Co-regulering og betydningsdannelse i psykoterapi ved psykose

Formålet med artiklen er at anvende viden og modeller fra forskning i intersubjektivitet i tidlig mor-barn-interaktion til at beskrive interpersonelle vanskeligheder og ændrede oplevelser af selv og anden, som de kommer til udtryk i psykoterapeutiske forløb med personer med psykose. Som model bliver Beatrice Beebes co-reguleringsmodel fremlagt. Den ser en balance mellem selv- og interaktiv regulering hos begge parter i tidlig morbarn-interaktionen som optimal for udviklingen. En ubalance både mod mere selvregulering og mod mere interaktiv regulering ses som mulige risikoprocesser, der kan lede mod mindre optimal udvikling og i sidste ende være forbundet med psykopatologiske funktionsmåder. Der opstilles den antagelse, at en mere balanceret nonverbal co-regulering er en forudsætning for mere fælles betydningsdannelse på det verbale plan i psykoterapi ved psykose. I tre caseeksempler fra psykoterapeutiske forløb med personer med psykoseproblematik ses en meget ubalanceret co-regulering i interaktionen med terapeuten. Via terapeutiske strategier i terapien viser det sig muligt i sekvenser at opnå en mere balanceret co-regulering, der er forbundet med større positiv affektivitet og større fælles meningsdannelse. Disse mikroforandringsprocesser kan bidrage til at forstå udviklingsprocesser mod bedring ved psykose samt mulige veje til risikoudvikling mod intersubjektiv isolation og privat eningsdannelse i form af vrangforestillinger

Making Meaning Together:Embodied Narratives in a Case of Severe Autism

Shared understanding is generated between individuals before speech through a language of body movement and non-verbal vocalisation, expression of feeling and interest made in gestures of movement and voice. Human understanding is co-created in these embodied projects, displayed in serially organised expressions with shared timing of reciprocal actions between partners. These develop in narrative events that build over cycles of reciprocal expressive action in a four-part structure shared by all the time-based arts: ‘introduction’, ‘development’, ‘climax’, and ‘conclusion’. Pre-linguistic narrative establishes the foundation of later, linguistic intelligence. Yet, participating in social interactions that give rise to narrative development is a central problem of autism spectrum disorder. In this paper, we examine the rapid growth of narrative meaning-making between a non-verbal young woman with severe autism and her new therapist. Episodes of embodied, shared understanding were enabled through a basic therapeutic mode of reciprocal, creative mirroring of expressive gesture. These developed through reciprocal cycles and as the relationship progressed, complete co-created narratives were formed resulting in shared joy and the mutual interest and trust of companionship. These small, embodied stories enabled moments of co-regulated arousal that the young woman had previous difficulty with. These data provide evidence for an intact capacity for non-verbal narrative meaning-making in autism

Antenatal caregiving representations and perinatal behavior in mothers with severe lifetime psychopathology

Psychopathology poses a risk for optimal parenting. The current study explored antenatal caregiving representations as markers for later risk of nonoptimal maternal behavior among mothers with severe mental illness. Sixty‐five mothers diagnosed with psychosis, bipolar disorder, depression (psychopathology group), and nonclinical controls participated in a longitudinal study from pregnancy to 16 weeks after birth. Mental health diagnoses and caregiving representations were assessed during pregnancy. Maternal behavior was assessed during the 5‐min recovery phase of the still‐face paradigm at 16 weeks. Mothers with psychopathology reported significantly higher levels of “heightened” caregiving representations (i.e., separation anxiety from the child) than did controls. The only significant diagnostic group difference in perinatal maternal behavior was that mothers diagnosed with depression exhibited more overriding‐intrusive behavior than did nonclinical control mothers. Regression modeling results showed that antenatal caregiving representations of “role reversal” predicted significantly lower levels of sensitivity and higher levels of overriding‐intrusive behavior independent of the effect of psychopathology. The findings can be interpreted in the context of representational transformation to motherhood during pregnancy. The results provide preliminary evidence for the potential of a new questionnaire measure of caregiving representations as a screening instrument for antenatal representational risk

Hair cortisol in the perinatal period mediates associations between maternal adversity and disrupted maternal interaction in early infancy

Existing literature points to the possibility that cortisol could be one link between maternal adversity and poorer parenting quality, but most studies have examined salivary cortisol concentrations rather than hair cortisol concentrations. The current study examined hair cortisol concentration (HCC) during the third trimester of pregnancy as a mediator between maternal adversity indicators (childhood abuse, severe mental illness, symptomatic functioning) and maternal caregiving behavior at 4 months postpartum. Forty‐four women participated in the study: 30 with severe mental disorders, and 14 nonclinical controls. HCC was assessed during the third trimester of pregnancy (HCC‐P) and at 4 months postpartum (HCC‐4M). Sexual, physical, and emotional abuse were assessed by the Adverse Childhood Experiences Study Questionnaire. Maternal disrupted interaction was reliably coded from mother–infant video interactions during a Still‐Face Procedure. Mediation models indicated that maternal HCC‐P and HCC‐4M mediated associations between maternal psychopathology (severe mental illness, symptomatic functioning) and maternal disrupted interaction at 4 months. Maternal HCC at 4 months also mediated associations between experienced childhood abuse and overall disrupted interaction. Our findings indicate that HCC may be a potential early biomarker for future caregiving challenges among mothers with severe mental illness and histories of childhood abuse

Making meaning together : embodied narratives in a case of severe autism

Human narrative understanding is co-created in imaginative projects and experiences displayed in serially organised expressions of gesture and voice. Shared timing of reciprocal actions develop between two or more persons in narrative events that build over cycles in a four-part structure of 'introduction', 'development', 'climax', and 'conclusion'. Pre-linguistic narrative establishes the foundation of later, linguistic intelligence. Yet, participating in social interactions that give rise to narrative development is a central problem of autism spectrum disorder. In this paper, we examine the rapid growth of narrative meaning-making between a non-verbal young woman with severe autism and her new therapist. Episodes of embodied, shared understanding were enabled through a basic therapeutic mode of reciprocal, creative mirroring of expressive gesture. These developed through reciprocal cycles and as the relationship progressed, complete co-created narratives were formed resulting in shared joy and the mutual interest and trust of companionship. These small, embodied stories enabled moments of co-regulated arousal that the young woman had previous difficulty with. These data provide evidence for an intact capacity for non-verbal narrative meaning-making in autism

Indigenous participation in intercultural education:learning from Mexico and Tanzania

Intercultural education seeks to create a forum for integrating Western scientific knowledge and indigenous knowledge to address local and global challenges such as biocultural diversity conservation, natural resource management, and social justice for indigenous peoples. Intercultural education is based on learning together with, rather than learning about or from, indigenous communities. In the best examples, problem-based learning dissolves the dichotomy between indigenous and nonindigenous, resulting in full partnerships in which participants share expertise to meet mutual needs. With reference to literature and two illustrative examples of intercultural education initiatives in Mexico and Tanzania, we present an original conceptual framework for assessing indigenous participation in intercultural education. This incorporates a new ladder of participation depth (in relation to both curriculum content and decision making) alongside separate considerations of breadth, i.e., stakeholder diversity, and scope, i.e., the number of key project stages in which certain stakeholder groups are participating. The framework can be used to compare intercultural education initiatives in differing contexts and might be adaptable to other intercultural work