Maternal mental health and the contents of her representational world are important determinants of early parent-child relationship. We examined, first, the role of prenatal and postnatal depressive symptoms and maternal attachment style in predicting the quality of mother-child interaction. Second, we analysed whether the secure-autonomous attachment style can protect the dyadic interaction from the negative effects of maternal depression. The participants were 59 mother-infant pairs examined during pregnancy (T1), 4-5 months postpartum (T2) and when the children were approximately 14 months old (T3). Maternal attachment style was assessed with a modified Adult Attachment Interview -procedure, depressive symptoms with Edinburgh Postnatal Depression Scale, and observed mother-child interaction with Care Index. The results show that autonomous mothers were more sensitive and responsive and their children more cooperative than dyads with dismissing maternal attachment style. As hypothesized, mothers with the combination of both prenatal and postpartum depressive symptoms were highly unresponsive in their dyadic interaction. Further, prenatal depressive symptoms had a stronger impact on maternal unresponsiveness than postnatal symptoms. As hypothesized, mother's autonomous attachment style protected the mother-child interaction from the negative impact of maternal postnatal depressive symptoms, whereas dyads with preoccupied mothers were especially at risk for interaction problems when mothers had postpartum depressive symptoms.

We examined the development of alliance in therapy in different attachment groups in a naturalistic setting. The participants were 36 self-referred Palestinian political ex-prisoners, who were victims of torture and ill treatment and had sought psychotherapy. Their therapy lasted for 10-12 months. The analyses showed that the development of alliance during therapy followed different patterns across the attachment groups. Yet early alliance did not differ between the groups. For the autonomous individuals, alliance dropped in the middle of therapy, and increased back to its initial level by the end. Similarly, for the preoccupied individuals alliance decreased steeply in the middle of the therapy, and then increased even more steeply by the end. In contrast, for the dismissing individuals, alliance was approximately the same at the beginning and in the middle of the therapy, and then it decreased at the end.

Using psychoanalysis as a starting point, we explore the value of therapeutic neutrality in psychotherapies that seek to foster self-understanding, experiencing, and insight. Contrary to much of the current zeitgeist, therapist neutrality is posited to be a key element of effective psychotherapy in such approaches. We suggest 5 meanings of effective therapeutic neutrality: The therapist (a) takes, at least in part, an observer position in the relationship; (b) refrains from taking sides in the patient's inner struggles; (c) also does not take sides in the patient's relational struggles; (d) refrains from manipulating the patient into emotional expression; and (e) follows some guidelines about when to directly gratify the patient's dependency and affectional needs/ demands. Rules of thumb are presented about the conditions under which direct gratification is called for. However, as a bottom line, if neutrality is to be an effective stance in any psychotherapy, it must be carried out in the context of empathy, caring, and affirmation.

Attachment patterns are especially salient in facing danger and threats to one's life. Earlier research has suggested that secure persons are protected and insecure persons vulnerable in conditions of traumatic stress. We argued that the general view may not apply to the complex person-trauma interaction that is characteristic to torture and ill-treatment. Rather, as Crittenden maintains, each attachment pattern involves a unique strategy that is the most adaptive solution, depending on the nature of the trauma. We hypothesized that the general view of the secure attachment pattern being protective, and the insecure patterns being unprotective, would apply when political prisoners are exposed to physical torture and ill-treatment. Whereas, when exposed to psychological torture involving interpersonal cruelty, securely attached persons would be more vulnerable than insecure. The hypotheses were examined among 176 Palestinian male former political prisoners living in the Gaza Strip. Their mental health was assessed by posttraumatic (PTSD) and somatic symptoms, and adult attachment patterns by an applied AAI-method. The results confirmed that among insecure (both dismissing and preoccupied) men, the exposure to a high level of physical

Gaza Community Mental Health Program, Palestine P sychological defences are conceptualized as protective processes that help individuals to maintain their integrity in the face of threat and danger. Accordingly, their role in defending trauma victims from post-traumatic symptoms was examined. The sample consisted of 128 Palestinian male political ex-prisoners who had reported various degrees of torture and ill-treatment. The rst aim was to analyze the dimensionality and distribution of different defence mechanisms. The second was to examine which defences would moderate the association between the reported torture and ill-treatment and the post-traumatic symptoms (PTS). Third, the direct associations between reported torture and ill-treatment and defences and between the defences and symptoms were explored. Defence mechanisms were assessed by a 40-item version of the Defense Style Questionnaire (DSQ), and Post-traumatic symptoms by the Harvard Trauma Questionnaire (HTQ), and experiences of torture and ill-treatment by a scale developed for that purpose. The results show, rst, that the men used predominantly mature defences such as anticipation, sublimation, suppression, and rationalization, but also relatively frequently somatization and dissociation, which are characteristic responses among trauma victims. Second, the principal component analysis revealed four defence dimensions, differentiated by the level of maturity and the approach to reality: the mature reality-based, the consciousness-limiting, the immature reality-escaping, and the immature reality-distorting defences. Third, against our hypothesis, the moderating analyses indicated that the reported torture and ill-treatment were relatively more associated with vigilance, avoidance, and intrusion symptoms if men used consciousness-limiting defences. Yet as expected, the mature realitybased defences did not show a protective effect. Furthermore, a high level of reported torture and ill-treatment was associated with a low level of the mature reality-based defences, but not with a high level of immature defences. Last, similarly to earlier studies, the immature realitydistorting and immature reality-escaping defences associated directly with high, and mature reality-based defences with low, levels of PTS-symptoms. L es défenses psychologiques sont considérées en tant que des processus protecteurs qui aident les individus à maintenir son intégrité face aux menaces et au danger. Par conséquent, on a examiné le rôle de protection qu'elles jouent pour les victimes de trauma par rapport aux symptômes de tension post traumatique. La population étudiée était composée par 128 hommes Palestiniens ex-prisonniers politiques qui manifestaient différents niveaux de torture et mauvais traitement. Le premier objectif a été l'analyse des dimensions et de la distribution des différents mécanismes de défense. Le deuxième, l'examen des défenses qui agissent en tant que modératrices dans l'association entre torture et mauvais traitement rapportés par les sujets concernant les ...