Short‐term psychodynamic infant–parent interventions at Child health centers: Outcomes on parental depression and infant social–emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent–infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short‐term Psychodynamic Infant–Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social–Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers’ questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect‐sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.     

Money: a therapeutic tool for couples therapy

This article addresses the therapeutic importance of discussing money at every stage of a couple's relationship, both as a concrete reality and as a metaphor for security, adequacy, competence, commitment, acceptance, and acknowledgment in a relationship. I will present a developmental schema looking at financial issues that couples confront at various stages in the adult life cycle and how these affect and reflect relationship problems. The article also presents a money questionnaire as a useful tool for exploring family-of-origin financial history, affect, and behavior.     

A pediatric screening instrument to detect problematic infant–parent interactions: Initial reliability and validity in a sample of high‐ and low‐risk infants

The purpose of this study was to determine the initial reliability and validity of a screening instrument developed to detect problematic interactions between infants and parents as part of a pediatric well‐baby exam. Participants included 117 infant–mother dyads (57 preterms and 60 full terms) assessed when infants were 6 to 9 months old. Mothers and infants were observed playing an interactional game such as peek‐a‐boo during the course of the pediatric exam. The game was scored for degree of interactional reciprocity using the Pediatric Infant Parent Exam (PIPE). Acceptable levels of interrater reliability were achieved. As predicted, higher risk infants and their mothers exhibited more problematic interactions than lower risk infants and their mothers. Results indicated that the PIPE was a reliable means of screening for interactional difficulties, that was sensitive to, but not synonymous with, neonatal health indices. ©2001 Michigan Association for Infant Mental Health.     

Infant–mother and infant–father synchrony: The coregulation of positive arousal

To examine the coregulation of positive affect during mother–infant and father–infant interactions, 100 couples and their first‐born child were videotaped in face‐to‐face interactions. Parents' and infant's affective states were coded in one‐second frames, and synchrony was measured with time‐series analysis. The orientation, intensity, and temporal pattern of infant positive arousal were assessed. Synchrony between same‐gender parent–infant dyads was more optimal in terms of stronger lagged associations between parent and infant affect, more frequent mutual synchrony, and shorter lags to responsiveness. Infants' arousal during mother–infant interaction cycled between medium and low levels, and high positive affect appeared gradually and was embedded within a social episode. During father–child play, positive arousal was high, sudden, and organized in multiple peaks that appeared more frequently as play progressed. Mother–infant synchrony was linked to the partners' social orientation and was inversely related to maternal depression and infant negative emotionality. Father–child synchrony was related to the intensity of positive arousal and to father attachment security. Results contribute to research on the regulation of positive emotions and describe the unique modes of affective sharing that infants coconstruct with mother and father. ©2003 Michigan Association for Infant Mental Health.     

Alliance to the group-as-a-whole as a predictor of outcome in psychodynamic group therapy

Abstract Eighteen patients diagnosed with burnout-related depression and receiving short-term psychodynamic group psychotherapy were included in this study. The participants completed the group version of the California Psychotherapy Alliance Scales (CALPAS) five times during treatment and evaluated the relationship positively. Alliance increased significantly as treatment progressed; however, the amount of change was small. Level of alliance to the group-as-a-whole, averaged over time, was predictive of two out of three outcome measures, whereas growth in alliance during the early phase of therapy was not predictive of outcome. Exploratory examination of the alliance at different time points showed that alliance to the group-as-a-whole at mid-phase of treatment was substantially correlated with outcome. Personality features such as dismissing attachment style and being overly nurturant or exploitable were predictive of early growth in alliance.     

Interactive silences within spontaneous early infant–father ‘dialogues’

The present longitudinal and naturalistic study aims to investigate infants' and fathers' facial expressions of emotions during pauses preceding and following spontaneous early infant–father conversation. Studying emotional expressions in the course of pauses in early infant–father interaction is important because it may extend our knowledge on how, without being able to speak, infants begin communication and develop a capacity to share understanding of what they and Significant Others (such as fathers) mean by what they do. Eleven infant–father dyads from Crete, Greece, were observed during their natural interactions at home from the second to the sixth month of life. The microanalysis of fathers' and infants' facial expressions of emotions provided evidence that: (a) in the course of pauses preceding and following early infant–father conversation, either the infant is interested in the father while the latter expresses pleasure to the infant, or the infant expresses external interest while the father is interested in the infant, (b) infants seem to attune their descending and stable emotional intensity to the same direction as their father's emotional intensity, (c) infants and fathers remain consistent in their emotional expression in the beginning and at the end of the pause, and (d) infant and paternal pleasure and interest did not change significantly across the nine age points of this study. Exploratory analysis of the relationship of paternal and infant emotional expressions across infants' birth order provided evidence of certain differences and similarities. It is proposed that pausal interruptions preceding and following free early infant–father ‘dialogues’ constitute interactive silences, since in their course there is evidence of inter‐subjective emotional coordination and intra‐subjective regulation of emotion. Copyright © 2008 John Wiley & Sons, Ltd.     

Simulation as a tool in family therapy research

The efficacy and validity of simulation for purposes of training and evaluation are well established. Simulation has proven valuable in human behaviour research as well. However, based on the belief that families and other small groups behave differently, many family theorists have concluded that simulation may not be valid for family research despite the fact that some empirical studies showed little difference between simulated and actual families, suggesting that the disparity may not be as great as commonly believed. Ongoing and future studies controlling for 'time together', a dimension presumed to be critical in comparing simulated with actual families, may demonstrate that differences are not sufficiently large to preclude the use of simulated families in family research. Methodological problems are addressed and directions for future research proposed.     

A longitudinal,naturalistic and cross‐cultural study on emotions in early infant‐parent imitative interactions

The present longitudinal, naturalistic and cross‐cultural study aims to investigate and extend our understanding of the intersubjective nature of the early imitations that may be observed in free interactions between young infants and their parents. Thirty infants, 15 from Greece and 15 from Scotland, were observed separately with their mothers and fathers at home every 2 weeks, from the second to the sixth month after birth. In each dyad, the emotional states of both interacting partners before, during and after the imitative episodes were subjected to microanalysis. The results indicate that emotional coordination, either by direct matching of expressions or by attunement, precedes, accompanies and follows imitation. This kind of coordination was found to be the same in Crete and Scotland, and for parents and infants of both sexes. It is concluded that this coordination of emotions with early imitative phenomena is evidence of motivational coherence, both within the subjects, and between them in an intersubjective play.     

'Holding' as a therapeutic manoeuvre in family therapy

This paper describes the use of planned parental physical 'holding' as part of family therapy in a Child and Family Guidance Clinic. It is used when the child is overactive or out of parental control, or is not attached to its parents. Direct or indirect suggestions that parents hold their children are made by the therapist.     

The South African truth and reconciliation commission as a therapeutic tool

A Truth Commission is one of the institutions used in international law to investigate gross human rights violations within a specific country. In this article we examine claims that the South African Truth and Reconciliation Commission (TRC) was therapeutic. In the absence of empirical evidence, this examination will be guided by a theoretical framework that will reflect ways by which we believe international legal institutions can contribute tot he healing of the people of a country in which human rights abuses have taken place. We developed this framework with reference to the literature. Our conclusion is that the legislator's emphasis on truth, reconciliation, stability, and restorative justice enhanced the TRC's potential to promote healing, but that some features of this procedure and the enabling Act, the Promotion of National Unity and Reconciliation Act (1995), restricted its ability to be therapeutic. We conclude by looking at the role culture may have played in the success of the TRC.