Die Autoren berichten über die erste kontrollierte Psychotherapiestudie, die psychoanalytische und kognitiv-verhaltenstherapeutische Langzeitpsychotherapien mit randomisierter und präferierter Zuweisung mit­einander vergleicht. In vier Behandlungszentren wurden 554 chronisch depressive Patienten interviewt, von denen 252 in die Studie aufgenommen werden konnten. In den Selbsteinschätzungen der Patienten zeigten sich große und stabile Veränderungen. Die vollständige Remissionsrate (für BDI) lag nach einem Jahr bei 34 % und stieg auf 45 % nach drei Jahren. Analoge Ergebnisse zeigten sich in den Einschätzungen der unabhängigen, bezogen auf die (...) Therapieverfahren verblindeten Rater (QIDS). Entgegen ihrer Hypothesen fanden die Autoren aber keinen statistisch signifikanten Unterschied zwischen den Verfahren und auch keine Effektunterschiede zwischen randomisierter Therapiezuweisung und Behandlung mit der präferierten Psychotherapie. Besser als in anderen Studien sind die erzielten Remissionsraten, die zeigten, dass chronisch depressive Patienten von Langzeitpsychotherapien profitieren. (shrink)

Background: The transition to child care is a challenging time in a child’s life and leads to elevated levels of cortisol. These elevations may be influenced by the quality of the mother-child-relationship. However, remarkably little is known about cortisol production in response to the beginning of child care among children-at-risk such as children with an immigrant background. However, attending kindergarten or any other child day-care institution can for example have a compensating effect on potential language deficits thus improving the educational (...) opportunities of these children. Method: Data of a subsample of N = 24 “hard-to-reach” mother-child dyads was collected in the context of the psychoanalytic early prevention project “First Steps”. The project focuses on the earliest integration of children with an immigrant background by supporting parenting capacities in the critical phase of migration and early parenthood. Children’s hair cortisol concentration (HCC) was assessed one week before (mean age = 38.77 months) and three months after kindergarten entry (mean age = 42.26 months). Hair analysis was conducted for both times of measurement, reflecting the first 3 months after kindergarten entry and 3 months prior. Furthermore, the emotional quality of the mother-child-relationship was assessed with the help of the Emotional Availability Scales (EAS) shortly before kindergarten entry when the children were about three years old (mean age = 37.2). Results and Conclusion: Children’s mean cumulated HCC was higher after kindergarten entry than before. The increase correlated negatively with several dimensions of the EAS. Repeated measures ANCOVA revealed that particularly responsive children and children who had experienced less intrusive mother-child-relationships demonstrated lower elevations in HCC after kindergarten entry. Furthermore, a decreased EA score was found in all EA dimensions, besides the dimension “mother’s non-hostility”, indicating problematic EA within the mother-child-relationships of the sample. The results suggest that children with an immigrant background who experience more emotional available mother-child-relationships seem to regulate stress induced by kindergarten entry more effectively, indicated by lower cortisol elevations after entry. This implicates that supporting early mother-child-relationships by intervention may have a positive effect on the children’s ability to regulate stress induced by kindergarten entry thus promoting child development. (shrink)

Children who live on the margins of society are disadvantaged in achieving their developmental potential because of the lack of a necessary stable environment and nurturing care. Many early prevention programs aim at mitigating such effects, but often the evaluation of their long-term effect is missing. The aim of the study presented here was to evaluate such long-term effects in two prevention programs for children-at-risk growing up in deprived social environments focusing on child attachment representation as the primary outcome as (...) well as on self-reflective capacities of teachers taking care of these children. The latter was a key component for promoting resilient behavior in children. Five hundred and twenty-six children aged 36 to 60 months at risk due to immigration status, low family socio-economic status and child behavior were examined in a cluster-randomized study comparing two preventions, the psychodynamic, attachment-based holistic approach EARLY STEPS (ES) with the classroom based FAUSTLOS (FA) for their efficacy. Primary outcome was the child attachment representation measured by the Manchester Child Attachment Story Task (MCAST). Secondary outcomes were derived from (a) the Caregiver-Teacher Report Form (C-TRF: problem behaviors, including anxiety/depressive symptoms, emotional-reactive and somatic problems, social withdrawal, aggressive behavior, and attention deficit), from (b) the Strength and Difficulties Questionnaire (SDQ, parent version: resilience and wellbeing) and (c) Self-Reflective Scales for teachers (SRS: self-reflective capacities of teachers). Compared to baseline, attachment and behavioral problems improved in both programs. ES led to more secure and more organized attachment representations (medium effect sizes). Aggressive behavior and externalizing problems were reduced in the FA group compared with ES, particularly in boys (medium effect sizes). Self-reflective capacities of the teachers increased only in the ES group. High correlation between children’s attachment type with the number of social risk factors and the increase of problematic social behavior strongly indicate that an increase in teachers’ self-reflective capacities helps to change children’s attachment patterns which thus strengthens the resilience of these children-at-risk [An ethical vote from LPPKJP 2009-02-25 was obtained and the trial registered; Clinical trial registration information: The trial was registered 14.02.2012 (DRKS00003500;https://www.drks.de)]. (shrink)

BackgroundIn many Western countries like Germany, the social integration of children with an immigrant background has become an urgent social tasks. The probability of them living in high-risk environments and being disadvantaged regarding health and education-related variables is still relatively higher. Yet, promoting language acquisition is not the only relevant factor for their social integration, but also the support of earlier developmental processes associated with adequate early parenting in their first months of life. The Emotional Availability Scales measure the quality (...) of caregiver-child-interactions as an indicator of the quality of their relationship and thus of such early parenting, focusing on mutual and emotional aspects of their interaction.MethodThis pilot study examined in a randomized controlled trial the effects of the prevention project First Steps regarding the hypothesis that the Emotional Availability improved to a greater extent in “difficult-to-reach” immigrant mother-child dyads in a psychoanalytically oriented early intervention compared to a usual care intervention offered by paraprofessionals with an immigrant background. A sample of N = 118 immigrant women in Germany from 37 different countries and their children was compared with regard to the parental EA-dimensions sensitivity, structuring, non-intrusiveness and non-hostility and the child dimensions responsiveness to and involvement of the caregiver in the pre-post RCT design.Results and ConclusionDifferent from what was expected, repeated ANOVAs revealed no significant pre-post group differences for the parental dimensions. For the child dimensions the effect of time of measurement was highly significant, which can be interpreted as mostly natural developmental effects. Still, on the level of simple main effects for each intervention, only in the FIRST STEPS groups child responsiveness significantly improved. When controlled for confounding variables, a significant interaction effect for maternal sensitivity in favor of the FIRST STEPS intervention was found. The systematic group differences indicate that the more extensive and professional intervention, focusing on the individual needs of the participants, is more suitable to support the quality of the mother-child-relationship amongst immigrant mother-child dyads than usual care. The results are discussed taking into account the context of the maternal migration process and potential maternal traumatization.Clinical Trial Registration[https://clinicaltrials.gov], identifier [DRKS00004632]. (shrink)

Psychoanalysis was characterised by Freud as ‘the science of the unconscious mind’, and he never gave up hope that future developments in the neurosciences might contribute to a scientific foundation of psychoanalysis. This book explores the critical interdisciplinary dialogue between contemporary psychoanalysis and cognitive science, building bridges between researchers and clinicians to enable a better understanding of their passions, professional realities and engagement with psychoanalysis. Each chapter presents clinical case studies of the unconscious, alongside key areas of debate and development, (...) including: what are the differences between the conceptualisation of ‘the unconscious’ in psychoanalysis and in cognitive science? Are core concepts of psychoanalysis still plausible? And are such understandings of the unconscious still central to treating patients in contemporary psychotherapy? (shrink)