The Children's Play Therapy Instrument (CPTI). Description, development, and reliability studies.

The Children's Play Therapy Instrument (CPTI), its development, and reliability studies are described. The CPTI is a new instrument to examine a child's play activity in individual psychotherapy. Three independent raters used the CPTI to rate eight videotaped play therapy vignettes. Results were compared with the authors' consensual scores from a preliminary study. Generally good to excellent levels of interrater reliability were obtained for the independent raters on intraclass correlation coefficients for ordinal categories of the CPTI. Likewise, kappa levels were acceptable to excellent for nominal categories of the scale. The CPTI holds promise to become a reliable measure of play activity in child psychotherapy. Further research is needed to assess discriminant validity of the CPTI for use as a diagnostic tool and as a measure of process and outcome.

Mechanisms of defense: development and research perspectives.

The author offers a selective overview of defense mechanisms. With an eye to clarifying the definition of defense mechanisms and the use of this concept in treatment, she traces the evolution of the concept since its initial formulation, examines the developmental aspects of defenses and the implications for psychopathology, and discusses various recent research studies.

Psychological interventions for the suicidal adolescent.

Acute and chronic styles of suicidal behaviors require different psychotherapeutic approaches--the former needs a supportive-cognitive-focused approach, the latter (chronic or characterological) style needs an expressive insight-oriented psychotherapy with supportive elements to address the adolescent's developmental requirements for structure within the sessions. The psychotherapist needs to be appraised of the epidemiological, dynamic factors as well as the sources of external support the patient can count upon. It is interesting to note that psychodynamic factors alone or psychopathology alone are not sufficient to estimate the ebb and flow of the suicidal risk. A combination of all these factors must be taken into account in estimating suicidal risk at any point in treatment. It is advisable that an independent clinician's consultation be sought during treatment in the case of suicidal attempts as the therapist can easily overestimate or underestimate suicidal risks. Individual treatment requires family intervention from counseling to therapy. Particular problems addressed in the paper are countertransference reactions created by the suicidal behavior in the clinician such as rejection and withdrawal. The psychotherapy should address the resolution of aggressive, envious introjected images, issues of omnipotent control and interpersonal skills deficits. To transform suicidal behavior into reenactment of the aggression within the relationship to the therapist is the main immediate goal. A critical caveat; a patient who lies by commission or omission represents an obstacle for individual therapy on an outpatient basis as he will disguise his suicidal intentions and plans, excluding them from the therapeutic process.

The Cornell Interview of Peers and Friends: development and validation.

The Cornell Interview of Peers and Friends (CIPF), a 30-minute semistructured interview, evaluated 7- to 11-year-old children's perceptions of their social relationships. Significant differences on the CIPF were found between clinical and nonclinical groups and between boys and girls. Three CIPF subscales, Developmental Appropriateness, Social Skills, and Self-esteem, were assessed and significantly differentiated between clinical and nonclinical populations. Satisfactory interrater reliability is reported for the interview's total score and the three subscale scores. The CIPF offers potential for screening children at risk for emotional disturbance and for assessing outcomes of therapeutic interventions.

Treatment strategies for a case of concurrent pervasive developmental disorder and cerebral gigantism.

A 4-year-old girl presented for a psychiatric evaluation with reported episodes of clumsiness, aggressiveness, lack of relatedness, and temper tantrums. Her evaluation disclosed multiple developmental deficits, including cognitive, affective, and social lags. Given her individual history and her specific constellation of symptoms as well as a familial history indicative of developmental impairment, the child was diagnosed as having pervasive developmental disorder. This diagnosis reflects the expanded nosology for autism, as specified in DSM-III-R. Subsequently, after a genetic evaluation, the child was found to have an organic central nervous system deficit in the form of cerebral gigantism, a neural disorder. The recognition of an organic impairment in this case contributed to an understanding of the pervasive developmental disorder symptomatology and facilitated the formulation of an appropriate therapeutic protocol that addressed both developmental and neurological components.

Narcissistic personality disorder in childhood.

Narcissistic personality disorders can be identified in childhood and adolescence using the same diagnostic criteria as for adults. There are, however, additional descriptive characteristics specific to children: in particular, quality of friendships, quality of performance in school, gaze aversion, pathologic play, and separation anxiety. Various developmental pathways may present a special risk for the formation of narcissistic personality disorder: having narcissistic parents, being adopted, being abused, being overindulged, having divorced parents, or losing a parent through death. The diagnosis of narcissistic personality disorder has important implications for treatment. The goals of treatment (in intensive psychoanalytic psychotherapy) are to work on the grandiose self, the pathologic defense mechanisms that interfere with development, and interactions with parents and peers. Concomitant parent counseling or family therapy is strongly recommended to work on the maladaptive narcissistic defenses operating at the family level, which help to maintain the disorder.

Child analysis with a severely disturbed adopted child.

Much of this paper focuses on the psychoanalysis of Bert, a severely disturbed 9-year-old adopted boy. Constitutional factors, parents' personalities and parenting styles, and libidinal and aggressive zonal fixations all played a role in determining Bert's problems. Besides the normal developmental challenges, the adoptive child faces the unique developmental task of becoming the true adoptive child of true adoptive parents. Bert's case shows how this process can be facilitated in psychoanalytic treatment. After a brief introduction to the psychological implications of adoption at various stages of development, the paper elaborates on how and why Bert first came for treatment and describes three phases in the treatment, the first session, the period of transference developments, and the termination phase. The final section outlines special treatment issues and the implications for the psychoanalytic treatment of an adopted child.

Pathological narcissism in childhood.

Matt's analysis yields a number of theoretical and clinical implications. It demonstrates that narcissistic character pathology can exist in childhood and shows how family dynamics may contribute. The clearly defensive function of Matt's pathology and his later progress through normal infantile narcissism toward further development suggest that the pathogenesis of narcissistic pathology resides neither in regression to an infantile position nor in untamed infantile narcissism. Rather, as the case demonstrates, narcissistic pathology actually reflects a pathological formation of the self used for defensive purposes. Matt's analysis also shows how such pathology in children may be effectively resolved through interpretation. Finally, the analysis demonstrates the peculiarities of the countertransference in such cases and how they may be pivotal in the course of treatment.