Marina Miscioscia

Contribution of Analyses on Triadic Relationships to Diagnostics and Treatment Planning in Developmental Psychopathology

Recent clinical and theoretical research in the field of developmental psychopathology has focused on the importance of interactions in a child’s development. The literature has investigated how children’s early relationships contribute to the structure and expression of any subsequent psychological problems. The main focus of this pilot study is the application of the Lausanne Trilogue Play paradigm as part of psychodiagnostic assessments to elucidate family functioning in clinical settings. The research aims particularly to observe the characteristics of a family’s interactions in the light of their child’s psychopathological symptoms, based on a sample of 38 families with school-age children referred to a Neuropsychiatry Unit for Children and Adolescents for emotional or behavioral problems. The children’s psychopathological symptoms were assessed by administering the Child Behavior Check List to their parents. Triadic family interactions were observed using the Lausanne Trilogue Play procedure. Statistically significant relationships emerged between the family’s interaction patterns and the child’s externalizing and internalizing problems, suggesting an interdependence between these relational and individual factors in the development of the young person’s psychopathology. The clinical and therapeutic implications of these findings are discussed.

Alexithymia in Young Adults With Substance Use Disorders: Critical Issues About Specificity and Treatment Predictivity

Several studies have reported high rates of alexithymia in drug-dependent individuals, but supporting evidence attests association between alexithymia and a variety of psychiatric disorders, raising doubts about its specificity. Moreover, controversies are emerging about alexithymia assessment: self-report measures present shortcomings with respect to discriminant validity and reliability. As regards treatment for substance use disorders (SUDs), alexithymia has been linked to poorer outcomes, but the results are inconsistent. The aim of the present study is to investigate alexithymia in substance-dependent young adults by examining: (a) the specificity of alexithymia in drug-dependent inpatients, compared to healthy individuals and patients with psychiatric disorders (behavioral and emotional disorders) and (b) the predictivity of alexithymia in determining treatment outcomes in terms of relapses, drop-outs from treatment and the rate of relapse per month of treatment. Two studies were conducted to fulfill these aims: Study 1 and Study 2. Study 1 involved 90 late adolescents, aged 17–21. To fulfill the first aim, 30 inpatients diagnosed with SUD were compared with 30 healthy controls and 30 individuals referred to an outpatient neuropsychiatric unit (a). The participants completed the Toronto Alexithymia Scale−20 (TAS-20) and the Symptom Checklist-90-Revised (SCL-90-R). The results indicated that both clinical groups reported higher TAS-20 scores than the non-clinical subjects, but they did not differ from each other (a); moreover, a large correlation was detected between alexithymia and depressive symptoms, as assessed by the SCL-90-R. Study 2 involved 55 inpatients with SUD recruited in a therapeutic community. The participants completed the TAS-20, and clinicians filled out the Observer Alexithymia Scale (OAS). No association was found between self-report and observational measures. Neither self-reported nor observed alexithymia predicted the number of relapses, drop-out from treatment, or the rate of relapses per month of treatment (b). When the interaction with gender was explored, the global score of alexithymia and the “Distant” OAS subscale predicted the number rate relapses only in males. The TAS-20 did not discriminate between the clinical groups. The limited ability of both observed and self-reported measures in predicting treatment outcome raises questions on the specificity of alexithymia among the substance-dependent inpatient population.

An integrated approach to child psychotherapy with co-parental support: a longitudinal outcome study

Studies about the effectiveness of psychodynamic psychotherapy interventions with children and adolescents suggest potential adverse effects of this treatment when not supported by a parallel work with parents: it seems that it could damage family functioning and affect family balances. This research aims to assess psychopathological outcomes after two years of psychodynamic psychotherapy by comparing two groups (G) of children and adolescents, related to a Childhood Adolescence Family Service: G1 – individual therapy for child/adolescent only; G2 - therapy for child/adolescent and a separate session of co-parenting support. 21 families with children aged between 6 and 17 years completed the entire treatment. The research protocol involves: Lausanne Trilogue Play, Children Behavior Check List and Family Empowerment Scale. Results show a positive effect of the treatment on the child/adolescent psychopathological profile with a significant improvement concerning the reduction of both internalizing and externalizing problems. Results show the effectiveness of the integrated intervention in the improvement of parents’ abilities to validate the children emotional state. Our results suggesting that parenting support increase parental sensitivity, helping the parents to become more able to recognize the children’s emotional state and to validate it.

Tuberous sclerosis-associated neuropsychiatric disorders: a paediatric cohort study

We aimed to study tuberous sclerosis‐associated neuropsychiatric disorders (TAND) in children and adolescents with tuberous sclerosis complex (TSC).

Triadic interactions in families with preterm children: a comparative study with children born at term

The relationship between parents and infants born preterm is multifaceted and could present some relational patterns which are believed to predict psychological risk more than others. For example, insensitive parenting behavior has been shown to place very preterm children at greater risk of emotional and behavioral dysregulation. The main objective of this study was to compare the quality of family interactions in a sample of families with preterm children with one of the families with at-term children, exploring possible differences and similarities. The second aim of this research was to consider the associations among family interactions and parental empowerment, the child’s temperament, parenting stress, and perceived social support. The sample consisted of 52 children and their families: 25 families, one with two preterm brothers with preterm children (mean 22.3 months, SD 12.17), and 26 families with children born at term (mean 22.2 months, SD 14.97). The Lausanne Trilogue Play procedure was administered to the two groups to assess the quality of their family interactions. The preterm group was also administered the Questionari Italiani del Temperamento, the Family Empowerment Scale, the Multidimensional Scale of Perceived Social Support, and the Parenting Stress Index – Short Form. Differences in the quality of family interactions emerged between the preterm and at-term groups. The preterm group showed significantly lower quality of family interactions than the at-term group. The parenting stress of both parents related to their parental empowerment, and maternal stress was also related to the partner’s parental empowerment. Social support had a positive influence on parenting stress, with maternal stress also related to perceived social support from the partner, which underscores the protective role of the father on the dyad.

The Desire of Parenthood: Intuitive Co-parental Behaviors and Quality of Couple Relationship among Italian and Belgian Same-Sex and Opposite-Sex Couples

Studies that focused on family issues have allowed a great understanding of the aspects related to its subsystems, such as parenting desire and its expectations, couples’ satisfaction and quality of child’s outcomes. All these aspects are greatly interconnected and contribute to the creation of specific family dynamics, such as the quality of family interactions. The present study focuses on intuitive co-parental behaviors and the quality of couple relationship observed during the decision process (intention and desire) to be (or become) parents. Our first goal was to explore these aspects in a cross-national sample made of Italian and Belgian heterosexual, lesbian and gay couples. We then aimed to evaluate if the degree of internalized homophobia affects co-parental alliance. The quality of couple relationship and co-parental behaviors have been evaluated through the recruitment of a group of 115 stable heterosexual, gay and lesbian couples (230 individuals, 20–50 years of age) without children, who wanted to become parents. We used the Prenatal Lausanne Trilogue Play to evaluate the Co-parental Alliance; the couple’s satisfaction was assessed with the Dyadic Adjustment Scale and the Internalized Homophobia with the MISS-LG. In line with the existent literature, the analysis did not find any difference between lesbian, gay and heterosexual couples in terms of co-parental alliance. High levels of couple adjustment lead to better parental performances among both Italian and Belgian couples. The results suggest also that sexual stigma differs from one country to another, and it has an impact on the capability of managing co-parenting. Clinical implications should be verified in further longitudinal studies in order to observe the impact on the inter-generational transmission of psychopathology.

Interactive family dynamics and Non-Suicidal Self-Injury in psychiatric adolescent patients: a single case study

Non-Suicidal Self-Injury (NSSI) is a common, multifaceted phenomenon among adolescents. Recent researchers have shown that a number of psychological and psychiatric correlates are implicated in the onset/repetition of NSSI, but those previous studies did not directly observe the family interaction patterns of this clinical population. In this paper, the quality of family interactions was observed using the Lausanne Trilogue Play procedure to deepen the specific interactive dimensions associated with NSSI in adolescents. The results of a single case study showed a lack of positive emotional exchanges, a parenting style expressing hostility, a high level of control and difficulties in triangulation. Through this method, the authors show that a better understanding of the role of family interactions is crucial and could improve the assessment and treatment of Non-Suicidal Self-Injurious behaviors. Research and clinical implications are discussed.

The Use of Lausanne Trilogue Play in Three Cases of Gastroschisis Diagnosed during Pregnancy

From pregnancy to the 1st years of a child’s life, families develop and increase representations and interactive competences toward the child. Prenatal diagnosis of a severe fetus’ defect could profoundly alter the parental perception and development of these representations. The aim of the study was to evaluate triadic interactions in families, whose baby was prenatally diagnosed with severe gastroschisis. Three families took part in the preliminary case study, which was carried out when the babies were 6 months old. The Lausanne Trilogue Play shows that prenatal diagnosis of fetal malformation may affect family triadic interactions as follows: (a) parents, especially mothers, tend to be intrusive during the play; (b) parents presents maladjustments in the child stimulations, especially during the third part, when both parents have to simultaneously interact with the baby; (c) parents experience difficulties in creating a space that allows them to communicate directly with each other, leaving the child in a peripheral position. Observational data and clinical implications are discussed.

A psychological perspective on preterm children: the influence of contextual factors on quality of family interactions

Preterm birth has a critical influence on interactive, communicative, and expressive child behaviour, particularly during the first years of life. Few studies have stressed the assessment of mother-father-child interaction in families with preterm children, generating contradictory results. The present study wished to develop these fields: (i) comparing the quality of family interactions between families with preterm children and families with children born at full term; (ii) observing the development of family interactions after six months in the families with children born preterm; (iii) assessing family and contextual factors, as parental stress and social support, in parents of preterm children in order to observe their influence on the quality of family interactions. 78 families are recruited: 39 families with preterm children (M = 19,8 months, SD = 11,05) and 39 families with full-term children (M = 19,66 months; SD = 13,10). Results show that families with preterm children display a low quality of mother-father-child interactions. After six months, family interactions result is generally stable, except for some LTP-scales reflecting a hard adjustment of parenting style to the evolution of the child. In families with preterm children, the parenting stress seemed to be correlated with the quality of mother-father-child interactions.