachment Questionnaire (M. West, A. Sheldon, & L. Reiffer, 1987). Three months after delivery, the women completed the Edinburgh Postnatal Depression Scale (J.L. Cox, J.M. Holden, & R. Sagovsky, 1987) and the Parenting Stress Index-Short Form (R. Abidin, 1986). Pearsons correlations and a series of multiple regressions were conducted. The results indicated that in the prenatal period, higher state anxiety, β = .35, p < .001, lower dyadic adjustment, β = -.26, p = .03, and higher insecurity in attachment relationships, β = .39, p < .001, predicted FOC in first-time mothers only. In the postnatal period, FOC predicted postnatal maternal risk for depression, β = .39, p = .02, and parenting stress, β = .42, p = .02, for nulliparous women only. The specific antecedents and consequences of FOC in nulliparous and parous women should be taken into consideration when developing specific interventions.

The role of both parents' attachment pattern in understanding childhood obesity.

Within the research area on the determinants of childhood obesity, a relatively new approach is the use of attachment theory to explore the mechanisms underlying children’s obesity risk, especially considered as emotion regulation strategies in parent–child relationship. Few are the empirical researches that have addressed this issue. The empirical investigations have used self-report measures to assess adult attachment. In attachment studies, the use of interview methods and/or performance-based instruments is advised to evaluate the entire range of possible adult attachment patterns and comprehensively explain the emotional strategies, correlates, and consequences of individual differences in attachment system functioning. The aim of this study was to explore the extent to which both parents’ attachment patterns serve as self-regulative mechanisms related to childhood overweight/obesity by the Adult Attachment Projective Picture System (AAP) in a sample of 44 mothers and fathers of children referred for obesity. Insecure attachment was found as a risk factor both for mothers and fathers. Also unresolved/disorganization was found to play a significant role in childhood obesity. The role of father’s attachment was explored and findings suggested considering it in etiology and treatment of childhood obesity.

Effects of a multidisciplinary lifestyle intervention for obesity on mental and physical components of quality of life: the mediatory role of depression.

The current study investigates the effects of a multidisciplinary lifestyle intervention for obesity on Health Related Quality of Life (HRQoL). In this study, 92 adults with obesity were weighed and completed the Short Form Health Survey (SF–36) and the Center for Epidemiologic Studies Depression Scale (CES–D) at the baseline and at the end of a 3-month intervention. Repeated measures analysis of variance (ANOVA), a series of hierarchical regressions, and the statistical mediation analysis of Baron and Kenny were conducted. (a) Over 3 months, changes in weight and the mental and physical scales of the SF–36 and depression were all significant. (b) The results indicate a significant mediation of changes in depression scores for the association between weight loss and enhancement on the General Health scale of the SF–36. Improvements to HRQoL from a multidisciplinary lifestyle intervention seem to affect both the physical and mental components of the SF–36 score and to reduce depression, contributing to enhanced self-perceptions of well-being.

Description of the EUROBIS Program: A Combination of an Epode Community-Based and a Clinical Care Intervention to Improve the Lifestyles of Children and Adolescents with Overweight or Obesity

The present paper describes the Epode Umbria Region Obesity Prevention Study (EUROBIS) and aims to implement the C.U.R.I.A.MO. model through the EPODE methodology. The main goal of the EUROBIS is to change the pendency of slope of the actual trend towards the increase in the yearly rates of childhood overweight and obesity in Umbria and to improve healthy lifestyles of children and their parents. The project is the first EPODE program to be performed in Italy. The aims of the Italian EUROBIS study are: (1) a community-based intervention program (CBP) carrying out activities in all primary schools of the Umbria Region and family settings as first step, to reverse the current obesity trend on a long-term basis, and (2) a clinical care program for childhood and adolescent by C.U.R.I.A.MO. model. C.U.R.I.A.MO. model is a multidisciplinary approach to improve three key aspects of healthy lifestyles: nutrition, exercise, and psychological aspects with the strategy of a family-based approach. The community-based intervention and clinical trial provide an innovative valuable model to address the childhood obesity prevention and treatment in Italy.

Parental Alliance and Family Functioning in Pediatric Obesity from Both Parents' Perspectives

Objective: The aim of the present study was to investigate the maternal and paternal specific contributions on the associations between family socioeconomic status, parental anthropometric factors, parental alliance, and family functioning. These were assessed separately for mothers and fathers, by means of a case-control study with families of Italian youths with and without overweight/obesity. Methods: Ninety families with children aged 11 to 16 years (mean = 13.27 years; SD = 1.5) participated in the study. Half of the families included children with overweight/obesity (n = 45). The body mass indices (BMIs) of youths and parents were measured and the former transformed in BMI z-scores. The parents completed the Parenting Alliance Measure and the Family Assessment Measure Version III, General Scale. Results: Higher levels of dysfunction in parental alliance and family functioning of the mothers and fathers of the overweight/obese group were found. Socioeconomic status did not contribute significantly to the prediction of overweight and obesity in youth. Both maternal and paternal BMIs were positively associated with youth overweight/obesity. The degrees of parental alliance perceived by both mothers (odds ratio [OR], 81; 95% confidence interval [CI], 0.72–0.90) and fathers (OR, 89; 95% CI, 0.81–0.98) predicted childs weight status. The perception of poor parental and familial functioning by both parents contributed to the prediction of overweight and obesity in youth (mother: OR, 1.06; 95% CI, 1.02–1.10; father: OR, 1.06; 95% CI, 1.01–1.11). Conclusion: The results support a strong effect of parental and family functioning on a youths overweight/obesity also from the fathers perspective. The importance of considering the fathers perspective is discussed.

Assessing Changes in Psychoanalytic Psychodynamic Therapy with an Early Adolescent

This paper describes changes in personality functioning according to Exner’s Rorschach Comprehensive System (CS) in an early adolescent boy, Gabriele, referred for anxiety and obsessive compulsive symptoms. The DSM-IV diagnosis was General Anxiety Disorder (GAD). The therapy lasted about 2 years, and sessions were all audio-taped to create a more objective database. A total of 50 sessions were analyzed. The therapist employed a broadly defined, object-relations-focused, psychodynamic framework, with particular emphasis placed on balancing supportive versus insight-oriented modes of therapy (Skean, 2005). After a brief introduction of Gabriele’s clinical history and anamnesis, the paper illustrates (a) changes in the symptoms from the beginning to the end of the supportive psychodynamic psychotherapy, which also included some cognitive-behavioral therapy (CBT) interventions; (b) changes in the CS administered at the beginning and at the end of the psychotherapy; and (c) the relevance of therapeutic allianc...