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.     

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.     

Relational trauma in infancy. Psychoanalytic,attachment and neuropsychological contributions to parent–infant psychotherapy

Abstract

The paper argues that residential projects working mainly with those diagnosed schizophrenic are specialized work groups, in Bion's terms, operating upon the assumption of pairing, and illustrates this with reference to a period of organizational change at one such project. The reasons why this might be so are discussed, and are related to the central issue of hope and despair in work with those who are unlikely to recover.     

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.     

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.     

Case–contrast study about parent–infant interaction in a Brazilian sample of siblings of children with autism spectrum disorders

Siblings of children with autism spectrum disorders (ASD) present greater susceptibility to developmental problems, in comparison with siblings of typically developing children. The greater prevalence of mental health disorders among parents of children with ASD increases younger siblings’ vulnerability to emotional problems. The aim of this study is to compare the interaction between carers and babies aged 2 to 26 months (M = 11.7, SD = 6.9) who are siblings of children with ASD (ASD dyads) with the interaction of dyads of siblings of typically developing children (TD dyads). The protocol of Clinical Indicators of Risk for Child Development and the Coding Interactive Behaviour measures were used to evaluate interaction. ASD dyads presented higher scores of constriction in their interaction, P = .024, with babies presenting higher scores of withdrawal behavior, P = .003, and carers presenting higher scores of depressive mood, P = .008, when compared to TD dyads. The ASD dyads have interactive impairments more frequently than do the TD dyads.     

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.     

Action–effect anticipation in infant action control

There is increasing evidence that action effects play a crucial role in action understanding and action control not only in adults but also in infants. Most of the research in infants focused on the learning of action-effect contingencies or how action effects help infants to infer goals in other persons' actions. In contrast, the present research aimed at demonstrating that infants control their own actions by action-effect anticipation once they know about specific action-effect relations. About 7 and 9-month olds observed an experimenter demonstrating two actions that differed regarding the action-effect assignment. Either a red-button press or a blue-button press or no button press elicited interesting acoustical and visual effects. The 9-month olds produced the effect action at first, with shorter latency and longer duration sustaining a direct impact of action-effect anticipation on action control. In 7-month olds the differences due to action-effect manipulation were less profound indicating developmental changes at this age.     

Power assertion in everyday mother–infant interactions

Mothers’ power assertion was assessed following everyday infant transgressions. Power assertiveness showed limited stability, increased with age, and was higher when infants were harming others and when the physical danger was more severe. Naturalistic research is key to understanding how power assertion influences social development.     

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.     

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).     

Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent–infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent–infant dyads may illuminate important aspects of the method itself as well as the therapists’ role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent–infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent–infant dyads where child protective issues arise, where caregivers’ insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists’ role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.     

Promoting the Scientist–practitioner Mindset in Clinical Training

While the scientist–practitioner model of training has enjoyed wide-spread appeal, difficulties in implementing the model have continued since its inception. Despite these difficulties, we remain advocates of the model and believe responsibility for inculcating a scientist–practitioner mindset rests with both training programs and trainees themselves. Thus, we offer several suggestions for both trainees and training programs in hopes of perpetuating the scientist–practitioner ideal.     

Exploring gender differences in infant motor development related to parent’s promotion of play

This study explored how parents’ promotion of play may impact gender differences in motor development of six-nine month old infants. Twenty-nine infants between six-nine months of age and their primary caregivers took part in assessments of anthropometry, motor development, video observations of play and a qualitative interview. Results revealed females had significantly higher scores for fine motor skills and significantly higher incidence of touching toys in an individual play scenario compared to males. Males had a higher intensity level of play during both play scenarios. Qualitative explorations found that parents perceived other adults such as surrounding family and friends to promote gender differences but not themselves; however, parents’ verbal interactions with infants did appear to differ by gender. Parents of males more frequently made statements to promote gross motor skills while parents of females more frequently made statements to promote fine motor skills. While biological influences are suggested to play a role on gender differences of motor development early in life, environmental explanations related to socialization, gender-differentiated expectations and experiences amplify these differences to a greater degree than may have been previously considered during this time period.     

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.     

Triadic awareness predicts partner choice in male–infant–male interactions in Barbary macaques

Social knowledge beyond one’s direct relationships is a key in successfully manoeuvring the social world. Individuals gather information on the quality of social relationships between their group companions, which has been termed triadic awareness. Evidence of the use of triadic awareness in natural contexts is limited mainly to conflict management. Here we investigated triadic awareness in wild Barbary macaques (Macaca sylvanus) in the context of bridging interactions defined as male–infant–male interactions whereby a male (initiator, holder) presents an infant to another male (receiver, non-holder) in order to initiate an affiliative interaction with that male. Analyses based on 1263 h of focal observations on ten infants of one wild social group in Morocco supported the hypothesis that males use their knowledge of the relationship between infants and other adult males when choosing a male as a partner for bridging interactions. Specifically, (i) the number of bridging interactions among holder–infant–receiver triads was positively affected by the strength of the infant–receiver relationship and (ii) when two males were available as bridging partners, a male was more likely to be chosen as the receiver the stronger his social relationship with the infant relative to the other available male. This demonstrates that non-human primates establish triadic awareness of temporary infant–male relationships and use it in a naturally occurring affiliative context. Our results contribute to the discussion about the mechanism underlying the acquisition of triadic awareness and the benefits of its usage, and lend support to hypotheses linking social complexity to the evolution of complex cognition.