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)

We have already had the occasion to study how Goldstein offered his fundamental postulates to neurorehabilitation, enabling it to establish itself as a new disciplinary branch of medicine [Gilart de Keranflec’h 2021]. Now we shall hypothesize that the proposals that Goldstein borrowed from his fellow contemporary neurologists by reformulating them, those he rejected and those he prolonged, were successive acculturations leading to a broader area than neurology alone, namely rehabilitative care. Long before he experienced exile —a major biographical turning point (...) in his life—had Goldstein not already led neurology down the path of exile, by demanding that it take into consideration its necessary hybridization with social and environmental issues? Combining dimensions of care, cures and even healing, rehabilitative care challenges the medical discipline alone for its pre-eminence over positive health outcomes for patients with health problems whose severity leaves them in a situation of disability. (shrink)

In Anknüpfung an eine Arbeit von 2006 zur Frequenzvereinbarung am Behandlungsbeginn greifen die Autorinnen das Thema des Settings und des Handlungsdialogs erneut auf, diesmal anhand eines Behandlungsverlaufs. Bei Patienten, die frühe Traumata erlebt haben, die nicht erzählbar sind, weil sie vor der Zeit liegen, in der das autobiographische Gedächtnis etabliert ist, spielt die Angstregulierung eine fundamentale Rolle. Hochfrequenz kann bei diesen Patienten Ängste auslösen, die als nicht steuerbar erlebt oder befürchtet werden. Ein niederfrequentes Setting ist hier oft – vor allem (...) am Beginn der Behandlung – das, worauf Analytiker und Patient sich verständigen können. Ein Frequenzwechsel wird möglich, wenn Fortschritte in der Symbolisierungsfähigkeit es erlauben, dass Ängste als solche wahrnehmbar und nicht mehr überwiegend agiert oder somatisiert werden. Dieser Entwicklungsprozess wird ausführlich an einer Behandlung dargestellt, die in wiederholten Intervisionen begleitet wurde. (shrink)