Journal of Infant, Child, and Adolescent Psychotherapy最新文献

{"title":"Caregiver Mentalizing and Child Emotional Regulation: A Novel Approach to Examining Bidirectional Impact","authors":"Eva A. Sprecher, Caroline Cresswell, Asa Kerr-Davis, Michelle Sleed, Nick Midgley","doi":"10.1080/15289168.2023.2274200","DOIUrl":"https://doi.org/10.1080/15289168.2023.2274200","url":null,"abstract":"ABSTRACTMentalization theory suggest bidirectional links between a caregiver’s capacity to mentalize their child and emotional regulation in their children. However, there has been little empirical investigation to verify this theory. The bidirectional relationship between caregiver mentalizing and child emotional regulation may be especially important to understand in caregiving contexts where there is greater risk of relationship breakdown or child emotional dysregulation, such as in fostering relationships. This study used a novel time-sequence analysis approach to explore the putative bidirectional relationship between caregiver mentalizing and child emotional regulation in the context of long-term foster care. Existing theories about caregiver mentalizing and child emotional regulation were evaluated and developed by looking at moment-by-moment interactions between a foster carer and a child in her care. The findings of this study gave mixed support for bidirectional relationships between foster carer mentalizing, and child emotional regulation predicted by existing theoretical models. These findings have implications for refining and applying mentalization theory broadly and more specifically in the context of foster care. Furthermore, this study provides a useful example of how time-sequence analysis may be useful for exploring the links between phenomena, such as caregiver mentalizing and child emotional dysregulation, occurring over time in observational data. AcknowledgmentsWe would like to thank Ruth and Alex for their generous participation in this study. The data used in this study comes from the Relationship Stories study which was conceived and designed by Nick Midgley, Karen Irvine, Jamie Murdoch, Zena Louise Richards, Thando Katangwe-Chigamba and Eva Sprecher.Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThis study uses data collected from a project funded by the National Institute for Health Research (NIHR) [name of NIHR programme (127422 Midgley/Public Health Research]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The Funder has no involvement in the design of the study or collection, analysis, and interpretation of data. This study is adapted from the first author’s PhD thesis.Notes on contributorsEva A. SprecherEva A. Sprecher, Ph.D., is a Research Fellow at UCL and the Anna Freud.Caroline CresswellCaroline Cresswell, Ph.D., is a Research Fellow at the University of Hertfordshire in the Clinical Trials Support Network.Asa Kerr-DavisAsa Kerr-Davis, M.Sc., is a PhD student at UCL and the Anna Freud and an assistant psychologist in Oxford Health NHS Foundation Trust.Michelle SleedMichelle Sleed, Ph.D., is a senior research fellow and research tutor at the Anna Freud and a research tutor at UCL.Nick MidgleyNick Midgley, Ph.D., is a Professor of Psychological Therapies with Childre","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"54 27","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134902634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who is This Child? From Observation to Formulation and Therapy Goals","authors":"Yonit Shulman","doi":"10.1080/15289168.2023.2275329","DOIUrl":"https://doi.org/10.1080/15289168.2023.2275329","url":null,"abstract":"ABSTRACTClinical observation is constantly used in our work: during assessment, when a specific question or need arises, and in fact, during each and every therapeutic hour. When observing a child, whether in natural setting or in the therapy room, on preliminary assessment or during an ongoing psychotherapy, two basic questions need to be related to: “Who is this child?” and- “How may we help him?” In the following paper, characteristics and phases of developmental-psychodynamic noninterventive observation are described. It is then demonstrated by two clinical vignettes, how such observation may afford at least preliminary replies to these questions, and provide meaningful, useful leads to therapists, care-takers, and educational teams to explore and to move forward. Observation is a process of hypothesizing, confirming or refuting our hypotheses, and finally of integration, as we face the creative challenge of translating nonverbal, emotional experience into verbal, concise professional language. The end product of observation is formulation: relating to specific, unique child and family, connected to emotional experience and preserving its truth and authenticity, and at the same time useful and practical in defining and formulating therapeutic goals. Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationNotes on contributorsYonit ShulmanYonit Shulman, M.A., is Senior Clinical Psychologist and Supervisor, Head of Psychology Sector, at Oti- The Israeli Autism Association; is Academic Co-Director of the Child & Adolescent Psychoanalytic Psychotherapy Program, Advanced Studies, School for Social Work, Tel- Aviv University and Bar-Ilan University; is in private practice; and is the former Head of the Child and Adolescent Section of the Israeli Psychoanalytic Psychotherapy Association.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"58 44","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134902766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering the Mental World of Children: Attachment Quality, Mental State Talk, and Children’s Drawings","authors":"Holly Rosen, Geoff Goodman, Donna Tuman, Deborah Ohm","doi":"10.1080/15289168.2023.2272214","DOIUrl":"https://doi.org/10.1080/15289168.2023.2272214","url":null,"abstract":"ABSTRACTThe present study utilized archival data to uncover trends associated with children’s drawings, attachment quality, and mental state talk (MST). Two samples of 5–12-year-old children and their caregivers were recruited: one child sample from a public elementary school (n = 54), and the other from consecutive admissions to a child psychiatric inpatient unit (n = 45). Children completed drawings of family, primary caregiver, and self. Drawings were coded using the Formal Elements (FE) and Content rating scales designed to identify selective content and organizational qualities. Attachment quality and MST were obtained using the Attachment Story Completion Task and Children’s Apperception Test. Consistent with the first hypothesis, attachment quality demonstrated a marginally significant positive relationship with Content scores of inpatient children’s family drawings. Consistent with the second hypothesis, attachment quality demonstrated a significant positive relationship with MST in both samples. Consistent with the third hypothesis, MST demonstrated a significant positive relationship with Content scores of nonpatient children’s caregiver drawings, FE scores of nonpatient children’s family drawings, and both Content and FE scores of inpatient children’s family drawings. Drawings hold promise as tools to access children’s internal working models and mental states. Clinical implications are discussed. AcknowledgmentsThe authors wish to acknowledge the following persons for their assistance with coding for this study: Alisa Barsch, Sorrel Johnson, Jenae Richardson, Emily Rispoli, Rachel Ross, Alexandra Tannenbaum, Adama Toure, Theresa Whelan, and Andrea Youniss. The authors acknowledge the guidance and insights of Dr. Valeda Dent in helping to formulate this study. The authors also gratefully acknowledge the cooperation of the children and caregivers who participated in this study.Disclosure statementNo potential conflict of interest was reported by the author(s).Data availability statementDue to patient confidentiality issues, the data will not be made available.Additional informationFundingThis work was supported by the International Psychoanalytical Association Research Advisory Board; Long Island University; Contemporary Freudian Society.Notes on contributorsHolly RosenHolly Rosen, Psy.D., is a postdoctoral fellow at Psychiatry Associates Faculty Group Practice within NYU Langone Medical Center. She received her doctorate degree in Clinical Psychology at Long Island University Post Campus in Brookville, NY in 2023. She completed her predoctoral internship at VA New York Harbor Health Care: Brooklyn Campus. Prior to that, she received outpatient training at Montefiore Medical Center and inpatient training at New York Presbyterian Hospital. Throughout her clinical training, she served as a counselor at Options for Community Living, a transitional living facility for individuals with mental illness and substance abuse disorders. Dr. Rosen ","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"53 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136346416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the Mediational Intervention for Sensitizing Caregivers on Mentalizing in Orphans and Vulnerable Children in South Africa","authors":"Madeleine Allman, Paulina Kulesz, Lochner Marais, Carla Sharp","doi":"10.1080/15289168.2023.2275230","DOIUrl":"https://doi.org/10.1080/15289168.2023.2275230","url":null,"abstract":"ABSTRACTMediational Intervention for Sensitizing Caregivers (MISC) is a mentalization-based intervention which aims to enhance caregiver sensitivity and responsiveness. MISC has demonstrated treatment effects on mental health problems of Orphans and Vulnerable Children (OVC) in South Africa by working with Community-Based Organization (CBO) care workers as the point of intervention. Recent elaboration of mentalization-based theory points to alternate figures in a child’s early environment as critical resources for enhancing children’s mentalizing capacity. In this study, we evaluated the treatment effect of MISC on children’s mentalizing capacity at baseline and following 12-months of the intervention, controlling for the effects of age, gender, orphan status, socioeconomic status, quality of the home environment, and mental health difficulties at baseline. MISC and Treatment as Usual (TAU) groups were compared using a mixed model linear regression. Results demonstrated significant effects of MISC, time, and mental health difficulties on mentalizing capacity. To our knowledge, this study is the first mentalization-based caregiver intervention to demonstrate treatment effects on child mentalizing capacity, and MISC is the first mentalization-based caregiver intervention to focus on paraprofessionals as the point of intervention. AcknowledgmentsWe wish to thank the children and caregivers who participated in this research and made the study possible.Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThis work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under Grant [R01HD081985].Notes on contributorsMadeleine AllmanMadeleine Allman, M.P.H., M.A., is a doctoral student at the University of Houston Clinical Psychology Program in the Child track. She is interested in the translation and implementation of interventions for children and families who have suffered attachment trauma, as well as the development of social cognition.Paulina KuleszPaulina Kulesz, Ph.D., works as a Research Associate Professor at the University of Houston and Statistical Consultant. She is an applied statistician, data scientist, and psychometrician with an extensive neuropsychological and educational psychology background.Lochner MaraisLochner Marais, Ph.D., is a Professor of Development Studies at the Centre for Development Support at the University of the Free State (UFS). His research interests include housing policy, small cities and towns (mining and renewable towns and cities), and public health focusing on children. In addition to concentrating on these themes separately, he focuses on integrating them. Marais has authored, coauthored, and compiled over 250 research reports, including 180 refereed articles in peer-reviewed journals or books. He has also co-edited nine books and is the author of one scholarly book. Over the past 10 years, he has been a c","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"28 2‐3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135342182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attention Deficit Hyperactivity Disorder in Childhood, Resilience, Compassion, Mentalization, and the Prevention of Borderline Personality Disorder in Adulthood: A Review","authors":"James B. McCarthy, Francine Conway, Jessica D. Kastin, Frank H. Seabrook","doi":"10.1080/15289168.2023.2266673","DOIUrl":"https://doi.org/10.1080/15289168.2023.2266673","url":null,"abstract":"ABSTRACTThis paper explores the co-occurring features of Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) and ADHD as a risk factor for the emergence of BPD. It emphasizes the importance of clinical treatment to improve resiliency and addresses co-occurring areas of vulnerability in individuals with ADHD and those with BPD, as well as in individuals with both disorders. Although the specific developmental pathways and mediating factors remain uncertain, many investigations have identified ADHD and emotion dysregulation in childhood as risk factors for developing personality disorders, particularly BPD, in late adolescence and early adulthood. The frequent co-occurrence of ADHD with BPD in adulthood contributes to worse outcomes and continuing problems with impulsivity and regulating emotional arousal among individuals with both disorders. While the comorbidity of ADHD and BPD poses a risk, it is essential to also consider what factors may help moderate the risks and contribute to resiliency. This review highlights the gaps in the literature about resilience by reviewing existing literature that points to treatment approaches, such as compassion-focused and mentalization-focused psychotherapy, that may mediate ADHD-related risks. Long-term treatment outcome studies of emotion regulation therapies with children are needed to ascertain their effectiveness in reducing the psychological adversity associated with experiencing ADHD in childhood and reducing the emergence of BPD in adolescents and adults. Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationNotes on contributorsJames B. McCarthyJames B. McCarthy, Ph.D., A.B.P.P., is Professor of Psychology and Director of Psychology Field Training at Pace University, New York City. Dr. McCarthy is a clinical psychologist, psychoanalyst, and researcher who has frequently contributed to the literature on adolescence, psychoanalytic psychotherapy, and severe mental illness. Dr. McCarthy is the former Director of Psychology at Sagamore Children’s Psychiatric Center in Dix Hills, NY, and the former Director of Psychology at New York City Children’s Center-Queens Campus in Bellerose, NY. His most recent book is Psychosis in Childhood and Adolescence.Francine ConwayFrancine Conway, Ph.D., is the Chancellor of Rutgers University, the former Provost of Rutgers University, and Distinguished Professor at the Graduate School of Applied and Professional Psychology at Rutgers University-New Brunswick, where she was formerly the Dean from 2016 to 2020. Dr. Conway is an internationally recognized scholar, researcher, and clinical psychologist who has made frequent contributions to the literature on the treatment of children with behavioral problems and children with Attention Deficit Hyperactivity Disorder. Her most recent book is Cultivating Compassion: A Psychodynamic Understanding of Attention Deficit Hyperactivity Disorder.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"34 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135111329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relational and Existential-Humanistic Supervision and Therapy for Adolescents with Life-Threatening Illness: From Cocoon to Butterfly","authors":"Robert M. Gordon, Taylor D. Groth","doi":"10.1080/15289168.2023.2254661","DOIUrl":"https://doi.org/10.1080/15289168.2023.2254661","url":null,"abstract":"ABSTRACT This paper describes the flexible application of existential-humanistic (E-H) and relational approaches to supervision when working with adolescents with life-threatening illness. Powerful therapeutic work can occur through the balance of utilizing practical therapeutic interventions─including open-ended questions regarding existential anxieties, use of countertransference and somatic reactions, reflecting on values and priorities, dream interpretation, learning from each emotion, creativity, and what is psychological health─and understanding how an illness is processed through the patient’s unique cultural, family, medical, and relational history. The relational approach provides a balance to the E-H therapy emphasis on individuality in its focus on the complexity and adhesiveness of how early relational patterns and expectations are repeated throughout life. The E-H approach, on the other hand, provides a richness and depth to adolescents’ anxieties and desire for freedom and choice. The language of agency, uncertainty, groundlessness, and responsibility can be particularly relevant to the turbulence of this developmental stage. The ultimate goal of supervision is that the supervisor becomes part of the supervisee’s “internal chorus” along with other teachers, therapists, and mentors when dealing with future clinical challenges.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90742023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“I Try to Think Behind My Child’s Cry”: Preparation for Separation Experiences in the Light of Parental Mentalization","authors":"Nina Mellenius, R. Korja, M. Kalland, Rauno Huttunen, Johanna Sourander, Saara J. Salo, Saija Westerlund-Cook, N. Junttila","doi":"10.1080/15289168.2023.2240004","DOIUrl":"https://doi.org/10.1080/15289168.2023.2240004","url":null,"abstract":"ABSTRACT The study focused on expanding the understanding of how parental mentalization (PM) occurs in an ecologically valid context during a toddler’s first transition phase from home care to early childhood education and care (ECEC). Little attention has been paid to understanding how PM occurs during a potentially stressful period of life when preparing for the first experiences of separation between the parent and the toddler. The aim of this phenomenographic study was to distinguish the qualitatively different ways parents (n = 21) experience, conceptualize, perceive, and understand the forthcoming first separation from their toddler (at 10–24 months). The results are presented in the outcome space on the basis of the phenomenographic analysis, which consisted of three categories of description: the parent’s own experiences and orientation for the forthcoming separation phase, the parent’s representation of the child’s forthcoming experiences, and PM indicators. These categories contained 10 subcategories and 480 meaning units. The mentalization indicators provide a broad view of PM in the transition phase, which consists of tolerable and reflective uncertainty. This is where some core functions of PM may be observed, maintaining flexibility toward the reactions of parents themselves and their toddlers.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"33 1","pages":"290 - 309"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90992893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Interplay of Negation and Epistemological Strategies in the Development of Agency","authors":"R. Webb, Philip J. Rosenbaum","doi":"10.1080/15289168.2023.2221158","DOIUrl":"https://doi.org/10.1080/15289168.2023.2221158","url":null,"abstract":"ABSTRACT In this paper we look at negation from a developmental perspective. We propose that in the march toward the embodiment of the virtuous “Yes” of agency the “No” of childhood is different from the “No” of adolescence and young adulthood. In the former the “No” of negation reflects an epistemological strategy of obedience/disobedience and in the latter a strategy of wondering. How “No” is negotiated in development reflects an important interplay between the child/adolescent and their caregivers with the existential-relational position occupied most typically by the caregivers as central to whether the “No” can be one of negation or devolve into negativism. To illustrate our ideas we offer four vignettes.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"695 1","pages":"268 - 278"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80393299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Family Cycle in Supervision: Enhancing Clinician Mentalizing in Work with Highly Stressed Families","authors":"Victoria Stob, A. Slade, Line Brotnow, J. Woolston","doi":"10.1080/15289168.2023.2228719","DOIUrl":"https://doi.org/10.1080/15289168.2023.2228719","url":null,"abstract":"ABSTRACT In the last two decades there has been significant growth in the use of mentalization theory to conceptualize and organize the therapeutic practice of clinicians working with complex and multi-stressed families. In this paper we describe the supervisory use of the Family Cycle – a clinical activity designed to promote mentalizing in parents and children participating in an intensive home visiting program aimed at avoiding child/adolescent psychiatric hospitalization. We describe the Family Cycle in the supervisory context as a structure that facilitates fostering safety and regulation in the supervisory relationship, all in the service of mentalizing the experience of the families in therapy. We highlight barriers to working effectively with mentalization-based techniques and emphasize how supervisors can effectively model the mentalizing stance through interactions with clinicians. We end with a supervisory vignette illustrating concretely how one would go about applying this technique to supervision.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"57 1","pages":"226 - 237"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88734270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Vulnerable Mothers, Infants and Young Children Living in Poverty: Co-Creating a Psychoanalytic Playground in Various Alternative Settings","authors":"T. Tokgoz","doi":"10.1080/15289168.2023.2226538","DOIUrl":"https://doi.org/10.1080/15289168.2023.2226538","url":null,"abstract":"ABSTRACT The families referred to the Anni Bergman Parent Infant Program (ABPIP) Home-Visiting Project often face multiple, overwhelming stressors embedded within the market-oriented system of poverty and exploitation. These stressors compromise the quality of parental care, which in turn negatively impacts the infant’s well-being. These financially vulnerable families are usually in an urgent crisis that needs immediate attention. The author describes the innovative model of this outreach program based on psychoanalytic infant observation that encourages interventions on multiple levels simultaneously. Another unique aspect of the program is its reshaping of the analytic frame. Considering the ever-changing nature of the physical settings, the analyst’s internal setting becomes a vital, anchoring, and facilitating factor of therapeutic change. Through two detailed case examples, the author shows how these outreach analysts place themselves in between external and internal realities, recognizing the interdependent nature of both, while also maintaining a psychoanalytic attitude and frame that is primarily situated within the analyst. The author also reflects on her own precarious status as an international, temporary visa holder in the US and the ways this external reality entered into the playground of therapy that allowed the author to understand and help a child in a deeper, more personal way based on the dyad’s shared preoccupation with the notion of home.","PeriodicalId":38107,"journal":{"name":"Journal of Infant, Child, and Adolescent Psychotherapy","volume":"13 1","pages":"215 - 225"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87125145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}