A qualitative analysis of adolescent motherhood within the broader family context in Peru.

Objective: The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets. Background: Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group. Method: This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed. Results: The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy. Conclusion: Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy. Implications: Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.

Manifestations of Intergenerational Trauma During the Perinatal Period Among Adolescent Mothers in Lima, Peru: A Qualitative Analysis.

Adverse childhood experiences have a lasting impact on health across the life course. The perinatal period offers a unique opportunity to rework problematic dynamics in families experiencing intergenerational trauma. This study explores the family dynamics that are activated during the perinatal period and considers the potential for intervention with adolescent parents and their families in Lima, Peru. This narrative analysis was part of a broader study that included focus groups and in-depth interviews. Of the ten adolescent mothers interviewed, four narratives were selected for presentation in this manuscript. These particular narratives were selected to illustrate the diversity of the experiences among this group and for the exceptional level of detail provided about their life experiences and family relationships. Narrative excerpts were analyzed in the context of the entire interview and the aggregate content of other interviews in order to explore both explicit and implicit meanings. This study identified critical relational shifts among adolescent parents and their families during the perinatal period. In one instance, adolescent parenthood created an opportunity for the family to come together. In the other cases, conflict escalated, relations grew distant, or both. These narrative data demonstrate that intergenerational trauma can interfere with family relationships in the context of adolescent pregnancy and prevent adolescent parents from accessing needed support from their families. Intervention with families could address the impact of trauma and improve communication and collaboration.

Luminescent 1H-1,3-benzazaphospholes.

2-R-1H-1,3-Benzazaphospholes (R-BAPs) are an interesting class of σ2P heterocycles containing P[double bond, length as m-dash]C bonds. While closely related 2-R-1,3-benzoxaphospholes (R-BOPs) have been shown to be highly photoluminescent materials depending on specific R substituents, photoluminescence of R-BAPs has been previously limited to an example having a fused carbazole ring system. Here we detail the synthesis and structural characterization of a new R-BAP (3c, R = 2,2'-dithiophene), and compare its photoluminescence against two previously reported R-BAPs (3a, R, R' = Me and 3b, R = 2-thiophene). The significant fluorescence displayed by the thiophene derivatives 3b (φ = 0.53) and 3c (φ = 0.12) stands in contrast to the weakly emissive methyl substituted analogue 3a (φ = 0.08). Comparative computational investigations of 3a-c offer insights into the interplay between structure-function relationships affecting excited state relaxation processes.

Editorial Perspective: The mental health impact of school closures during the COVID-19 pandemic.

School closures were one of the earlier actions taken as the world tried to contain the COVID-19 outbreak, a decision impacting nearly three-fourths of the learners worldwide. One year into the pandemic, over 200 million students still faced disruptions to their education. Nearing the end of another academic year that has occurred entirely during the pandemic, many schools remained fully or partially closed for in-person education, altering routines and representing potential hardships to the next generation and their families. This article will explore the potential impacts of school closures on children and adolescents related to increased screen time, irregular sleep patterns, less balanced diets, learning difficulties, and changes in social interaction. In addition, we note broader familial difficulties likely accompanying the loss of the mitigating effects of schools and their associated support systems, such as parental stress and work responsibilities, loss of employment, intimate partner violence, child abuse and neglect, and parental substance abuse, which appear to have increased during the pandemic. Considering what is known about the impact from previous natural catastrophes, the populations at risk, and the early but not yet definitive data from the current pandemic, we stress the urgent need for robust data as we prepare for a new academic year in the Northern Hemisphere. Although we currently lack consistent and complete data, signs for concern include a rise in pediatric emergency room visits for mental health and substance use issues in many parts of the world. This paper aims to stimulate a discussion about the potential mental health effects of school closures for children and adolescents in the context of a pandemic.

Culture - Surprise and the Psychoanalyst.

The author describes how an immersion experience in another culture can benefit the psychoanalyst-and the individual who is a psychoanalyst-by confronting trusted theories and challenging the analyst to create new methods for understanding basic aspects of human experience, such as the meaning of the "self."

Three Ways Isolable Carbenes Can Modulate Emission of NH-Containing Fluorophores.

Fluorescent molecules and materials that exhibit emission changes in response to analytes are of great interest across multiple disciplines. Herein, we investigate the response of NH-containing fluorophores carbazole and 2-phenylbenzimidazole (Ph-BIM) with two representative isolable singlet carbenes. Specifically, N-heterocyclic carbene 1,3-bis(2,6-diisopropylphenyl)imidazol-2-ylidene (IPr) and cyclic (alkyl)(amino)carbene (2,6-diisopropylphenyl)-4,4-diethyl-2,2-dimethyl-pyrrolidin-5-ylidene (EtCAAC) were discovered to afford three different types of reaction products with carbazole and Ph-BIM. Depending on the reaction pair, hydrogen bonding (1), NH-insertion (2,3), or proton transfer (4) products can be isolated, each displaying variable photophysical responses. These products have been structurally authenticated by single crystal X-ray diffraction and NMR spectrometric methods. Studies of the solution state behavior of 1-4 reveals that these adducts are labile and can reversibly dissociate to free carbenes and fluorophores to varying extents. These equilibria produce concentration dependent solution state behavior as identified and quantified via UV-visible absorption, emission, 1H DOSY, and NMR spectroscopic measurements.

Ten Little Monkeys.

Observations of videotaped sessions of the analytic treatment of a four-year-old autistic boy offer insights into the meanings and the mechanisms of transference. These observations illustrate the well-known fact that the relationship of transference to symbolization is ambiguous. They also demonstrate that multiple simultaneous meanings exist in a transference field, and many of these meanings emerge from partially or nonsymbolized domains of experience, including and perhaps most important, bodily experience. Whereas many clinicians would agree with these proposals, finding supportive data for them is difficult. One way to explore nonsymbolized phenomena is by analyzing the observable data in videotapes of an autistic child with limited symbolic capacity. Then these data can be put together with the emerging symbolic communications of the child as well as the countertransference reactions of the analyst and some of the biological processes contributing to these meanings. In this study, complex interactions between and among transference reactions of varying degrees of symbolization and in different domains of meaning may provide clues to transference in patients of all ages.

The sandwich model: the 'music and dance' of therapeutic action.

My premise is that a 'layered' approach is necessary to understand the process of exchanges that result in therapeutic change. I imagine these processes occurring in three layers - although the number of domains in which change is taking place is actually infinite - such as in a sandwich. The top layer, or top slice of bread of the sandwich, represents a broad view of the change process; it is non-linear and includes the feature of uncertainty, a general principle of dynamic systems theory. The middle layer, or the meat of the sandwich, is explained by theories that are immediately and clinically useful to a therapist, such as psychoanalytic theories. These are primarily linear theories and use language and symbols to 'tell a story of what happened'. The bottom layer, or bottom slice of bread of the sandwich, is the micro-process; this layer includes the moment-to-moment patterns of coordinated rhythms that both communicate meaning and provide the essential scaffold for all higher-level change processes. The micro-process also requires a non-linear theory to make sense of its variability and emergent properties. Taking a bite out of the sandwich will include a 'polysemic bundle of communicative behaviors' (Harrison and Tronick, 2011). I will illustrate the 'sandwich model' with the clinical case of the analytic treatment of a 5 year-old boy.

"The noise monitor": a developmental perspective on verbal and nonverbal meaning-making in psychoanalysis.

This paper discusses a contribution of developmental theory to the psychoanalytic concept of "the talking cure." The developmental theory presented is the dyadic expansion of consciousness model (Tronick 2007), a model consistent with the principles of nonlinear systems theory. The concept of "polysemic bundles" as a way of understanding the multiple simultaneous meaning-making processes occurring in dyadic communication is introduced. The theoretical discussion--focused primarily on the analysis of children--is illustrated with descriptions of videotaped sequences from the first session in the analysis of a five-year-old boy. The relevance of these insights to the analytic treatment of adults is then considered.

Psychodynamic psychotherapy: adults and children.

Psychodynamic psychotherapy is a major therapeutic modality for adults and children. It covers a number of related therapies based on psychoanalytic concepts and models. In this paper, we address new developments in thinking and practice, recent changes relating to teaching, and new findings from research and developmental science. A child case is presented to illustrate the complexity of arriving at a diagnosis and treatment.

Skills of the surgeon, eye of an artist, mind of the analyst.

Plastic and reconstructive surgery challenges the surgeon in ways often difficult to comprehend. Not only does the surgeon have to perfect the appropriate techniques for the surgical intervention, but he/she also assesses the patient with the eye of the artist and the mind of a psychoanalyst. Working with children and adolescents and their parents requires even more complex skills because it is required to assume the position of the parent to interpret their wishes, hopes, and fears. Over decades, John Mulliken has been the exemplar of the surgeon able to take on these manifold challenges. Dr Mulliken's special focus on healing the cleft lip and palate has offered to generations of young people and their families a life freer of the complex and sometimes devastating consequences of living with a deformity. Moving for ever earlier intervention, Dr Mulliken broke new ground surgically but from a psychological perspective offered the chance to avoid a host of psychological problems. Dr Mulliken's surgical intervention for nevi and other vascular malformations has had a long-lasting psychological impact on the lives of children. This article traces the place of plastic and surgical reconstructive surgery as a field intertwined with the psychological development of the individual and describes the ways in which Dr Mulliken's approaches have enhanced the well-being of so many.

Contributions to understanding therapeutic change: now we have a playground.

The understanding of therapeutic change is explored in two ways. The first is by providing a model of change that emphasizes moment-to-moment, "local-level" interactions in the analytic dyad. The second is to offer detailed clinical information--taken from the videotape of a child analyst's first session with a three-year-old girl--that illustrates how this change model can be useful to clinicians. The clinical material is presented in the form of verbal trascripts and descriptions of nonverbal communicative exchanges between child and analyst. Both the model of change and the technique of videotape microanalysis build upon work by infant researchers and thus show how advances in related fields can supplement traditional psychoanalytic methods.

Change in psychoanalysis: getting from A to B.

The change that occurred during an analytic hour with a seven-year-old girl is explored by means of videotape observation and aspects of developmental theory drawn from the field of infant research. Detailed review of the videotape and transcript of twelve minutes of the analytic hour revealed significant change in the girl's attitude toward the loss represented by a cancelled session. The moment-to-moment process between two points, A and B--identified as representing the beginning and end of the change in the girl's ability to deal with loss in the analytic relationship--is studied and described in two forms: written transcript for the verbal material, and narrative description for the nonverbal material. The methodology is based on observed behaviors but also relies on the clinical experience of the analyst in the interpretation of affects and the recognition of intentions in both participants. The results suggest that, taken as a whole, many such small transitional episodes during the course of a treatment play an important role in the process of therapeutic change.

Explicating the implicit: the local level and the microprocess of change in the analytic situation.

This paper proposes a method of examining the micro-events of the analytic process that borrows heavily from developmental research. The increasing importance of illuminating the microprocess of interaction to understanding the process of change in analytic treatment is emphasised. A set of constructs and terminology is proposed for the study of the moment-to-moment interactive process in psychoanalytic therapy referred to as the local level. A theory of therapeutic action based on 'local-level' process is then explicated. Its central element involves a step-by-step process of 'fitting together', which leads to changes in implicit knowing through alteration of emotional procedures.