Evaluation of changes in mother-infant brief psychotherapy: A single case study

Representation-oriented brief psychotherapy with mother-infant dyads is used to examine correspondences between maternal behaviors and maternal representations of her infant. A single case study is presented to illustrate how one can objectify interactional variables that may correspond behaviorally to underlying maternal mental representations. This paper presents the results of a collaboration that focuses on the process of enacting fantasy via the domain of behavior. Attention is drawn to interacted themes that are enacted versions of representational themes. Enacted themes are pathogenic in behavioral terms for the infant. Five themes are identified in the case material. Changes in the mother's representations affect both the mother-infant relationship and the infant's functioning.     

Mother—infant psychotherapies: A widening scope in technique

Evidence-based practice in psychotherapy is gaining ground, but we are in great need of more detailed study concerning some basic aspects: the interrelationships between nonspecific and specific factors and their impact on outcome and the precise observation of what goes on between therapist and patient. A comparison of two forms of mother–infant psychotherapy reveals an important gap between what therapists believe and what they actually do. We describe several components of processes: the contribution of the infant, the treatment of affect, the construction of an interpretative focus, and the relationships between cognitive and emotional contributions. These observations indicate the need for a more realistic appraisal of what goes on in technique applications, as well as for a widening of the definition of technique. © 1998 Michigan Association for Infant Mental Health     

An experimental study on mother-infant skin-to-skin contact in full-terms

In premature infants, daily skin-to-skin contact (SSC) has various beneficial effects on the health of the infant and the mother. These beneficial effects might extend to full-term infants. This experimental within-subject study examines the immediate effects of SSC on full-terms’ cortisol physiology during SSC and subsequent physiological and behavioral reactions to a mild stressor (a bathing session). Additionally, the effects of SSC on the quality of maternal behavior are examined.Between 5 and 7 weeks postpartum, 17 full-term infant-mother dyads were visited at home twice. During one home visit, a bathing session was proceeded by 50 min of mother-infant SSC, while during the other visit the bathing session was proceeded by 50 min of the infant resting alone. The order of the home visits was counterbalanced. Infant salivary cortisol measures were taken to measure the cortisol response to the experimental condition (SSC versus solitary resting) and the bathing session. Furthermore, infant behavioral distress and the quality of maternal behavior during the bathing session were scored from videotapes.Two-way within-subject repeated measures ANOVA’s showed that, when compared to solitary resting, full-terms’ cortisol concentrations significantly decreased during SSC, followed by higher cortisol reactivity in response to the subsequent bathing session. No effects of SSC on infant behavioral distress and maternal caregiving behavior were found. Apparently, a single session of mother-infant SSC can affect infant cortisol physiology in full-term infants. Future SSC research is needed to investigate the neurobiological mechanisms and dose-response relations in full-term infants.     

The use of the Rorschach in brief clinical evaluation

An adaptation of the Rorschach is described that can be used as part of a brief clinical evaluation. Some case illustrations are provided to demonstrate the method.     

Successful intervention with multi-problem mothers: Effects on the mother-infant relationship

A two-step model of intervention for multi-problem mothers was proposed. In order to improve mother-child interaction and later developmental outcomes, the first step is for the practitioner to help the mother change her external competencies (adult social skills) and internal perceptions (support, depression). These changes make the second step possible—the mother then can learn to foster her own child's development. The model was tested in a study of 95 multi-problem women who participated in a nursing intervention program from mid-pregnancy through the child's first birthday. The results supported the two-step model. Improvements in the mothers' external competencies were related to completion of intervention goals. These external improvements also were related to more optimal patterns of mother-child interaction during teaching and feeding episodes at 1 year. Furthermore, an especially insecure type of attachment relationship was found more frequently among the infants of mothers in the group that did not improve. Changes in internal perceptions were unrelated to intervention or interaction measures. These unexpected results suggest that the mother's internal improvements may have a more delayed or a less direct effect upon the child.     

Adolescent Report of Interparental Conflict: The Role of Threat and Self-blame Appraisal on Adaptive Outcome

Research consistently shows that children exposed to interparental conflict are at-risk for experiencing psychopathology. Establishing a link, however, between interparental conflict and maladjustment is not the same as understanding how specific outcomes manifest. Therefore, we examined the relation of interparental conflict and appraisal with adolescent outcome with 169 high school students (ages 14–19 years). Specifically, threat and self-blame appraisals were hypothesized to mediate the relation between interparental conflict and both adaptive and maladaptive outcomes. Results suggest that threat partially mediated the relation between interparental conflict and externalizing problems, interparental conflict and internalizing problems, and interparental conflict and adaptive behaviors. Additionally, self-blame appears to partially mediate the relation between interparental conflict and internalizing problems. Implications of the current findings are discussed.     

Teaching children with autism to follow gaze shift: A brief report on three cases

This study evaluated the extent to which prompting and reinforcement increased three participants' correct selections of items following a therapist's gaze shift using a non‐concurrent multiple baseline design for two participants and an ABCD design for one participant. Results show that each participant learned to discriminate an adult's gaze direction to make a correct selection and each participant's responding generalized to selections with non‐reinforcing stimuli. Two participants also displayed the skill during probe sessions with their parents; however, the third participant required tangible reinforcement for correct selections to demonstrate the skill with a parent.     

The little puppet: working with autistic defences in mother-infant psychotherapy

This paper outlines a constellation around birth in our society that is related to advanced western medicine and the way that families move around the globe. It describes a brief therapy with a three-year-old child who was diagnosed as autistic, and a mother who resorted to 'heroic' defences against the anxiety of being unsupported in a strange country. The therapist undertook to process the catastrophic experiences of the birth as expressed in the child's play and transform the accompanying monstrous fantasies into human experiences and thoughts. By providing a maternal container for both mother and child, the therapist was able to dissolve the couple's negative enmeshment and help create a space in the mother's mind in which she could process her own feelings, and thereby process and understand the child's feelings and communications.     

Coregulation in mother-infant dyads: links to infants' cardiac vagal tone

This investigation explored links between mother-infant coregulated communication patterns and infants' emerging parasympathetic regulatory processes (cardiac vagal tone). Participants included 56 first-time mothers and their 6-mo.-old infants (31 girls, 25 boys). A 4-min. baseline EKG was gathered from the infant and an ensuing 15-min. mother-infant dyadic free-play episode was videotaped and coded using Fogel's 1994 Regional Coding System. This system was developed to describe variations in coregulated features of communication among dyads, ranging from symmetrical patterns to disruptive patterns of coregulation. Analysis suggests a positive link between infants' cardiac vagal tone and more symmetrical features of coregulated communication patterns in mother-infant dyads. Cardiac vagal tone was also negatively correlated with unilateral features of coregulation communication systems. These findings point toward the potential relation between emerging physiological regulatory abilities of infants and the more relational regulatory processes in mother-infant dyads.     

Developmental changes in mother-infant face-to-face communication: birth to 3 months

This study documented the growth of the earliest form of face-to-face communication in 16 mother-infant dyads, videotaped weekly during a naturalistic face-to-face interaction, between 1 and 14 weeks, in 2 conditions: with the infant in the mother's arms and with the infant semi-reclined on a sofa. Results showed a curvilinear development of early face-to-face communication, with a significant increase occurring between Week 4 and Week 9 depending on the dyad. After 2 months, trajectories diverged into 2 groups: I whose duration of face-to-face communication continued to increase and I whose duration peaked and then began to decrease. After the 1st month, the duration of face-to-face communication was significantly longer when the infant was on the sofa rather than in the mother's arms. In the latter condition, during the 3rd month, girls spent a significantly longer time than boys in face-to-face communication. These findings suggest that context (infant being held vs. not being held) interacts with the infant's age and sex in affecting mother-infant communication.     

Empirically supported psychotherapies: comment on Westen, Novotny, and Thompson-Brenner (2004)

D. Westen, C. M. Novotny, and H. Thompson-Brenner (2004; see record 2004-15935-005) suggested that efforts to identify empirically supported treatments are misguided because they are based on assumptions that are not appropriate for some types of treatment and patients. The authors of this comment argue that Westen and colleagues are simply incorrect when they assert that empirically supported treatments require that psychopathology must be highly malleable, that treatments must be brief, or that the samples studied are unrepresentative of the kinds of patients typically encountered in clinical practice--comorbidity is common in many clinical trials. Randomized controlled trials remain the most powerful way to test notions of causal agency.     

Development of a spanish version of the Schwartz Outcome Scale-10: a brief mental health outcome measure.

The lack of culturally appropriate psychometric instruments for the assessment of cognitive and emotional functioning in minority populations has been a concern often discussed in the assessment literature. With the increased focus on the measurement of outcome in mental health treatment, the lack of appropriate instruments for minorities has become readily apparent in this venue as well. We report on the Spanish translation of a brief and reliable measure of psychological health and well-being that has been shown to be sensitive to treatment outcomes. The original and Spanish translated versions of this measure are highly correlated, providing clinicians and organizations with a instrument that can be used for assessment of psychological well-being and treatment outcomes with Hispanic patients.     

The role of oxytocin in early mother-infant interactions: Variations in maternal affect attunement

The aim of the present research was to investigate the relationship between oxytocin and maternal affect attunement, as well as the role of affect attunement in the relationship between oxytocin and infant social engagement during early mother-infant interactions. Forty-three mother-infant dyads participated in the present study when infants were 4 months. They were observed during (1) a situation where no communication took place and (2) a natural interaction between mother and infant. During this procedure, three saliva samples from mothers and their infants were collected to determine their levels of oxytocin at different time points. Maternal affect attunement (maintaining attention, warm sensitivity) and infant interactive behaviors (gaze, positive, and negative affect) were coded during the natural interaction. Results indicated that overall maternal oxytocin functioning was negatively related to her warm sensitivity, while infant oxytocin reactivity together with maternal affect attunement were associated with infant positive social engagement with their mothers. Specifically, infant oxytocin reactivity was significantly related to their gazes at mother, but only for infants of highly attuned mothers. These results point to the complex role oxytocin plays in parent-infant interactions while emphasizing the need to analyze both overall oxytocin functioning as well as reactivity as different indices of human affiliative behavior.