Levels of change in parent–infant psychotherapy

This paper offers a way of thinking about the process of parent–infant psychotherapy. I start by outlining some ideas as to what can go awry in troubled parent–infant relationships, and then a way of working with parents with pre-verbal babies. I suggest a model for understanding three interlaced levels at which change might occur if a psychodynamic, systemically sensitive, therapeutic intervention is offered. I describe a particularly challenging clinical case in which a mother and I also worked with video material of her and her son.     

Post natal depression,the mother's conflict and parent – infant psychotherapy

This paper sets out to consider a psychodynamic approach to postnatal depression. In particular, it examines the advantages of psychodynamic parent?–?infant psychotherapy both as a treatment model, and also as a way of thinking that can help to formulate a theory of the postnatal period. An illustration is provided in the clinical account of the therapy of a couple and their nine-week-old infant. The author draws on this example, and on findings from psychoanalytic theory, infancy research, evolutionary biology and anthropology to suggest an integrated understanding of the postnatal state of mind and its challenges.     

Studying the process of psychoanalytic parent–infant psychotherapy: Embodied and discursive aspects

This paper presents findings from an intensive, mixed methods case study of one session of psychoanalytic parent–infant psychotherapy (PPIP) addressing early relational trauma, and aims to shed light on the multimodal interactive processes that take place in the moment-to-moment exchanges comprising the therapeutic encounter. Different research methods were used on video material from PPIP sessions, including microanalysis of adult–infant interactions, discourse analysis of talk, and coding systems developed to study parent–infant interaction. These different perspectives were brought together with the clinical narrative to illuminate the complex, dynamic processes of parent–infant–therapist interaction. More specifically, the detailed analysis of one interactive episode revealed brief behavioral manifestations of fearful and disoriented states of mind, reflecting dysregulated interaction between mother and infant, which also powerfully affected the therapist. The processes through which the therapist gradually resolves this rupture are also described in detail. Through this pilot study, we were able to show that it is possible to systematically study the process of PPIP. The study contributes to the growing psychotherapy research literature that takes into account both the verbal domain and implicit, interactional processes in therapeutic practice, and underscores the therapist's comprehensive engagement in the therapeutic process.     

Maternal romantic attachment,and antenatal and postnatal mother–infant attachment in a sample of Polish women

In this exploratory study, we evaluated the relationship between a woman's self-reported romantic attachment style (as measured with The Attachment Styles Questionnaire), her experience of pregnancy, antenatal (The Maternal–Fetal Attachment Scale) and postnatal (Postpartum Bonding Questionnaire) attachment with her baby, and depressive symptomatology (The Edinburgh Postnatal Depression Scale). In the first stage of the study 162 pregnant females participated; of these, 64 were followed up in the second stage. The maternal romantic attachment style predicted attachment with the baby in the antenatal, but not in the postpartum period. The anxious-ambivalent romantic attachment style predicted more interaction with and attributing more characteristics to the foetus, secure attachment style was positively correlated with role taking, and avoidant—with attributing more characteristics to the foetus. In the postpartum period, the correlation between antenatal and postnatal attachment was only moderate; role taking during pregnancy correlated with anxiety about care for an infant. However, our study shows the association of the profile of anxious-ambivalent romantic attachment with postpartum depression, which heightens the risk of postnatal mother–infant bonding impairments.     

Recollections of parent–child relationships,attachment insecurity,and obsessive–compulsive beliefs

To adequately understand Obsessive Compulsive Disorder (OCD), it is important to understand the developmental origins of obsessive beliefs and corresponding compulsive acts. Prior work has shown that having cold, neglectful parents in childhood and/or insecure attachment styles are both linked to emotional disturbances. In this study, we explored the potential contributions of early parent–child relationships to attachment styles and the severity of obsessive–compulsive beliefs in adulthood. A sample of 397 college students completed online, self-report measures of retrospective parent–child relationships, adult attachment styles, and ongoing obsessive–compulsive symptoms. Analyses revealed that attachment anxiety partially mediated the association between parent–child relationships and obsessive beliefs; attachment avoidance failed to operate as a mediating mechanism. Our findings provide support for interpersonal approaches to obsessive–compulsive symptoms and disorder, with implications for the continuity of relationship dysfunction from childhood into adulthood.     

Parent – infant psychotherapy,the transition to parenthood and parental narcissism: Implications for treatment

In this article the author discusses some of the indications for short- or long-term parent?–?infant psychotherapeutic interventions in terms of what he defines as ‘problems of parenthood’ and ‘problems of parental narcissism’. Brief parent?–?infant psychotherapeutic interventions are most frequently indicated in the case of the former: more neurotic problems of parenthood where the parents present a manic or counter-depressive type of narcissism. Masochistic problems of parenthood are also susceptible to treatment through brief parent?–?infant interventions, although in such cases treatment may have to be continued in another modality of long-term psychotherapy. More dissociated problems of parental narcissism constitute a contraindication for brief psychotherapeutic parent?–?infant interventions. The persecutory narcissism of these parents contributes to a ‘negative pre-transference’ which creates a major resistance to the therapeutic process.     

Promoting parent–infant responsiveness in families experiencing homelessness

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment.     

“What support would you find helpful?” The relationship between treatment expectations,therapeutic engagement,and clinical outcomes in parent–infant psychotherapy

The aim of this study was to investigate the impact of pretreatment expectations on clinical outcomes and engagement in Parent–Infant Psychotherapy (PIP). Sixty-one mothers who were experiencing mental health difficulties and who were receiving PIP with their young infants participated in the study. A mixed-methodology was used to examine participants’ expectations through transformation content analysis of pretreatment interviews; recurring themes were classified and quantified. Further statistical analyses explored relationships between the quantified themes of parental expectations and clinical outcomes and engagement in treatment. No significant correlation was found between expectations and engagement. One of the six clinical outcomes significantly correlated with parental expectations. Improved reflective functioning (RF) was predicted by participants describing expectations of wanting to improve their parent–infant relationship through the treatment, and expressing concerns about discussing their past experiences. These two expectations predicted improvements in RF independently and when combined. These results indicate that PIP may be more effective for some mothers than others and that assessing future clients’ expectations before beginning PIP may be beneficial.     

Measuring parent–infant interaction: the Parent−Infant Relational Assessment Tool (PIRAT)

The paper describes the genesis, construction and preliminary reliability testing of the Parent?Infant Relational Assessment Tool (PIRAT). PIRAT is a clinical assessment tool for the identification of risk in the early parent?infant relationship. The rationale was to design a flexible, reliable measure that would enable professionals working with infants and their caregivers to assess the parent?infant relationship as it appears in the consulting room, clinic or home environment and to pinpoint areas of concern at the earliest possible opportunity. The measure was developed in the Parent–Infant Project at the Anna Freud Centre and a subsequent study was undertaken to establish whether it could be successfully transferred to healthcare professionals for use in their workplace settings. A reliability study was conducted with a panel of health professionals, including midwives, health visitors, child protection social workers and clinical psychologists, using videotapes of their consultations in the home or clinic with mothers and infants of 0?2 years old. The results demonstrate good interrater reliability for the 10 participants in the study. Verbatim excerpts from the training sessions are included to elucidate the process of training and the ways in which participants engaged with and embedded the measure into their practice.     

Sliding doors: some reflections on the parent–child–therapist triangle in parent work–child psychotherapy

The parental presence as therapy agents, namely as a medium and support for the therapeutic process, is one of the paradoxical parameters of working with children. Parental presence serves as a reminder of the need to find a balance between inner and outer reality. The door that is closed in the therapy room leaves a parent on the other side but at the same time provides the child’s inner world with more latitude to reveal itself. This paper examines the fabric of relations created in the therapeutic parent–child–therapist triangle (analogous to Britton’s conceptualisation of the parent–parent–child link). How does this triangular connection affect the ability to be with the silent self (Winnicott) when the parent remains (tangibly and symbolically) on the other side of the therapy door? This paper presents two clinical examples to illustrate the complex fabric of relations created in the therapeutic parent–child–therapist triangle and the interactions between the internal and external reality of the parent–child relationship.     

Community-delivered infant–parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

The current study evaluated the effectiveness of a home-based psychotherapeutic Infant Mental Health Home Visiting (IMH-HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24-month old (M = 9.8, SD = 8.4), who were initiating IMH-HV services with community mental health-based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q-sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH-HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose–response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community-based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.     

Caregiving representations in war conditions: Associations with maternal trauma,mental health,and mother–infant interaction

Risk features in mothers’ caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers’ caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers’ pre- and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1-year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers’ prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother–infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed.     

The contributions of child–mother attachment,maternal parenting stress,and military status to the prediction of child behavior problems

Studies show that children with a military parent are at heightened risk of the development of behavior problems. However, there is limited work examining how other factors experienced by military families may also influence behavior problems. In the current study, we recruited three types of Canadian families with a preschooler: families with a deployed military member, families with a nondeployed military member, and nonmilitary families. We examined whether the nonmilitary parent's (in all cases the mother) parenting stress and attachment relationship with the child are associated with behavior problems, and whether deployment status further contributes to the prediction. Child–mother dyads participated in an observed attachment assessment, and mothers reported on their stress levels and their child's behavior. Results showed that both child attachment insecurity and parenting stress were associated with elevated levels of internalizing problems; however, only parenting stress was associated with conduct problems. Military deployment predicted higher levels of internalizing and conduct problems beyond the contributions of attachment and stress. Furthermore, having a father in the military (whether deployed or not) also contributed to internalizing problems. These findings shed light on how the military lifestyle impacts early childhood mental health through the complex interplay between various parts of their environment.     

From interactions to mental representations: Psychodynamic parent – infant therapy in a case of severe eating and sleep disorders

This paper describes the process of psychodynamic psychotherapy with an infant and his family, during a developmental phase in which the infant's mental organization was in transition from the level of interactions to representations. The treatment of a 23-month-old boy suffering from a severe sleeping and eating disorder was initiated in a parent?–?child psychotherapeutic setting. The sleep disorder was a consequence of separation anxiety. Additionally, phobic avoidance of new oral experiences led to an eating disorder. These symptoms had developed in the context of dysregulation of the triadic family relationships (mother?–?father?–?children), which tended to split into two-plus-one relationships. After one year, the setting was changed to alternating individual and family sessions. Due to his developing symbolic capacities, the boy was able to express his inner concerns and his internalised affect-laden experiences through play and actions. His internal world could now be addressed by interpretations. New psychodynamic theories and research results on early triadic development were taken as the theoretical background for the psychotherapeutic work. We understood the course of the treatment and the development of the transference/countertransference relationships in terms of processes of triadification (at the level of interpersonal relationships) and triangulation (at the level of intrapsychic representations).     

Fatal violence – from trauma to offence: A case study in forensic psychotherapy and trauma therapy with a migrant patient

Abstract

That persons who are objects of violence and traumatisation become offenders themselves is a typical feature of ill-fated cycles of violence in countries torn by fierce political, ethnic, and religious conflicts. Some refugees and migrants with this background present a challenge to forensic psychotherapy when they continue such patterns of physical force and criminal behaviour in a host country like Germany, and are found to be either not responsible or of diminished responsibility for their criminal acts by reason of mental disorders or addictions. Their offences create a critical legal situation for them, since they are threatened with deportation. At the same time, their clinical condition is critical, for they were possibly subjected to traumatic experiences by authorities in their past; their cooperation in the treatment can seriously affect their legal status. Finding a way out of these complications has to take these special factors into account. Our paper focuses on the case study of a refugee from North Africa, illustrating a model of cooperation in forensic inpatient treatment, special trauma therapy (narrative exposure therapy), and expert testimony.     

Motherhood in adolescent mothers: Maternal attachment,mother–infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother–infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother–infant dyads compared to 30 adult mother–infant dyads. At infant 3 months, mother–infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother–infant dyads (vs. adult mother–infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother–infant dyads (vs. insecure adult mother–infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother–infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.     

Evaluating the “possums” health professional training in parent–infant sleep

Infant sleep problems are among the most common issues reported by parents in the postnatal period. Yet, infant sleep and infant sleep interventions remain controversial. This study evaluated health professional training in a novel approach to parent–infant sleep: the Possums Sleep Intervention. Health professionals (n = 144) completed a short survey before and after the training, which focused on the sleep component. The Possums Sleep Intervention training included the following topics: sleep science, cued care, sleep hygiene, relaxation for parents and babies, problem solving, and acceptance and commitment therapy (ACT). Health professionals reported: improvements in knowledge on infant sleep regulation, the mother–infant relationship and ACT; improvements in health professionals’ own sleep quality; improvements in psychological flexibility; and a reduction in professional burnout and secondary traumatic stress. Moreover, the health professional training was received positively. Overall, this study is supportive of the Possums Sleep Intervention health professional training.     

Comparing emotional coordination in early spontaneous mother–infant and father–infant interactions

We compare matching of facial expressions and attunement of emotional intensity in spontaneous communication of mothers with infants and of fathers with infants, in families in Crete. Eleven infant–mother and 11 infant–father dyads were video-recorded at home in familiar interactions from the 2nd to the 6th month. Microanalysis of infant, maternal and paternal facial expressions of emotion provided evidence of quantitative differences that favour father–infant interaction as more playful, but the infants' behaviours with mothers and fathers show similar developmental curves. These results are discussed in the frame of the theory of innate intersubjectivity and of the emotional support parents give to developing motives of infants.