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Als, H., Brazelton, T.B. (1984). Parenting an Infant with a Birth Defect—The Regulation of Self-Esteem. Psychoanal. St. Child, 39:561-589.

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(1984). Psychoanalytic Study of the Child, 39:561-589

Parenting an Infant with a Birth Defect—The Regulation of Self-Esteem

Heidelise Als, Ph.D. and T. Berry Brazelton, M.D.

THIS PAPER EXAMINES HOW FIVE FAMILIES EXPERIENCED PARenting infants with birth defects. The concept of assault to the parent's self-esteem or narcissistic injury (e.g., Bibring, 1953); (Kohut, 1966) is the theoretical framework used to understand the intrapsychic and the external, reality-based aspects of parental reactions. These were influenced by a complex interplay of factors: the severity and correctability of the defect, how they were told about it, and the nature of the medical procedures required; previous expectations for the child and their view of


Dr. Mintzer is in private practice of psychotherapy, Newton and Boston; Dr. Als is Assistant Professor of Pediatrics (Psychology), Harvard Medical School, and Director of Clinical Research, Child Development Unit, Children's Hospital Medical Center, Boston; Dr. Tronick is Professor of Psychology, University of Massachusetts, Amherst; Dr. Brazelton is Associate Professor of Pediatrics, Harvard Medical School, and Chief, Child Development Unit, Children's Hospital Medical Center, Boston, Mass.

Based on a study submitted in partial fulfillment of the D.W.S./Ph.D. degree, Smith College School for Social Work (Greenberg [Mintzer], 1979).

The work was supported by Grant 3312 from the W. T. Grant Foundation and was conducted in part at the facilities of the Mental Retardation Center of the Children's Hospital Medical Center, Boston, Mass.

Special thanks go to the families who allowed us to observe and to view them so closely; to Nancy Kozak Meyer, Lois Barclay Murphy, and Shelly S. Ehrlich.

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