I am a clinical psychologist, psychotherapist, and doctor of research. Feel free to contact me by email at alberto.stefana@gmail.com or WhatsApp phone call at (+39) 3381131304 Phone: 3381131304
In History of Countertransference, Stefana follows the development of this concept over time, exp... more In History of Countertransference, Stefana follows the development of this concept over time, exploring a very precise trend which begins with the original notion put forward by Sigmund Freud and leads to the ideas of Melanie Klein and the British object relations school. The book explores the studies of specific psychoanalytic theorists and endeavours to bring to light how the input from each one may have been influenced by previous theories, by the personal history of the analyst, and by their historical-cultural context. By shedding light on how different psychoanalytic groups work with countertransference, Stefana helps the reader to understand the divergences that exist between them. _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
‘The present volume is a comprehensive, detailed, and eminently fair analysis of the gradual development, problems and increasing sophistication of the concept and therapeutic utilization of countertransference. Stefana provides the historical background to the controversial origin of the discovery of the countertransference complications in the management of transference, and appropriately deepens the description of new theoretical and clinical developments to permit the reader to reach his own conclusion regarding the contemporary controversies of countertransference management. This book is a fascinating history of psychoanalytic discoveries, and should of great practical interest not only to the psychoanalytic clinician, but it is also a scholarly contribution to the study of developing psychoanalytic science.’ - Otto Kernberg, MD; psychoanalyst and professor of psychiatry at Weill Cornell Medical College, USA.
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'This superb history of the concept of countertransference makes an invaluable contribution to our field. The depth, breadth and range of Alberto Stefana’s understanding and his outstanding scholarship make this book essential reading for anyone who is engaged in the study and practice of analytic therapy.' - Theodore J. Jacobs, M.D., Clinical Professor of Psychiatry, The Albert Einstein College of Medicine, New York, USA.
Background The management of mentally ill offenders in the community is one of the great challeng... more Background The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry. Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders. Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment. Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls. Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.
This article outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–1... more This article outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–1998) and examines the issues of creativity and art, showing how her theory was influenced by the artistic and psychoanalytic milieu in which she was immersed. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly created reality, occurs during moments of “primary madness” (of illusion of unity, of pre-logical fusion between subject and object), making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role. Using Milner’s ideas about the creative process as a base, the author investigates the links between psychoanalysis and the unconscious processes in symbol formation and artistic creation, showing that Milner’s work is still relevant to psychoanalysis today.
This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–199... more This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–1998) and examines the issues of creativity and art. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly-created reality, occurs during moments of ›primary madness‹ (of illusion of unity, of pre-logical fusion between subject and object) making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role.
AIM:
The aim of this study was to investigate fathers' emotional experiences of their infant's pr... more AIM: The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.
BACKGROUND: When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.
DESIGN: A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.
METHOD: Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.
RESULTS: Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.
CONCLUSION: Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.
The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between ... more The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent, or adult), enabling him to experience holding and freely explore different communication possibilities. After having explored the “technique” as it has been developed by Winnicott, this study also exposes some theoretical considerations, and some variations in the basic technique, brought together by the crucial role played by reciprocity: “Me a little and you a little.” The paper is a clinical case with a Chinese adolescent.
Le jeu du squiggle est avant tout une méthode favorisant la relation et l'échange mutuel entre l'analyste et le patient (qu'il s'agisse d'un enfant, d'un adolescent ou d'un adulte) et permettant à ce dernier de faire ;'expérience du holding et d'explorer librement différentes modalités de communication. Après avoir examiné la “technique” développée par Winnicott, l'auteur de cet article expose des considérations théoriques et propose des variantes par rapport à la technique de base, issues du rôle crucial joué par la réciprocité : “un peu moi, un peu toi.” Il présente le cas clinique d'un adolescent chinois.
Das „Schnörkelspiel“ ist in erster Linie eine Methode, eine Beziehung zwischen Analytiker und Patient (Kind, Jugendlichem oder auch Erwachsenem) herzustellen und den wechselseitigen Austausch zu fördern. Als solche gibt es dem Patienten Gelegenheit, sich gehalten zu fühlen und ungehindert unterschiedliche Kommunikationsmöglichkeiten zu erforschen. Im Anschluss an eine Untersuchung dieser von Winnicott entwickelten „Technik“ stellt der Autor auch theoretischen Überlegungen sowie Varianten der Grundtechnik vor, deren verbindendes Element die entscheidende Funktion der Wechselseitigkeit ist: „Ein bisschen von mir und ein bisschen von dir.“ Zur Illustration dient die Behandlung eines chinesischen Jugendlichen.
Il “gioco dello squiggle” rappresenta soprattutto un metodo per relazionarsi e promuovere uno scambio reciproco tra l’analista e il paziente (bambino, adolescente o anche adulto), consentendo a quest’ultimo di fare esperienza della funzione di holding e di esplorare liberamente diverse possibilità comunicative. Nel presente lavoro, dopo aver esaminato la ‘tecnica’ del metodo per come era stata originariamente sviluppata da Winnicott, presenterò una serie di considerazioni teoriche e anche alcune variazioni rispetto alla tecnica di base, ispirate dal ruolo centrale che nella relazione ha la reciprocità: ‘un po’ io e un po’ tu’. Il paper presenta un caso clinico con un adolescente cinese.
El “juego del squiggle” es, sobre todo, un método para relacionarse y alentar el intercambio mutuo entre el analista y el paciente (no importa si es niño, adolescente o adulto), permitiéndole a este último sentirse sostenido y explorar libremente diferentes posibilidades de comunicación.
Luego de haber explorado la “técnica” tal como fue desarrollada por Winnicott, el autor expone algunas consideraciones teóricas, y algunas variaciones en la técnica básica, concitadas por el papel crucial que desempeña la reciprocidad: “Yo un poquito y tú un poquito.” El artículo trata del caso clínico de un adolescente chino.
Introduction: The preterm infants’ developmental outcomes depend on biological and environmental ... more Introduction: The preterm infants’ developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/ father–infant interactions and the parents’ ability to respond to the trauma of premature birth. In the case of premature birth, the father’s ability to take an active part in the care of the infant from the start is essential. The parents’ emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent–infant affective relationship and the parents’ confidence in their ability to provide care for their baby. Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants’ hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-toface interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions. Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother–infant relationship.
The aim of this paper is to historically contextualize and analyze the birth and early developmen... more The aim of this paper is to historically contextualize and analyze the birth and early development of the concept of countertransference, introduced by Sigmund Freud in 1909. In order to do so, scientific publications will be considered, as well as the epistolary and the historical information about the personal relationship between Freud and his students, and among his students and some of their colleagues and patients.
Most research projects and current support programs in the area of infant prematurity have concen... more Most research projects and current support programs in the area of infant prematurity have concentrated mainly or exclusively on infants and mothers. The few studies which have also focused their investigations on fathers have all recognized the crucial role played by fathers, both in supporting their partners and in the infant’s psychological development,1-7 and suggest the need to consider the emotional state and behavior of both parents in relation to the wellbeing of infant and partner.8, 9 We must, therefore, ask the question, why are there so few studies of this kind? Our investigation 10, 11 of the literature has allowed us to identify the three factors which constitute most, if not all, of the reasons. 1. Insufficient recognition of the problem: even where the term “parents” is used in the titles and abstracts of articles on prematurity, the participants are often exclusively, or almost exclusively, mothers. 2. The relative invisibility of the fathers’ emotional difficulties and their need to be supported, because the symptoms of emotional discomfort in new fathers are different from, and less easily observable than, those of the mothers.12, 13 Fathers of premature infants are constantly preoccupied with the management of their own feelings, in an attempt not to be a burden to their partner,14 and to reconcile their own emotional state with what they feel is expected of them by others.15 For this reason, the emotional state of the father often manifests itself outside of the neonatal intensive care unit (NIC U).16 Furthermore, their anxieties and depressive disorders show up at a later stage than those of mothers.17 3. Methodological limits in those studies that do focus on the fathers of preterm babies: these limits indicate difficulties in recruiting and engaging fathers, and they inevitably influence the validity of the results. This leads, for instance, to underestimations of the fathers’ emotional distress. 3.1. Several qualitative studies conducted through interviews have focused on both mothers and fathers, but whereas the number of mothers interviewed was almost always sufficient for acquiring reliable data, the number of fathers interviewed was almost always too few, often less than ten.18 3.2. Most of the quantitative studies have used self-report tools, which do not take into consideration gender and culture differences, with possible negative consequences for the validity of the results. Support for this type of criticism comes from a series of studies that were conducted to validate the Edinburgh Postnatal Depression Scale (EPDS) on fathers: four of the five studies conducted to date have identified cut-off points for fathers which are substantially lower than those for mothers.19-22 These studies indicate another aspect which should not be overlooked: the cultural one.23 Societies in Western Europe and North America are multi-ethnic, and premature births to parents with cultural backgrounds very different from the host culture are increasing quick. This has important implications both for the detection and evaluation of the emotional state of fathers (and mothers) from diverse cultures, and for the types of intervention programs that could be helpful for them.24 With regard to the use of self-report questionnaires, various authors have recognized the need for a follow-up clinical interview to complement the questionnaires. According to the author of the EPDS: “a cut-off can only indicate the likelihood of clinical depression, not its severity or duration. A clinical interview is therefore necessary to determine the nature of the association of paternal depression with infant behavior and the quality of the parental relationship”.25 Furthermore in view of the possible problems of reliability and validity in the evaluation,26 they indicate the need for clinical interviews (note the plural) conducted by trained and certified clinical researchers. 3.3. Extremely little direct observation has been reported of the behavior of fathers in the NIC U, or of their interactions with the preterm infant, whether in the NIC U or in the months/years following the infant’s discharge. This is a significant limitation, because observation makes it possible to see aspects of the father-infant relationship which could not emerge from questionnaires or interviews, most importantly the real-time dynamics of father-infant interaction, which must not be overlooked when considering the preterm infant behavior per se. Focusing attention on these relational dynamics, using video microanalysis (i.e., a frame-by-frame observational technique which enables to see the moment-to-moment communication between partners, and to obtain measures of the process of dyadic coregulation) 27-29 and a theoretically oriented perspective, would also, crucially, allow us to detect and monitor indices of possible risk for the parents’ emotional health, the quality of attachment, and the child’s emotional, behavioral and cognitive development. T he reasons outlined in points 2 and 3 have led to an underestimation of the fathers’ distress levels (anxiety, stress and depression) and, more generally, have limited our knowledge of how the fathers’ internal world re-organizes itself when faced with a premature birth. Meanwhile, the reason described in the first point has functioned as a smokescreen obscuring — at least partially — the need to identify the connections if any between, on the one hand, the emotional state of fathers in the perinatal period and during the child’s first year of life and, on the other hand, a range of other factors. These factors include the quality of the couple’s relationship, the support given to the mother-infant relationship, the interaction between father and infant and the infant’s attachment to the father. Removing the smokescreen will also allow us to examine the connections between these relationships and the emotional, behavioral and cognitive development of the premature infant. Being aware of these limitations — not, at first glance, entirely obvious — is the first step towards overcoming them and advancing scientific research.
The goals of this particular work are (1) to contextualise the work "Mourning and Melancholia" bo... more The goals of this particular work are (1) to contextualise the work "Mourning and Melancholia" both within a domestic and historic context at the precise time in which Sigmund Freud was drafting it, and within the context of the period of his larger scientific production, during the years preceding the above-mentioned work; and (2) to analyse its content.
This article presents some reflections on the delicate and complex phenomenon of erotic transfere... more This article presents some reflections on the delicate and complex phenomenon of erotic transference (and of correlated countertransference issues), a particular form of transference that compels the subject to convert the object into an erotic phantasy. It must be noted that the adjective ‘erotic’ is a bridge concept between ‘pleasurable’ and ‘sexual’. It follows that erotic transference can have various tonalities that range from loving to sexualized and from a dream state (benign) to a drugged or delusional state (malignant). Some writers distinguish between various types of erotic transference, which, however, can be placed on the ‘pleasurable$sexual’ continuum, and which can in turn be superimposed onto the ‘preoedipal$oedipal’ dimension.
I genitori dei bambini prematuri. Una prospettiva psicodinamica, May 2016
La transizione alla genitorialità è un processo evolutivo che comporta importanti riassestamenti ... more La transizione alla genitorialità è un processo evolutivo che comporta importanti riassestamenti e ridefinizioni sia dell’identità individuale sia di quelle di coppia e sociale, e un sensibile incremento della vulnerabilità psicologica. La lunga durata della gestazione propria degli esseri umani assolve dunque una funzione psicologica oltre che fisiologica. Capita però che a causa dell’interazione di fattori genetici, epigenetici e ambientali la gestazione venga interrotta dalla nascita pretermine del piccolo. Tale evento rappresenta per i genitori uno shock che li stordisce e spaventa, un trauma che distrugge le rappresentazioni genitoriali fino a quel momento costruite, che causa l’insorgere di angosce di morte e di sentimenti di insoddisfazione, frustrazione e colpa, e che comporta la perdita dello spazio necessario per elaborare l’esperienza. La capacità dei genitori di reagire e adattarsi a tale situazione traumatica risulta essere particolarmente importante non solo per la qualità di vita degli stessi genitori, ma anche per lo sviluppo neuro-comportamentale e socio-emotivo cui vanno incontro i bambini prematuri in quanto esso dipende da fattori contestuali e ambientali oltre che da fattori di rischio biologici. Ne deriva la necessita che gli operatori della Terapia Intensiva Neonatale sostengano i genitori nell’elaborazione del trauma, nel ri-avvio del processo di transizione verso la genitorialità, e nell’assunzione di un ruolo attivo, centrale e professionale nella care del proprio bambino prematuro.
This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-199... more This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-1998) and examines the issues of creativity and art. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly-created reality, occurs during moments of ‘primary madness’ (of illusion of unity, of pre-logical fusion between subject and object) making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role.
After having briefly outlined the evolutional history of the “squiggle game” (from S. Freud’s int... more After having briefly outlined the evolutional history of the “squiggle game” (from S. Freud’s interpretation of dreams, through C.G. Jung, M. Klein and M. Fordham to M. Milner’s “free drawings”), the “technique” is exposed as it has been developed by Winnicott. We offer comparisons between the use of the tool by Winnicott and their current positions, some variations are exposed in the basic technique, brought together by the crucial role played by reciprocity: “me a little and you a little”. The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent or adult), enabling him to experience holding and freely explore different communication possibilities.
The medical intervention concerning protection and care of both physical and mental health begins... more The medical intervention concerning protection and care of both physical and mental health begins with the meeting between the clinician and the patient and with the observation of the personal conditions of the individual with the problem, or put forward himself/herself as a problem. After having shortly outlined the theoretical and methodological evolution of the strictly connected concepts of “illness” and “semeiotics”, from the protohistoric age to nowadays, focus is placed on the reasons triggering the need of a greater epistemological awareness in the use of the semeiotics by the specialist. The usefulness of replacing a “semeiotic of deviation” with a “semeiotic of differences” is also explained, which entails a process of comparison between the semeiotic of the doctor and the patient’s one.
Contemporary psychoanalysis is characterized by a diversity of models, theories and techniques wh... more Contemporary psychoanalysis is characterized by a diversity of models, theories and techniques which were unknown in the past. Some psychoanalytic authors identify a possible common ground in countertransference. This paper presents a descriptive and historical review of the development of the concept of countertransference, focusing on a well defined trend, starting with the original contribution by Freud up to those analysts of the British object relations school who gave – and continue to give – a fundamental contribution in expanding the discussion, necessary for scientific development, on the theoretical and clinical aspects of countertransference.
With a subjective experience of pain, the patient is at the heart of the medical profession. Even... more With a subjective experience of pain, the patient is at the heart of the medical profession. Even in a psychiatric intervention, the meeting between clinician and patient, mutual observations and interaction reveal details about a certain problem, which – in this context – becomes configured and embodied. Herein, to the authors present arguments on how psychiatric semeiotics must be based on adequately articulated epistemological awareness.
The intention of the authors of this article is to present a succinct review of the effects of te... more The intention of the authors of this article is to present a succinct review of the effects of television advertisements on children’s behaviour. In addition to this, they try to highlight certain limitations and the problematic nature, typical of much of the research examining the impact of television advertising on the attitudes and behaviours of children. Ultimately, they make some useful recommendations for future studies aimed at investigating these themes.
This article presents some reflections on the delicate and complex phenomenon of erotic transfere... more This article presents some reflections on the delicate and complex phenomenon of erotic transference (and of correlated countertransference issues), a particular form of transference that compels the subject to convert the object into an erotic phantasy. It must be noted that the adjective ‘erotic’ is a bridge-concept between ‘pleasurable’ and ‘sexual’. It follows that erotic transference can have various tonalities that range from loving to a sexualized and from a dream state (benign) to a drugged or delusional state (malignant). Some writers distinguish between various types of erotic transference, which, however, can be placed on the ‘pleasurable↔sexual’ continuum, and which can in turn be superimposed onto the ‘preoedipal↔oedipal’ dimension.
In History of Countertransference, Stefana follows the development of this concept over time, exp... more In History of Countertransference, Stefana follows the development of this concept over time, exploring a very precise trend which begins with the original notion put forward by Sigmund Freud and leads to the ideas of Melanie Klein and the British object relations school. The book explores the studies of specific psychoanalytic theorists and endeavours to bring to light how the input from each one may have been influenced by previous theories, by the personal history of the analyst, and by their historical-cultural context. By shedding light on how different psychoanalytic groups work with countertransference, Stefana helps the reader to understand the divergences that exist between them. _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
‘The present volume is a comprehensive, detailed, and eminently fair analysis of the gradual development, problems and increasing sophistication of the concept and therapeutic utilization of countertransference. Stefana provides the historical background to the controversial origin of the discovery of the countertransference complications in the management of transference, and appropriately deepens the description of new theoretical and clinical developments to permit the reader to reach his own conclusion regarding the contemporary controversies of countertransference management. This book is a fascinating history of psychoanalytic discoveries, and should of great practical interest not only to the psychoanalytic clinician, but it is also a scholarly contribution to the study of developing psychoanalytic science.’ - Otto Kernberg, MD; psychoanalyst and professor of psychiatry at Weill Cornell Medical College, USA.
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'This superb history of the concept of countertransference makes an invaluable contribution to our field. The depth, breadth and range of Alberto Stefana’s understanding and his outstanding scholarship make this book essential reading for anyone who is engaged in the study and practice of analytic therapy.' - Theodore J. Jacobs, M.D., Clinical Professor of Psychiatry, The Albert Einstein College of Medicine, New York, USA.
Background The management of mentally ill offenders in the community is one of the great challeng... more Background The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry. Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders. Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment. Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls. Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.
This article outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–1... more This article outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–1998) and examines the issues of creativity and art, showing how her theory was influenced by the artistic and psychoanalytic milieu in which she was immersed. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly created reality, occurs during moments of “primary madness” (of illusion of unity, of pre-logical fusion between subject and object), making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role. Using Milner’s ideas about the creative process as a base, the author investigates the links between psychoanalysis and the unconscious processes in symbol formation and artistic creation, showing that Milner’s work is still relevant to psychoanalysis today.
This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–199... more This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900–1998) and examines the issues of creativity and art. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly-created reality, occurs during moments of ›primary madness‹ (of illusion of unity, of pre-logical fusion between subject and object) making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role.
AIM:
The aim of this study was to investigate fathers' emotional experiences of their infant's pr... more AIM: The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.
BACKGROUND: When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.
DESIGN: A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.
METHOD: Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.
RESULTS: Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.
CONCLUSION: Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.
The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between ... more The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent, or adult), enabling him to experience holding and freely explore different communication possibilities. After having explored the “technique” as it has been developed by Winnicott, this study also exposes some theoretical considerations, and some variations in the basic technique, brought together by the crucial role played by reciprocity: “Me a little and you a little.” The paper is a clinical case with a Chinese adolescent.
Le jeu du squiggle est avant tout une méthode favorisant la relation et l'échange mutuel entre l'analyste et le patient (qu'il s'agisse d'un enfant, d'un adolescent ou d'un adulte) et permettant à ce dernier de faire ;'expérience du holding et d'explorer librement différentes modalités de communication. Après avoir examiné la “technique” développée par Winnicott, l'auteur de cet article expose des considérations théoriques et propose des variantes par rapport à la technique de base, issues du rôle crucial joué par la réciprocité : “un peu moi, un peu toi.” Il présente le cas clinique d'un adolescent chinois.
Das „Schnörkelspiel“ ist in erster Linie eine Methode, eine Beziehung zwischen Analytiker und Patient (Kind, Jugendlichem oder auch Erwachsenem) herzustellen und den wechselseitigen Austausch zu fördern. Als solche gibt es dem Patienten Gelegenheit, sich gehalten zu fühlen und ungehindert unterschiedliche Kommunikationsmöglichkeiten zu erforschen. Im Anschluss an eine Untersuchung dieser von Winnicott entwickelten „Technik“ stellt der Autor auch theoretischen Überlegungen sowie Varianten der Grundtechnik vor, deren verbindendes Element die entscheidende Funktion der Wechselseitigkeit ist: „Ein bisschen von mir und ein bisschen von dir.“ Zur Illustration dient die Behandlung eines chinesischen Jugendlichen.
Il “gioco dello squiggle” rappresenta soprattutto un metodo per relazionarsi e promuovere uno scambio reciproco tra l’analista e il paziente (bambino, adolescente o anche adulto), consentendo a quest’ultimo di fare esperienza della funzione di holding e di esplorare liberamente diverse possibilità comunicative. Nel presente lavoro, dopo aver esaminato la ‘tecnica’ del metodo per come era stata originariamente sviluppata da Winnicott, presenterò una serie di considerazioni teoriche e anche alcune variazioni rispetto alla tecnica di base, ispirate dal ruolo centrale che nella relazione ha la reciprocità: ‘un po’ io e un po’ tu’. Il paper presenta un caso clinico con un adolescente cinese.
El “juego del squiggle” es, sobre todo, un método para relacionarse y alentar el intercambio mutuo entre el analista y el paciente (no importa si es niño, adolescente o adulto), permitiéndole a este último sentirse sostenido y explorar libremente diferentes posibilidades de comunicación.
Luego de haber explorado la “técnica” tal como fue desarrollada por Winnicott, el autor expone algunas consideraciones teóricas, y algunas variaciones en la técnica básica, concitadas por el papel crucial que desempeña la reciprocidad: “Yo un poquito y tú un poquito.” El artículo trata del caso clínico de un adolescente chino.
Introduction: The preterm infants’ developmental outcomes depend on biological and environmental ... more Introduction: The preterm infants’ developmental outcomes depend on biological and environmental risk factors. The environmental factors include prolonged parental separation, less exposure to early mother/ father–infant interactions and the parents’ ability to respond to the trauma of premature birth. In the case of premature birth, the father’s ability to take an active part in the care of the infant from the start is essential. The parents’ emotional closeness to the preterm infant hospitalised in the neonatal intensive care unit (NICU) may be crucial to the well-being of the newborn, the development of mutual regulation, the establishment of a functioning parent–infant affective relationship and the parents’ confidence in their ability to provide care for their baby. Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants’ hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-toface interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions. Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother–infant relationship.
The aim of this paper is to historically contextualize and analyze the birth and early developmen... more The aim of this paper is to historically contextualize and analyze the birth and early development of the concept of countertransference, introduced by Sigmund Freud in 1909. In order to do so, scientific publications will be considered, as well as the epistolary and the historical information about the personal relationship between Freud and his students, and among his students and some of their colleagues and patients.
Most research projects and current support programs in the area of infant prematurity have concen... more Most research projects and current support programs in the area of infant prematurity have concentrated mainly or exclusively on infants and mothers. The few studies which have also focused their investigations on fathers have all recognized the crucial role played by fathers, both in supporting their partners and in the infant’s psychological development,1-7 and suggest the need to consider the emotional state and behavior of both parents in relation to the wellbeing of infant and partner.8, 9 We must, therefore, ask the question, why are there so few studies of this kind? Our investigation 10, 11 of the literature has allowed us to identify the three factors which constitute most, if not all, of the reasons. 1. Insufficient recognition of the problem: even where the term “parents” is used in the titles and abstracts of articles on prematurity, the participants are often exclusively, or almost exclusively, mothers. 2. The relative invisibility of the fathers’ emotional difficulties and their need to be supported, because the symptoms of emotional discomfort in new fathers are different from, and less easily observable than, those of the mothers.12, 13 Fathers of premature infants are constantly preoccupied with the management of their own feelings, in an attempt not to be a burden to their partner,14 and to reconcile their own emotional state with what they feel is expected of them by others.15 For this reason, the emotional state of the father often manifests itself outside of the neonatal intensive care unit (NIC U).16 Furthermore, their anxieties and depressive disorders show up at a later stage than those of mothers.17 3. Methodological limits in those studies that do focus on the fathers of preterm babies: these limits indicate difficulties in recruiting and engaging fathers, and they inevitably influence the validity of the results. This leads, for instance, to underestimations of the fathers’ emotional distress. 3.1. Several qualitative studies conducted through interviews have focused on both mothers and fathers, but whereas the number of mothers interviewed was almost always sufficient for acquiring reliable data, the number of fathers interviewed was almost always too few, often less than ten.18 3.2. Most of the quantitative studies have used self-report tools, which do not take into consideration gender and culture differences, with possible negative consequences for the validity of the results. Support for this type of criticism comes from a series of studies that were conducted to validate the Edinburgh Postnatal Depression Scale (EPDS) on fathers: four of the five studies conducted to date have identified cut-off points for fathers which are substantially lower than those for mothers.19-22 These studies indicate another aspect which should not be overlooked: the cultural one.23 Societies in Western Europe and North America are multi-ethnic, and premature births to parents with cultural backgrounds very different from the host culture are increasing quick. This has important implications both for the detection and evaluation of the emotional state of fathers (and mothers) from diverse cultures, and for the types of intervention programs that could be helpful for them.24 With regard to the use of self-report questionnaires, various authors have recognized the need for a follow-up clinical interview to complement the questionnaires. According to the author of the EPDS: “a cut-off can only indicate the likelihood of clinical depression, not its severity or duration. A clinical interview is therefore necessary to determine the nature of the association of paternal depression with infant behavior and the quality of the parental relationship”.25 Furthermore in view of the possible problems of reliability and validity in the evaluation,26 they indicate the need for clinical interviews (note the plural) conducted by trained and certified clinical researchers. 3.3. Extremely little direct observation has been reported of the behavior of fathers in the NIC U, or of their interactions with the preterm infant, whether in the NIC U or in the months/years following the infant’s discharge. This is a significant limitation, because observation makes it possible to see aspects of the father-infant relationship which could not emerge from questionnaires or interviews, most importantly the real-time dynamics of father-infant interaction, which must not be overlooked when considering the preterm infant behavior per se. Focusing attention on these relational dynamics, using video microanalysis (i.e., a frame-by-frame observational technique which enables to see the moment-to-moment communication between partners, and to obtain measures of the process of dyadic coregulation) 27-29 and a theoretically oriented perspective, would also, crucially, allow us to detect and monitor indices of possible risk for the parents’ emotional health, the quality of attachment, and the child’s emotional, behavioral and cognitive development. T he reasons outlined in points 2 and 3 have led to an underestimation of the fathers’ distress levels (anxiety, stress and depression) and, more generally, have limited our knowledge of how the fathers’ internal world re-organizes itself when faced with a premature birth. Meanwhile, the reason described in the first point has functioned as a smokescreen obscuring — at least partially — the need to identify the connections if any between, on the one hand, the emotional state of fathers in the perinatal period and during the child’s first year of life and, on the other hand, a range of other factors. These factors include the quality of the couple’s relationship, the support given to the mother-infant relationship, the interaction between father and infant and the infant’s attachment to the father. Removing the smokescreen will also allow us to examine the connections between these relationships and the emotional, behavioral and cognitive development of the premature infant. Being aware of these limitations — not, at first glance, entirely obvious — is the first step towards overcoming them and advancing scientific research.
The goals of this particular work are (1) to contextualise the work "Mourning and Melancholia" bo... more The goals of this particular work are (1) to contextualise the work "Mourning and Melancholia" both within a domestic and historic context at the precise time in which Sigmund Freud was drafting it, and within the context of the period of his larger scientific production, during the years preceding the above-mentioned work; and (2) to analyse its content.
This article presents some reflections on the delicate and complex phenomenon of erotic transfere... more This article presents some reflections on the delicate and complex phenomenon of erotic transference (and of correlated countertransference issues), a particular form of transference that compels the subject to convert the object into an erotic phantasy. It must be noted that the adjective ‘erotic’ is a bridge concept between ‘pleasurable’ and ‘sexual’. It follows that erotic transference can have various tonalities that range from loving to sexualized and from a dream state (benign) to a drugged or delusional state (malignant). Some writers distinguish between various types of erotic transference, which, however, can be placed on the ‘pleasurable$sexual’ continuum, and which can in turn be superimposed onto the ‘preoedipal$oedipal’ dimension.
I genitori dei bambini prematuri. Una prospettiva psicodinamica, May 2016
La transizione alla genitorialità è un processo evolutivo che comporta importanti riassestamenti ... more La transizione alla genitorialità è un processo evolutivo che comporta importanti riassestamenti e ridefinizioni sia dell’identità individuale sia di quelle di coppia e sociale, e un sensibile incremento della vulnerabilità psicologica. La lunga durata della gestazione propria degli esseri umani assolve dunque una funzione psicologica oltre che fisiologica. Capita però che a causa dell’interazione di fattori genetici, epigenetici e ambientali la gestazione venga interrotta dalla nascita pretermine del piccolo. Tale evento rappresenta per i genitori uno shock che li stordisce e spaventa, un trauma che distrugge le rappresentazioni genitoriali fino a quel momento costruite, che causa l’insorgere di angosce di morte e di sentimenti di insoddisfazione, frustrazione e colpa, e che comporta la perdita dello spazio necessario per elaborare l’esperienza. La capacità dei genitori di reagire e adattarsi a tale situazione traumatica risulta essere particolarmente importante non solo per la qualità di vita degli stessi genitori, ma anche per lo sviluppo neuro-comportamentale e socio-emotivo cui vanno incontro i bambini prematuri in quanto esso dipende da fattori contestuali e ambientali oltre che da fattori di rischio biologici. Ne deriva la necessita che gli operatori della Terapia Intensiva Neonatale sostengano i genitori nell’elaborazione del trauma, nel ri-avvio del processo di transizione verso la genitorialità, e nell’assunzione di un ruolo attivo, centrale e professionale nella care del proprio bambino prematuro.
This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-199... more This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-1998) and examines the issues of creativity and art. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly-created reality, occurs during moments of ‘primary madness’ (of illusion of unity, of pre-logical fusion between subject and object) making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role.
After having briefly outlined the evolutional history of the “squiggle game” (from S. Freud’s int... more After having briefly outlined the evolutional history of the “squiggle game” (from S. Freud’s interpretation of dreams, through C.G. Jung, M. Klein and M. Fordham to M. Milner’s “free drawings”), the “technique” is exposed as it has been developed by Winnicott. We offer comparisons between the use of the tool by Winnicott and their current positions, some variations are exposed in the basic technique, brought together by the crucial role played by reciprocity: “me a little and you a little”. The “squiggle game” is, above all, a method for relating and encouraging mutual exchange between the analyst and the patient (no matter if child, adolescent or adult), enabling him to experience holding and freely explore different communication possibilities.
The medical intervention concerning protection and care of both physical and mental health begins... more The medical intervention concerning protection and care of both physical and mental health begins with the meeting between the clinician and the patient and with the observation of the personal conditions of the individual with the problem, or put forward himself/herself as a problem. After having shortly outlined the theoretical and methodological evolution of the strictly connected concepts of “illness” and “semeiotics”, from the protohistoric age to nowadays, focus is placed on the reasons triggering the need of a greater epistemological awareness in the use of the semeiotics by the specialist. The usefulness of replacing a “semeiotic of deviation” with a “semeiotic of differences” is also explained, which entails a process of comparison between the semeiotic of the doctor and the patient’s one.
Contemporary psychoanalysis is characterized by a diversity of models, theories and techniques wh... more Contemporary psychoanalysis is characterized by a diversity of models, theories and techniques which were unknown in the past. Some psychoanalytic authors identify a possible common ground in countertransference. This paper presents a descriptive and historical review of the development of the concept of countertransference, focusing on a well defined trend, starting with the original contribution by Freud up to those analysts of the British object relations school who gave – and continue to give – a fundamental contribution in expanding the discussion, necessary for scientific development, on the theoretical and clinical aspects of countertransference.
With a subjective experience of pain, the patient is at the heart of the medical profession. Even... more With a subjective experience of pain, the patient is at the heart of the medical profession. Even in a psychiatric intervention, the meeting between clinician and patient, mutual observations and interaction reveal details about a certain problem, which – in this context – becomes configured and embodied. Herein, to the authors present arguments on how psychiatric semeiotics must be based on adequately articulated epistemological awareness.
The intention of the authors of this article is to present a succinct review of the effects of te... more The intention of the authors of this article is to present a succinct review of the effects of television advertisements on children’s behaviour. In addition to this, they try to highlight certain limitations and the problematic nature, typical of much of the research examining the impact of television advertising on the attitudes and behaviours of children. Ultimately, they make some useful recommendations for future studies aimed at investigating these themes.
This article presents some reflections on the delicate and complex phenomenon of erotic transfere... more This article presents some reflections on the delicate and complex phenomenon of erotic transference (and of correlated countertransference issues), a particular form of transference that compels the subject to convert the object into an erotic phantasy. It must be noted that the adjective ‘erotic’ is a bridge-concept between ‘pleasurable’ and ‘sexual’. It follows that erotic transference can have various tonalities that range from loving to a sexualized and from a dream state (benign) to a drugged or delusional state (malignant). Some writers distinguish between various types of erotic transference, which, however, can be placed on the ‘pleasurable↔sexual’ continuum, and which can in turn be superimposed onto the ‘preoedipal↔oedipal’ dimension.
The aim of this paper is to contextualize and analyze historically the birth and early developmen... more The aim of this paper is to contextualize and analyze historically the birth and early development of the concept of countertransference, introduce by Freud in 1909. In order to do so, will be considered scientific publications, the epistolary and the historical information about the personal relationship between Freud and his students, and among them and some of their patients.
AIM:
The aim of this study was to investigate fathers' emotional experiences of their infant's pr... more AIM: The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.
BACKGROUND: When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.
DESIGN: A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.
METHOD: Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.
RESULTS: Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.
CONCLUSION: Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.
International Journal of Environmental Research and Public Health
The purpose of this article is to narratively review the empirical literature on clinicians’ emot... more The purpose of this article is to narratively review the empirical literature on clinicians’ emotional, cognitive, and behavioral responses (i.e., countertransference) to depressive and other symptoms of patients with mood disorders. Therapist subjective responses (countertransference) can negatively affect both diagnostic and therapeutic processes, especially when they are not recognized and managed promptly. However, at the same time, countertransference recognition, processing, and management can help inform the diagnostic process and improve the therapy process and outcome. In the last couple of decades, the number of studies that empirically explore countertransference toward mood disordered patients, as well as its relationship with various characteristics of both patients and treatment, has increased. Current evidence suggests that patients with depression tend to elicit more positive feelings among clinicians than patients with other severe mental disorders such as borderlin...
Very few studies have assessed infant capacity for bidirectional, contingent communication at bir... more Very few studies have assessed infant capacity for bidirectional, contingent communication at birth, and to our knowledge there are none with preterm infants in the neonatal period. Presence versus absence of such interactive contingency makes a difference for our theories of development. We examined whether preterm infants can contingently coordinate behaviors with mothers and fathers in spontaneous communication in the Neonatal Intensive Care Unit (NICU), and whether mother-infant versus father-infant engagement and contingency differ. Twenty Italian preterm infants (60% girls, born 27-33 weeks, largely middle-class families) lying in a heated cot in the NICU were videotaped at 35 weeks with mothers, and fathers (counterbalanced), in face-to-face communication. Videotapes were coded on a 1-s time-base with parent and infant engagement scales. Multilevel time-series models evaluated self-contingency (auto-correlation) and interactive contingency (lagged cross-correlation). Mothers ...
Introduction. Little work assesses infant capacity for bi-directional, contingent communication a... more Introduction. Little work assesses infant capacity for bi-directional, contingent communication at birth. No work to our knowledge assesses this capacity with very preterm infants in the neonatal period. Presence vs. absence of such coordination makes a difference for our theories of development. For fullterms, Lavelli and Fogel (2013) showed mother-infant bi-directional effects in the first 2 weeks of life, with fine-grained coding/sequential analysis. For preterms, Feldman and Eidelman (2007) showed conditional probability of maternal affiliative behavior during infant alert state, at 37 weeks, using 10s coding-unit; direction of effects was not addressed. Aim: To examine bi-directional second-by-second contingent communication in mother-infant vs. father-infant dyads with very-preterm infants in the NICU. Hypotheses. Comparing mother- vs. father-infant dyads, (a) engagement levels will be higher in mother-infant dyads; (b) interactive contingency will be higher in mother-infant dyads. Study population. Very-preterm infants (N=20), born 27-33 weeks, weighing 665-2100g (mean 1450g), were studied at 35 weeks when medically stable, lying in heated-cot. Methods. Spontaneous face-to-face communication was videotaped, first with mother, then father, and coded on 1s time-base with engagement scales (Table 1). Multi-level time-series models evaluated self-contingency (auto-correlation) and interactive contingency (lagged cross-correlation). Covariates included twin-status, infant sex, infant medical status, maternal age, maternal depression, paternal depression (CES-D). Posthoc descriptive probability explication identified engagement levels involved in significant effects. Results. Percent time in engagement levels. Mothers (vs. fathers) spent more time in affiliative behavior (highest engagement levels 8+7+6), t(19)=2.43, p=.025, interpreted as more arousing. Fathers (vs. mothers) spent more time in midrange engagement level 5 (Table 1), t(19)=-2.56, p=.019, interpreted as more relaxed, less \u201cdemanding\u201d of infant engagement. Infants were more gaze-on-parent\u2019s-face and gaze-on-environment with mothers, t(19)=2.38, p=.028, and more eyes-closed with fathers, t(19)=-2.70, p=.014, interpreted as more alert with mothers. Self-and interactive contingency. In separate mother-infant and father-infant time-series models, all partners showed significant self-contingency, but only infant coordination with father (F\u2192I) was significant (Figure 1). Combining mother-infant and father-infant data, and testing differences for interactive contingency, only fathers and infants showed bi-directional contingency (Figure 1). Posthoc explication of infants\u2192parents showed that, given infants in lower engagement levels 1s prior, fathers (vs. mothers) stayed in lower engagement levels in the current second, closer to infants. Posthoc explication of parents\u2192infants showed that, given both parents in lower (or higher) engagement levels 1s prior, infants stayed in lower (or higher) engagement in the current second closer to fathers, thus coordinating more with fathers than mothers. Conclusions: We conjecture that fathers and infants were more coordinated because fathers were less \u201cdemanding\u201d infants to be in high engagement, so that fathers could stay closer to infants\u2019 engagement levels, facilitating infant-father coordination. In conclusion, bi-directional contingent communication is a robust interpersonal capacity form birth, even in very preterm infants
This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-199... more This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-1998) and examines the issues of creativity and art. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly-created reality, occurs during moments of \u2018primary madness\u2019 (of illusion of unity, of pre-logical fusion between subject and object) making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role
This letter discusses the use of the term "compliance". The term compliance has its roo... more This letter discusses the use of the term "compliance". The term compliance has its roots in pharmacological research. In time, the term compliance was adopted in areas related to cognitive behavioral therapy (CBT). The therapeutic alliance is an operational concept that embodies a process, an evolution, a bond built over time dial goes through the normal break-ups and repairs that occur within the diagnostic/therapeutic course of treatment, and on which the clinician works together with the patient. This partnership is thus the result of a process of continuous negotiation between the therapist and the patient, in which the subconscious dynamics of the patient have great importance. Compliance, comes from a good therapeutic alliance, from the quality of the therapeutic relationship that the doctor is able to establish with the patient, and is the result of a multi-dimensional process, in which the locus cannot only be on "which" therapy to prescribe, but must al...
Abstract Today it is still necessary and useful to deal with the empirical foundations and cultur... more Abstract Today it is still necessary and useful to deal with the empirical foundations and cultural dimensions of a discipline such as psychoanalysis that has played a vital role in shaping the contemporary world, on both sociocultural and clinical levels. This study aimed to describe and summarize the perspectives of experienced psychoanalysts on important aspects of psychoanalysis today. Semistructured interviews were conducted with 62 psychoanalysts. The interview data were processed using a theory-informed thematic analysis. There were 12 macro-themes: important aspects of psychoanalysis, important authors in psychoanalysis today, “contemporary psychoanalysis,” the proliferation of psychoanalytic “schools,” psychoanalytic identity and psychotherapy, psychoanalytic training, the Oedipus complex, dreams, the relationship between psychoanalytic theory and outcome and process research, the relationship between psychoanalysis and research in the neurosciences, empirically validated psychoanalytic concepts, and the marginalization of psychoanalysis. Our study revealed the image of a pluralistic psychoanalysis that the participants interviewed show they have, with various schools/definitions/sources, where Freud and the classical model are contested by numerous other approaches.
This letter discusses the role of Adolph Stern in the field of psychoanalysis. Adolph Stem who is... more This letter discusses the role of Adolph Stern in the field of psychoanalysis. Adolph Stem who is known as the father of the term "borderline personality" was an American psychiatrist and psychoanalyst. Stern's influence on the development of psychiatry and psychoanalysis has been significant. Two of his main contributions were one concerning the concept of counter-transference and the other, the term "borderline".
This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-199... more This paper outlines the thinking of the English psychoanalyst and painter Marion Milner (1900-1998) and examines the issues of creativity and art. Milner, as a result of personal research on the inability to paint, came to believe that the creative artistic process, intended as the creation of new symbols that attribute a personal and subjective meaning to the newly-created reality, occurs during moments of ‘primary madness’ (of illusion of unity, of pre-logical fusion between subject and object) making it possible to have a relationship of reciprocity between internal and external reality. In such a process, the aesthetic experience of the artist at work plays a key role.
Marion Milner places the passage from the original primary object to the secondary object (a pass... more Marion Milner places the passage from the original primary object to the secondary object (a passage that is based on the identification mechanism) equally at the centre both of a child\u2019s healthy psycho-emotional development and of the psychoanalytical process undergone by those who have been unable to achieve such development. But how is it possible to pass from the primary object to the secondary one? Milner identifies five elements in the answer: fantasy, illusion, setting, concentration and ecstasy, which all constitute facets of the one same entity. Five elements that we can identify in our clinical work if we pay attention both to the verbal and non-verbal material that the patient brings to the \u201chere and now\u201d of the analytical relationship and to our own counter-transference
Viene analizzato l'utilizzo che la psicoanalista inglese Marion Milner (1900-1998) fa degli s... more Viene analizzato l'utilizzo che la psicoanalista inglese Marion Milner (1900-1998) fa degli scenari immaginativi, suoi e del paziente, nella situazione analitica - considerata metafora del rapporto genitore-bambino - in cui il paziente introietta le modalitŕ di cura del terapeuta. L'illusione di unitŕ, di fusione "me-non me", avente una funzione strutturante ma che puň non trovare spazio nella prima infanzia, costituita ora dall'analisi, permette al paziente di regredire alle esperienze piů precoci per poterle elaborare in modo che possa riprendere, o avere luogo, un processo di sviluppo. Vengono presi in considerazione alcuni aspetti della teoria e della tecnica, e trattati i concetti di controtransfert, concentrazione nel corpo, vuoto, dubbio, cornice, fusione, creativitŕ, gioco, prelogica.
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‘The present volume is a comprehensive, detailed, and eminently fair analysis of the gradual development, problems and increasing sophistication of the concept and therapeutic utilization of countertransference. Stefana provides the historical background to the controversial origin of the discovery of the countertransference complications in the management of transference, and appropriately deepens the description of new theoretical and clinical developments to permit the reader to reach his own conclusion regarding the contemporary controversies of countertransference management. This book is a fascinating history of psychoanalytic discoveries, and should of great practical interest not only to the psychoanalytic clinician, but it is also a scholarly contribution to the study of developing psychoanalytic science.’ - Otto Kernberg, MD; psychoanalyst and professor of psychiatry at Weill Cornell Medical College, USA.
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'This superb history of the concept of countertransference makes an invaluable contribution to our field. The depth, breadth and range of Alberto Stefana’s understanding and his outstanding scholarship make this book essential reading for anyone who is engaged in the study and practice of analytic therapy.' - Theodore J. Jacobs, M.D., Clinical Professor of Psychiatry, The Albert Einstein College of Medicine, New York, USA.
Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders.
Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment.
Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls.
Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.
The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.
BACKGROUND:
When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.
DESIGN:
A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.
METHOD:
Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.
RESULTS:
Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.
CONCLUSION:
Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.
Le jeu du squiggle est avant tout une méthode favorisant la relation et l'échange mutuel entre l'analyste et le patient (qu'il s'agisse d'un enfant, d'un adolescent ou d'un adulte) et permettant à ce dernier de faire ;'expérience du holding et d'explorer librement différentes modalités de communication. Après avoir examiné la “technique” développée par Winnicott, l'auteur de cet article expose des considérations théoriques et propose des variantes par rapport à la technique de base, issues du rôle crucial joué par la réciprocité : “un peu moi, un peu toi.” Il présente le cas clinique d'un adolescent chinois.
Das „Schnörkelspiel“ ist in erster Linie eine Methode, eine Beziehung zwischen Analytiker und Patient (Kind, Jugendlichem oder auch Erwachsenem) herzustellen und den wechselseitigen Austausch zu fördern. Als solche gibt es dem Patienten Gelegenheit, sich gehalten zu fühlen und ungehindert unterschiedliche Kommunikationsmöglichkeiten zu erforschen. Im Anschluss an eine Untersuchung dieser von Winnicott entwickelten „Technik“ stellt der Autor auch theoretischen Überlegungen sowie Varianten der Grundtechnik vor, deren verbindendes Element die entscheidende Funktion der Wechselseitigkeit ist: „Ein bisschen von mir und ein bisschen von dir.“ Zur Illustration dient die Behandlung eines chinesischen Jugendlichen.
Il “gioco dello squiggle” rappresenta soprattutto un metodo per relazionarsi e promuovere uno scambio reciproco tra l’analista e il paziente (bambino, adolescente o anche adulto), consentendo a quest’ultimo di fare esperienza della funzione di holding e di esplorare liberamente diverse possibilità comunicative. Nel presente lavoro, dopo aver esaminato la ‘tecnica’ del metodo per come era stata originariamente sviluppata da Winnicott, presenterò una serie di considerazioni teoriche e anche alcune variazioni rispetto alla tecnica di base, ispirate dal ruolo centrale che nella relazione ha la reciprocità: ‘un po’ io e un po’ tu’. Il paper presenta un caso clinico con un adolescente cinese.
El “juego del squiggle” es, sobre todo, un método para relacionarse y alentar el intercambio mutuo entre el analista y el paciente (no importa si es niño, adolescente o adulto), permitiéndole a este último sentirse sostenido y explorar libremente diferentes posibilidades de comunicación.
Luego de haber explorado la “técnica” tal como fue desarrollada por Winnicott, el autor expone algunas consideraciones teóricas, y algunas variaciones en la técnica básica, concitadas por el papel crucial que desempeña la reciprocidad: “Yo un poquito y tú un poquito.” El artículo trata del caso clínico de un adolescente chino.
Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants’ hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-toface interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions.
Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother–infant relationship.
Our investigation 10, 11 of the literature has allowed us to identify the three factors which constitute most, if not all, of the reasons.
1. Insufficient recognition of the problem: even where the term “parents” is used in the titles and abstracts of articles on prematurity, the participants are often exclusively, or almost exclusively, mothers.
2. The relative invisibility of the fathers’ emotional difficulties and their need to be supported, because the symptoms of emotional discomfort in new fathers are different from, and less easily observable than, those of the mothers.12, 13 Fathers of premature infants are constantly preoccupied with the management of their own feelings, in an attempt not to be a burden to their partner,14 and to reconcile their own emotional state with what they feel is expected of them by others.15 For this reason, the emotional state of the father often manifests itself outside of the neonatal intensive care unit (NIC U).16 Furthermore, their anxieties and depressive disorders show up at a later stage than those of mothers.17
3. Methodological limits in those studies that do focus on the fathers of preterm babies: these limits indicate difficulties in recruiting and engaging fathers, and they inevitably influence the validity of the results. This leads, for instance, to underestimations of the fathers’ emotional distress.
3.1. Several qualitative studies conducted through interviews have focused on both mothers and fathers, but whereas the number of mothers interviewed was almost always sufficient for acquiring reliable data, the number of fathers interviewed was almost always too few, often less than ten.18
3.2. Most of the quantitative studies have used self-report tools, which do not take into consideration gender and culture differences, with possible negative consequences for the validity of the results. Support for this type of criticism comes from a series of studies that were conducted to validate the Edinburgh Postnatal Depression Scale (EPDS) on fathers: four of the five studies conducted to date have identified cut-off points for fathers which are substantially lower than those for mothers.19-22 These studies indicate another aspect which should not be overlooked: the cultural one.23 Societies in Western Europe and North America are multi-ethnic, and premature births to parents with cultural backgrounds very different from the host culture are increasing quick. This has important implications both for the detection and evaluation of the emotional state of fathers (and mothers) from diverse cultures, and for the types of intervention programs that could be helpful for them.24 With regard to the use of self-report questionnaires, various authors have recognized the need for a follow-up clinical interview to complement the questionnaires. According to the author of the EPDS: “a cut-off can only indicate the likelihood of clinical depression, not its severity or duration. A clinical interview is therefore necessary to determine the nature of the association of paternal depression with infant behavior and the quality of the parental relationship”.25 Furthermore in view of the possible problems of reliability and validity in the evaluation,26 they indicate the need for clinical interviews (note the plural) conducted by trained and certified clinical researchers.
3.3. Extremely little direct observation has been reported of the behavior of fathers in the NIC U, or of their interactions with the preterm infant, whether in the NIC U or in the months/years following the infant’s discharge. This is a significant limitation, because observation makes it possible to see aspects of the father-infant relationship which could not emerge from questionnaires or interviews, most importantly the real-time dynamics of father-infant interaction, which must not be overlooked when considering the preterm infant behavior per se. Focusing attention on these relational dynamics, using video microanalysis (i.e., a frame-by-frame observational technique which enables to see the moment-to-moment communication between partners, and to obtain measures of the process of dyadic coregulation) 27-29 and a theoretically oriented perspective, would also, crucially, allow us to detect and monitor indices of possible risk for the parents’ emotional health, the quality of attachment, and the child’s emotional, behavioral and cognitive development.
T
he reasons outlined in points 2 and 3 have led to an underestimation of the fathers’ distress levels (anxiety, stress and depression) and, more generally, have limited our knowledge of how the fathers’ internal world re-organizes itself when faced with a premature birth. Meanwhile, the reason described in the first point has functioned as a smokescreen obscuring — at least partially — the need to identify the connections if any between, on the one hand, the emotional state of fathers in the perinatal period and during the child’s first year of life and, on the other hand, a range of other factors. These factors include the quality of the couple’s relationship, the support given to the mother-infant relationship, the interaction between father and infant and the infant’s attachment to the father. Removing the smokescreen will also allow us to examine the connections between these relationships and the emotional, behavioral and cognitive development of the premature infant.
Being aware of these limitations — not, at first glance, entirely obvious — is the first step towards overcoming them and advancing scientific research.
‘The present volume is a comprehensive, detailed, and eminently fair analysis of the gradual development, problems and increasing sophistication of the concept and therapeutic utilization of countertransference. Stefana provides the historical background to the controversial origin of the discovery of the countertransference complications in the management of transference, and appropriately deepens the description of new theoretical and clinical developments to permit the reader to reach his own conclusion regarding the contemporary controversies of countertransference management. This book is a fascinating history of psychoanalytic discoveries, and should of great practical interest not only to the psychoanalytic clinician, but it is also a scholarly contribution to the study of developing psychoanalytic science.’ - Otto Kernberg, MD; psychoanalyst and professor of psychiatry at Weill Cornell Medical College, USA.
_._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.
'This superb history of the concept of countertransference makes an invaluable contribution to our field. The depth, breadth and range of Alberto Stefana’s understanding and his outstanding scholarship make this book essential reading for anyone who is engaged in the study and practice of analytic therapy.' - Theodore J. Jacobs, M.D., Clinical Professor of Psychiatry, The Albert Einstein College of Medicine, New York, USA.
Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders.
Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment.
Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls.
Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.
The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.
BACKGROUND:
When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.
DESIGN:
A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.
METHOD:
Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.
RESULTS:
Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.
CONCLUSION:
Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.
Le jeu du squiggle est avant tout une méthode favorisant la relation et l'échange mutuel entre l'analyste et le patient (qu'il s'agisse d'un enfant, d'un adolescent ou d'un adulte) et permettant à ce dernier de faire ;'expérience du holding et d'explorer librement différentes modalités de communication. Après avoir examiné la “technique” développée par Winnicott, l'auteur de cet article expose des considérations théoriques et propose des variantes par rapport à la technique de base, issues du rôle crucial joué par la réciprocité : “un peu moi, un peu toi.” Il présente le cas clinique d'un adolescent chinois.
Das „Schnörkelspiel“ ist in erster Linie eine Methode, eine Beziehung zwischen Analytiker und Patient (Kind, Jugendlichem oder auch Erwachsenem) herzustellen und den wechselseitigen Austausch zu fördern. Als solche gibt es dem Patienten Gelegenheit, sich gehalten zu fühlen und ungehindert unterschiedliche Kommunikationsmöglichkeiten zu erforschen. Im Anschluss an eine Untersuchung dieser von Winnicott entwickelten „Technik“ stellt der Autor auch theoretischen Überlegungen sowie Varianten der Grundtechnik vor, deren verbindendes Element die entscheidende Funktion der Wechselseitigkeit ist: „Ein bisschen von mir und ein bisschen von dir.“ Zur Illustration dient die Behandlung eines chinesischen Jugendlichen.
Il “gioco dello squiggle” rappresenta soprattutto un metodo per relazionarsi e promuovere uno scambio reciproco tra l’analista e il paziente (bambino, adolescente o anche adulto), consentendo a quest’ultimo di fare esperienza della funzione di holding e di esplorare liberamente diverse possibilità comunicative. Nel presente lavoro, dopo aver esaminato la ‘tecnica’ del metodo per come era stata originariamente sviluppata da Winnicott, presenterò una serie di considerazioni teoriche e anche alcune variazioni rispetto alla tecnica di base, ispirate dal ruolo centrale che nella relazione ha la reciprocità: ‘un po’ io e un po’ tu’. Il paper presenta un caso clinico con un adolescente cinese.
El “juego del squiggle” es, sobre todo, un método para relacionarse y alentar el intercambio mutuo entre el analista y el paciente (no importa si es niño, adolescente o adulto), permitiéndole a este último sentirse sostenido y explorar libremente diferentes posibilidades de comunicación.
Luego de haber explorado la “técnica” tal como fue desarrollada por Winnicott, el autor expone algunas consideraciones teóricas, y algunas variaciones en la técnica básica, concitadas por el papel crucial que desempeña la reciprocidad: “Yo un poquito y tú un poquito.” El artículo trata del caso clínico de un adolescente chino.
Methods and analysis: This is a mixed-method, observational and longitudinal study. The methodological strategy will include: (1) ethnographic observation in a level III NICU located in Italy for a duration of 18 months; (2) 3-minute video recordings of mother–infant and father–infant interaction in the NICU; (3) a semistructured interview with fathers during the infants’ hospital stay; (4) 3-minute video recordings of mother–infant and father–infant face-toface interaction in the laboratory at 4 months of corrected age; (5) self-report questionnaires for parents on depression and quality of the couple relationship at the approximate times of the video recording sessions.
Ethics and dissemination: The study protocol was approved by the Ethical Committee for Clinical Trials of the Verona and Rovigo Provinces. Results aim to be published in international peer-reviewed journals, and presented at relevant national and international conferences. This research project will develop research relevant to (1) the quality and modalities of maternal and paternal communication with the preterm infant in the NICU; (2) the influence of maternal/paternal social stimulation on the infant behavioural states; (3) the quality and modalities of paternal support to the partner and possible influences on mother–infant relationship.
Our investigation 10, 11 of the literature has allowed us to identify the three factors which constitute most, if not all, of the reasons.
1. Insufficient recognition of the problem: even where the term “parents” is used in the titles and abstracts of articles on prematurity, the participants are often exclusively, or almost exclusively, mothers.
2. The relative invisibility of the fathers’ emotional difficulties and their need to be supported, because the symptoms of emotional discomfort in new fathers are different from, and less easily observable than, those of the mothers.12, 13 Fathers of premature infants are constantly preoccupied with the management of their own feelings, in an attempt not to be a burden to their partner,14 and to reconcile their own emotional state with what they feel is expected of them by others.15 For this reason, the emotional state of the father often manifests itself outside of the neonatal intensive care unit (NIC U).16 Furthermore, their anxieties and depressive disorders show up at a later stage than those of mothers.17
3. Methodological limits in those studies that do focus on the fathers of preterm babies: these limits indicate difficulties in recruiting and engaging fathers, and they inevitably influence the validity of the results. This leads, for instance, to underestimations of the fathers’ emotional distress.
3.1. Several qualitative studies conducted through interviews have focused on both mothers and fathers, but whereas the number of mothers interviewed was almost always sufficient for acquiring reliable data, the number of fathers interviewed was almost always too few, often less than ten.18
3.2. Most of the quantitative studies have used self-report tools, which do not take into consideration gender and culture differences, with possible negative consequences for the validity of the results. Support for this type of criticism comes from a series of studies that were conducted to validate the Edinburgh Postnatal Depression Scale (EPDS) on fathers: four of the five studies conducted to date have identified cut-off points for fathers which are substantially lower than those for mothers.19-22 These studies indicate another aspect which should not be overlooked: the cultural one.23 Societies in Western Europe and North America are multi-ethnic, and premature births to parents with cultural backgrounds very different from the host culture are increasing quick. This has important implications both for the detection and evaluation of the emotional state of fathers (and mothers) from diverse cultures, and for the types of intervention programs that could be helpful for them.24 With regard to the use of self-report questionnaires, various authors have recognized the need for a follow-up clinical interview to complement the questionnaires. According to the author of the EPDS: “a cut-off can only indicate the likelihood of clinical depression, not its severity or duration. A clinical interview is therefore necessary to determine the nature of the association of paternal depression with infant behavior and the quality of the parental relationship”.25 Furthermore in view of the possible problems of reliability and validity in the evaluation,26 they indicate the need for clinical interviews (note the plural) conducted by trained and certified clinical researchers.
3.3. Extremely little direct observation has been reported of the behavior of fathers in the NIC U, or of their interactions with the preterm infant, whether in the NIC U or in the months/years following the infant’s discharge. This is a significant limitation, because observation makes it possible to see aspects of the father-infant relationship which could not emerge from questionnaires or interviews, most importantly the real-time dynamics of father-infant interaction, which must not be overlooked when considering the preterm infant behavior per se. Focusing attention on these relational dynamics, using video microanalysis (i.e., a frame-by-frame observational technique which enables to see the moment-to-moment communication between partners, and to obtain measures of the process of dyadic coregulation) 27-29 and a theoretically oriented perspective, would also, crucially, allow us to detect and monitor indices of possible risk for the parents’ emotional health, the quality of attachment, and the child’s emotional, behavioral and cognitive development.
T
he reasons outlined in points 2 and 3 have led to an underestimation of the fathers’ distress levels (anxiety, stress and depression) and, more generally, have limited our knowledge of how the fathers’ internal world re-organizes itself when faced with a premature birth. Meanwhile, the reason described in the first point has functioned as a smokescreen obscuring — at least partially — the need to identify the connections if any between, on the one hand, the emotional state of fathers in the perinatal period and during the child’s first year of life and, on the other hand, a range of other factors. These factors include the quality of the couple’s relationship, the support given to the mother-infant relationship, the interaction between father and infant and the infant’s attachment to the father. Removing the smokescreen will also allow us to examine the connections between these relationships and the emotional, behavioral and cognitive development of the premature infant.
Being aware of these limitations — not, at first glance, entirely obvious — is the first step towards overcoming them and advancing scientific research.
The aim of this study was to investigate fathers' emotional experiences of their infant's preterm birth and subsequent stay in neonatal intensive care unit.
BACKGROUND:
When a baby is born preterm, there is also the premature interruption of the process of preparation for fatherhood. As a result, the impact on fathers of the preterm birth can bring negative consequences for the development of father-infant relationship.
DESIGN:
A multi-method approach was used which included ethnographic observation, semi-structured interviews with fathers, a self-report questionnaire and clinical information between September 2015-March 2017.
METHOD:
Data were analysed using a mixed-method: a thematic analysis of data from the interviews and quantitative analyses to detect possible clusters of fathers' emotional experiences and associations between clusters and fathers' and/or infants' characteristics.
RESULTS:
Two clusters were identified. The "fathers-of-preterm-infants" touched their baby as soon as they were given the opportunity and without fear that they would harm their infant. They were struck by their baby's physical appearance. In contrast, the "preterm fathers" preferred not to touch their baby when first given the chance, for fear of breaking/damaging/infecting her/him. They were struck both by the baby's physical appearance and by the technology/equipment around her/him and were afraid that their infant would die. All the "fathers-of-preterm-infants", but only just over half of the "preterm fathers", were actively engaged in their infant's care. Clusters were associated with the infant's gestational age.
CONCLUSION:
Fathers of preterm infants should receive personalized support specifically addressed to them and based on the infant's gestational age.