Watching,waiting, and wondering: Applying psychoanalytic principals to mother-infant intervention

There is general acceptance that the intergenerational repetition of relational patterns is transmitted within the interactions between mother and infant. The highly invested nature of the mother-infant relationship makes it a prime arena for the playing out of unresolved relational conflicts of the mother. This occurs through the mother's responses to her infant in which she projects into the infant certain disavowed but highly invested positive or negative attributes. This leads to the interactional re-creation of a whole relational system reflecting the mother's current and past relationship experiences. When a mother's conflictual past is unresolved and unmitigated by current relationships, her interactions with her infant are more driven by such perceptions than by real appraisal of the infant's actual attributes. The sleeping, eating, and behavioral management problems of infancy are often manifestations of such situations. A deceptively simple set of instructions to the mother, to become a nonintrusive observer of her infant and only interact at the infant's initiative, allows a role for the infant's initiative in changing interactions and thus potentially changing a relational system.     

Infant vocalization: A comprehensive view

Two different accounts of infant vocal development have recently been advanced. Both stress the lawful nature of this development and propose that it occurs in a series of stages. One account stresses the infant's attempt to make speech-like sounds from the earliest months and proposes that characteristics of speech are successively brought under the infant's control. The other suggests that instead, processes of integration and coordination of aspects of vocalization are taking place and considers these processes in relation to the situational contexts of vocalizing. A more comprehensive view is proposed in which aspects of both accounts are incorporated.     

La socialisation des émotions chez le nourrisson: le rôle des expressions faciales contingentes des mères

Although maternal contingent responses to their infant's facial expressions of emotions is thought to play an important role in the socialization of emotions, available data are still scarce and often inconsistent To further investigate how mothers' contingent facial expressions might influence infant emotional development, we undertook to study mother‐infant dyads in four episodes of face‐to‐face interaction during the first year. Mothers' facial expressions were strongly related to their infant's facial expressions of emotions, most of their contingent responses being produced within one second following infants' facial expressions Specific patterns of responses were also found. The impact of maternal contingent responding on infants' expressive development was also examined.     

Infant Developmental Outcomes: A Family Systems Perspective

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty‐two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE‐index) of parent–infant interactions. At 5 months postpartum, in‐depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post‐traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.     

Mothers,fathers, and the crisis of newborn intensive care

At hospital discharge of their infant from a newborn intensive care unit, 50 mothers and fathers were interviewed and completed questionnaires. There were significant within-couple correlations for appraisals of the harm that ensued from this crisis, perceptions of personal control over the infant's recovery, and expectations about the infant's future health and development. Mothers perceived more personal control, mobilized more social support, and used more escapist coping strategies than did fathers. Mothers and fathers exhibited different patterns of relations between their own coping strategies and emotional well-being. But, neither the coping strategies used by one's spouse nor differences between spouses in the use of individual coping strategies correlated with emotional well-being. Analysis of parents' perceived differences between their own and their partner's coping strategies suggested the possibility of mutually helpful, complementary strategies of coping with this problem.     

Mother's prenatal and postpartum depression symptoms and infant's sleep problems at 6 months

Mother's prenatal and postpartum depression have been associated with infant's sleep problems. This study aimed to analyze (a) the effects of mother's prenatal and postpartum depression symptoms, including the effects of prenatal and postpartum anxiety and depression scores of the Edinburgh Postnatal Depression Scale (EPDS), on infant's sleep problems at 6 months, and (b) the interaction effect between mother's prenatal and postpartum depression symptoms and infant's sex on infant's sleep problems at 6 months. The sample was comprised of 164 mother–infant dyads whose mothers completed measures of depression at the third trimester of pregnancy, 2 weeks, 3 and 6 months postpartum and a measure of infant's sleep problems at 6 months (CSHQ-I). Mother's prenatal depression symptoms, specifically depression scores of the EPDS, predicted more infant's sleep anxiety and daytime sleepiness, while mother's depression symptoms at 2 weeks postpartum, specifically anxiety scores of the EPDS, predicted more bedtime resistance and CSHQ-I total scores at 6 months. Boys of mothers with more prenatal depression symptoms presented more sleep anxiety at 6 months. Both mother's prenatal and early postpartum depression symptoms have a negative effect on the emergence of infant's sleep problems. Additionally, boys seem more vulnerable to mother's prenatal depression symptoms.     

Infant's action skill dynamically modulates parental action demonstration in the dyadic interaction

When interacting with infants, human adults modify their behaviours in an exaggerated manner. Previous studies have demonstrated that infant‐directed modification affects the infant's behaviour. However, little is known about how infant‐directed modification is elicited during infant–parent interaction. We investigated whether and how the infant's behaviour affects the mother's action during an interaction. We recorded three‐dimensional information of cup movements while mothers demonstrated a cup‐nesting task during interaction with their infants aged 11 to 13 months. Analyses revealed that spatial characteristics of the mother's task demonstration clearly changed depending on the infant's object manipulation. In particular, the variance in the distance that the cup was moved decreased after the infant's cup nesting and increased after the infant's task‐irrelevant manipulation (e.g. cup banging). This pattern was not observed for mothers with 6‐ to 8‐month‐olds, who do not have the fine motor skill to perform the action. These results indicate that the infant's action skill dynamically affects the infant‐directed action and suggest that the mother is sensitive to the infant's potential to learn a novel action. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=VNS2IHwLIhg&feature=youtu.be     

Predicting intellectual outcomes: Sex differences in response to early environmental stimulation

Sex differences in parent-child interaction and infant development patterns were examined in a longitudinal sample of 193 parent-infant pairs. Few differences were found. However, there were differences in the patterns of prediction of later intellectual and linguistic outcomes for boys and girls. Stronger predictions of IQ or language skill were obtained for boys from measures of the mother's developmental expectations, the extent of the father's involvement in the infant's early care, the provision of appropriate play materials, and the extent of parental life change. Stronger predictions were found for girls for a measure of restriction and punishment. The combination of these two groups of findings — lack of difference on measures of environment and parent-child interaction, and the presence of differences in prediction — suggest that the same experiences produce difference effects for boys and girls.     

The father's role in the facilitation of infant mental health

Many recent studies have focused on the nature and significance of father-infant relationships. These studies show that men are as capable of behaving sensitively as women are, although cultural sex-stereotypes usually prevent them from assuming a prominent role in child care. Nevertheless, most infants become attached to both their parents during the first year of life although they tend to establish primary relationships with their primary caretakers. During the second year of life, fathers encourage boys to focus attention on their fathers. This may facilitate the development of gender identity. In addition, the security of the father-infant attachment relationship may affect the infant's orientation to novel social situations. Fathers also affect infants indirectly via their influence on the children's mothers.     

Early stages of initiative and environmental response

Research results on the association between maternal response to infant' initiative and the development of such initiatives is being presented. This study is based on 239 feeding situations belonging to 41 mother–infant pairs videotaped at home at 30-day intervals, from the beginning of spoon-feeding until 1 year of age. The results showed that the basic hypotheses of this study were confirmed. There was a clear association between maternal responses to initiatives of the infant and four variables: Initiatives, Attempted Initiatives, Aversive Behavior, and Conflictivity. A favorable maternal response went along with more initiatives, fewer Attempts, less Aversivity, and less Conflictivity. Conflictivity was understood as reciprocal exchange of antipathetic reactions such as opposition, disgust, and hostility. Therefore, conflicts show struggle and confrontation between both members of the interaction. Aversivity is the infant's sole reaction to disgust, distaste, or opposition. As the infant risks confrontations with the care-giver to sustain her initiatives, we can say that, although highly influentiable by maternal response, Initiative is a contribution of the infant to her own development. Thus, in our view, a developing self shows an emerging capacity to initiate actions of his/her own. This becomes a relational issue as soon as the infant's initiative hits the interactional field, causing an environmental response that ultimately will allow or impede initiative. In case of impediments, the strong reaction of the infant will produce an impact upon the progressive stages of construction of the relationship, and certainly will be influential upon the further development of the infant's self.     

The use of multitreatment modalities in early intervention: A quantitative case study

A quantitative single case study is presented to illustrate how an early intervention program used two therapeutic modalities to treat a depressed mother and her 2-month-old son. Drawing upon an ecological, transactional model of development, the case study utilized a multimethod, longitudinal approach to assess the infant's developmental competence and attachment status, the mother's history and current psychosocial functioning, patterns of mother-infant interaction, and components of the family's social ecology. Measures were administered during a baseline period to assess pre-intervention functioning and were systematically repeated throughout the 2-year period of intervention. The treatment modalities included psychodynamically oriented individual therapy and Parent-Infant Relationship Treatment (PIRT) in which the dyad was also seen by a second therapist to foster more adaptive mother-infant transactional patterns. The findings indicated increased infant developmental competence and a shift from an insecure to a secure attachment classification, improved maternal psychosocial functioning, and a decline in the dyadic interactional pattern of maternal intrusiveness and infant withdrawal. The advantages of using two treatment modalities and a single case approach to evaluation are discussed.     

Relationships between regulatory temperament dimensions and self-regulatory behaviors at 4 and 6 months of age

The present study focused on relationships between temperament and behavior in early regulation development. Unlike most studies on the topic, we observed infant behavior in a naturalistic playful situation rather than in experimental stressful procedure, and employed temperament measures uniquely reflecting regulatory dispositions rather than a global measure of reactivity. The infant's self-regulatory behaviors were observed at 4 and 6 months during face-to-face interactions and regulatory dimensions were assessed at 4 months. We found that low intensity pleasure and soothability dimensions, related to the infant physical and social experience, respectively, significantly affected regulatory behavior and their influence showed to depend on the infant's age, with the former dimension being influential at the earlier age and the latter being influential when the behavior was observed at the later age. Results are interpreted on the light of a dynamic view of regulation development.     

Maternal correlates of infant temperament ratings and of infant-mother attachment: A longitudinal study

This study examined longitudinally correlates of mothers' ratings of their infant's temperament and of the infant-mother attachment relationship. Measures included Carey's Revised Infant Temperament Questionnaire, child-rearing attitudes, psychophysiological responses to an unfamiliar infant's crying pre- and postdelivery, psychophysiological responses to the mother's own infant's crying, and assessments of infant-mother attachment. The results indicated that maternal ratings of infant temperament at 4 months were significantly related not only to concurrent cry responsiveness but also to cry responsiveness and child-rearing attitudes predelivery, as well as to the quality of attachment at 1 year. It is suggested that a differential response pattern of mothers of “easy” and of “difficult” infants, which affects the developing infant-mother bond, may in part originate in maternal dispositions existing prior to parenthood.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

Death by non-feeding: Not in the baby's best interests

It has recently been suggested that doctors have a duty to act in their patient's best interest and that this duty demands that life-sustaining treatment—including food and fluids—should sometimes be withheld or withdrawn and the patient allowed to die. In this article, the author explores the scope of the ‘best interests principle’ in the context of treatment decisions for seriously handicapped newborn infants. She argues that those who hold that it is permissible to starve or dehydrate an infant to death are mistaken to think that this course of action is in the infant's best interests. While it may be true that there are times whendeath is, everything considered, in an infant's best interests, a slow and distressingmethod of bringing death about is not. Since death by dehydration and starvation is not benign, the withholding of food and fluids is generally not in an infant's best interests. The author concludes by suggesting thatwhenever the withdrawal or non-employment of life-sustaining means imposes a heavy burden on the infant, the ‘best interests principle’ would demand that the infant be killed rather than allowed to die.     

'Talk to me baby, tell me what's the matter now': Semiotic and developmental perspectives on communication in psychoanalytic infant treatment

Infants suffer to a considerable degree from disturbances in nursing, sleep, mood, and attachment. Psychotherapeutic methods are increasingly used to help them. According to case reports, psychoanalytic work with infants and mothers has shown deep‐reaching and often surprisingly rapid results, both in symptom reduction and in improved relations between mother and child. The clinical urgency of the method makes it important to study its results and theoretical underpinnings. Among the theoretical issues often raised in discussions on this modifi ed form of psychoanalysis, those addressing the nature of communication between analyst, baby, and the mother are the most frequent. For example, how and what does an infant understand when the analyst interprets to her? What does the analyst understand of the infant's communication? These issues are addressed by investigating the infant's tools for understanding linguistic and emotional communication, and by providing a semiotic framework for describing the communication between the three participants in the analytic setting. The paper also investigates problems with the traditional ways of using the concept of symbolization within psychoanalytic theory. The theoretical investigation is illustrated by two brief vignettes from psychoanalytic work with an 8 month‐old girl and her mother. demand for the breast. Like the two lovers in the blues, they seemed to be slaves to     

The Developmental Origin of Metacognition

We explain metacognition as a management of cognitive resources that does not necessitate algorithmic strategies or metarepresentation. When pragmatic, world‐directed actions cannot reduce the distance to the goal, agents engage in epistemic action directed at cognition. Such actions often are physical and involve other people, and so are open to observation. Taking a dynamic systems approach to development, we suggest that implicit and perceptual metacognition emerges from dyadic reciprocal interaction. Early intersubjectivity allows infants to internalize and construct rudimentary strategies for monitoring and control of their own and others' cognitions by emotion and attention. The functions of initiating, maintaining, and achieving turns make proto‐conversation a productive platform for developing metacognition. It enables caregiver and infant to create shared routines for epistemic actions that permit training of metacognitive skills. The adult is of double epistemic use to the infant—as a teacher that comments on and corrects the infant's efforts, and as the infant's cognitive resource in its own right. Copyright © 2012 John Wiley & Sons, Ltd.     

The interaction approach to early intervention

A brief summary of research, supportive of the idea that quality of parent-infant interaction has a powerful effect on infant development, introduces an early intervention model based on that proposition. Also, central to the interaction model is the knowledge that (1) parent and infant both contribute to what happens between them and that (2) a multitude of factors, environmental and internal to parent and infant, affect the parent, the infant, and their interaction. Ten sets of principles and strategies that convey the essence of the interaction model constitute the core of this article. The principles and strategies address the importance of identifying sources of support and stress in the family, of developing relationships with both parents, and of supporting positive interactions between parents and the infant's siblings. The limitations of this model are also addressed, especially in cases where the parent is the primary risk factor. The infant's exposure to nurturing adults in quality day care programs and a more clinical approach with the parent and infant, such as Selma Fraiberg's model, may be more effective with such families.     

Mothers who are securely attached in pregnancy show more attuned infant mirroring 7 months postpartum

This study contrasted two forms of mother–infant mirroring: the mother's imitation of the infant's facial, gestural, or vocal behavior (i.e., “direct mirroring”) and the mother's ostensive verbalization of the infant's internal state, marked as distinct from the infant's own experience (i.e., “intention mirroring”). Fifty mothers completed the Adult Attachment Interview (Dynamic Maturational Model) during the third trimester of pregnancy. Mothers returned with their infants 7 months postpartum and completed a modified still-face procedure. While direct mirroring did not distinguish between secure and insecure/dismissing mothers, secure mothers were observed to engage in intention mirroring more than twice as frequently as did insecure/dismissing mothers. Infants of the two mother groups also demonstrated differences, with infants of secure mothers directing their attention toward their mothers at a higher frequency than did infants of insecure/dismissing mothers. The findings underscore marked and ostensive verbalization as a distinguishing feature of secure mothers’ well-attuned, affect-mirroring communication with their infants.