Mother – infant group psychotherapy as an intensive treatment in early interaction among mothers with substance abuse problems

In this article we present a novel method of outpatient care: brief, dynamic mother – infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother – infant relationship in this high-risk group. The clinical material is taken from 16 mother – infant dyads from six psychotherapy groups, which met weekly over six months from pregnancy to post-partum. The therapy process consists of 20 – 24 three-hour sessions. The basis of the therapy is to offer mothers experience of care, which they, in turn, can give to their infants. In this paper we analyse the core therapeutic elements that may contribute to better mothering and child development. They involve: the group providing a symbolic maternal lap, and the meeting of the mothers' and the infants' needs. It is hoped that this may offer the mothers a new experience within which to reappraise their early memories. This may help prevent them from projecting traumatic past experiences onto their infants. Our analyses show that in the therapy, mothers, feeling safe within the group, gradually experienced pleasure with their infants and their peers. These effects, according to the mothers, were the most noticeable. Brief dynamic mother – infant group psychotherapy seems to be a promising form of treatment for those substance-abusing women able to commit to outpatient care and examine the causes of their drug dependence. The groups may also be used as a diagnostic tool to detect problems in early mother-baby interaction.     

Pregnancy Plans of First‐time Mothers and Their Children's Outcomes: An Examination of Mechanisms

Unintended pregnancy is prevalent in the United States and has been linked to challenges for both mothers and their children over time. However, studies have not yet identified mechanisms through which pregnancy intention is associated with children's outcomes. Identification of mechanisms among families at risk for negative outcomes will inform early clinical intervention. This current study examined the association between mothers' pregnancy plans reported during pregnancy and children's externalizing, internalizing, dysregulation, and social–emotional competence outcomes at 3 years old among an at‐risk sample of 682 first‐time mothers from the Predicting and Preventing Neglect in Teen Mothers Study. Further, this study identified mechanisms in the association that can be targeted in clinical intervention. Mediation analyses revealed that mothers' parenting stress when children were 24 months old served as a mechanism in the association between unplanned pregnancy and children's low social–emotional competence at 36 months. Implications for research and clinical practice are discussed. Specifically, early intervention with mothers experiencing unplanned pregnancies may help to promote healthy outcomes among their children over time. Copyright © 2016 John Wiley & Sons, Ltd.     

Maternal representations during pregnancy and early motherhood

The aim of the present study was to study the maternal representations of pregnant women and mothers in their early postpartum period, by beginning the process of validating the maternal representations questionnaire L'entretien R₁ and by developing a means to assess the content‐free aspects of the representations. Participants were 23 primiparous (first‐time mothers) pregnant women in their fourth to seventh month of pregnancy and 22 primiparous mothers in their early (zero to six months) postpartum period. It was found that the four subscales of L'entretien (self‐as‐mother, self‐as‐person, own‐mother, and partner) produced meaningful results for Turkish subjects. The results were compatible with the idea of integrated representations of self‐as‐person and self‐as‐mother even in the second trimester of their pregnancy and also showed that they could differentiate themselves from their mothers as early as that period. The results revealed no significant differences in the content and content‐free dimensions of the representations of pregnant women and mothers. ©2004 Michigan Association for Infant Mental Health.     

The preoedipal patient and the pregnancy of the therapist

This article is a contribution to the sparse literature on the pregnancy of the therapist. The therapist's pregnancy is viewed as an event that can facilitate progress for some female patients with preoedipal problems. In these cases, it provides a dramatic opportunity to address developmental difficulties, including separation problems and inadequate ego ideal formation, through the analysis of the self-object transference. Clinical material illustrates the working through of these issues for a patient in whom the therapist's pregnancy was stressful but not traumatic. Therapeutic interventions were aimed at fostering greater differentiation between self and object. A contrasting case is also examined in which the pregnancy was felt to be traumatic and feelings about it largely denied. However, underlying transference issues were eventually addressed.     

How Stable is the Well-Being of Australian Mothers Who Care for Young Children with Special Health Care Needs?

Ninety-seven percent of children who have special health care needs are cared for by their mothers. These mothers cite that their informal care work can be intrinsically rewarding, however, the role is not without substantial difficulties and consequences. We investigated differences in the health and well-being of mothers whose young children do and do not have special health care needs. Quantitative data are drawn from Growing Up in Australia: The Longitudinal Study of Australian Children. This study employs a matched-case control methodology to compare the experiences of a group of 292 mothers whose children are identified as having long term special health care needs to those mothers whose children are typically developing at two time points; Wave 1 (2004) and Wave 3 (2008). The findings support previous research that mothers of children with special health care needs have poorer general health and mental health than mothers whose children do not have special needs. Mothers of children with special health care needs also perceived life as more difficult. Longitudinally, this study also shows that maternal well-being remains relatively stable during the years when children are transitioning to formal schooling. Implications for policy makers, practitioners and early childhood professionals are discussed.     

The social environments of early infancy in Japan and the United States

The social environments of early infancy in Japan and the United States were compared in terms of the context of caregiving and the quality of the month-infant interaction. Mothers of 17 Japanese infants and 17 infants in the United States were interviewed in their homes about the experiences that they provided for their 4-month-old infants, and mother-infant interactions were recorded on videotape. Levels of parents' education were similar in both countries. The context of the infant's development varied substantially with culture. Mothers in the United States provided a greater variety of experiences on the HOME and care of Japanese infants tended to be more exclusively provided by mothers whereas care of infants in the United States was shared by fathers and other caregivers to a greater extent. Examination of behaviour frequencies during mother-infant interaction indicated that mothers in Japan provided their infants with more vocal input and more physical play than mothers in the United States and Japanese mothers were more vocally responsive to their infants' vocalizations.     

Assessing the impact of a family nurse-led intervention on young mothers’ references to internal states

A mother's propensity to refer to internal states during mother–child interactions is important for her child's developing social understanding. However, adolescent mothers are less likely to reference internal states when interacting with their children. We investigated whether young mothers’ references to internal states are promoted by the Family Nurse Partnership (FNP) intervention, an intensive home-visiting programme designed to support adolescent mothers in England. We also investigated family, maternal, and child factors associated with young mothers’ references to inner states during interactions with their children. Adolescent mothers (n = 483, aged ≤ 19 years when recruited in pregnancy) and their children participated in an observational substudy of a randomized controlled trial investigating the impact of FNP compared to usual care. Mother–child dyads were video-recorded during free play, and mothers’ speech was coded for use of internal state language (references to cognitions, desires, emotions, intentions, preferences, physiology, and perception). We found no differences in mothers’ use of internal state language between the FNP and usual care groups. A sample-wide investigation identified that other features of mothers’ language and relationship status with the child's father were associated with internal state language use. Findings are discussed with reference to targeted interventions and implications for future research.     

Timing of Early Maternal Mental Health and Child Cortisol Regulation

Maternal mental health problems can negatively impact children's physiological stress regulation. Yet, little is known of their long‐term effects, especially related to the timing of maternal symptoms. We examined how maternal mental health problems during pregnancy versus in the early postpartum period predict children's cortisol levels and diurnal patterns at 10–12 years. Participants were a selection (N = 102) of an original sample of 805 Finnish families, who were followed from the second trimester of pregnancy (T1) to child's age of 2 months (T2) and 12 months (T3), and again at child's age of 10–12 years (T4). Based on the timing of psychological distress and depressive symptoms (T1–T3), the mothers could be assigned to three distinct mental health trajectory groups: mothers with prenatal mental health problems (n = 15), mothers with early postpartum mental health problems (n = 15) and mothers without mental health problems (n = 72). Children's cortisol (T4) was measured by saliva samples through five within‐1‐day assessments. The results show that maternal prenatal mental health problems predicted a relatively steep increase of child cortisol from awakening to 1 h later, indicating an intensified cortisol awakening response (CAR). Mothers' early postpartum mental health problems instead predicted a reduced CAR. Both maternal prenatal and postnatal mental health problems thus predicted children's later stress regulation, but in unique ways. We discuss the specific roles of direct biochemical effects during pregnancy and postpartum mother–infant interaction quality as modifiers of the hypothalamic–pituitary–adrenal system. Copyright © 2015 John Wiley & Sons, Ltd.     

The importance of maternal state of mind regarding attachment and infant age at placement to foster mothers' representations of their foster infants

Previous research has found that foster mother state of mind with respect to attachment and infant age at placement into foster care influence the developing foster mother–foster child relationship (Dozier, Albus, Stovall, & Bates, 2000; Stovall & Dozier, 2000). This study extends prior research by assessing factors related to foster mothers' representations of their foster infants. Participants were 48 foster mother–foster infant dyads in two mid‐Atlantic cities. We expected that foster mothers' states of mind and infant age at placement would be associated with foster mothers' acceptance of infants, commitment to infants, and belief in their influence on infants' development. Consistent with hypotheses, foster mothers' states of mind interacted with infant age at placement in predicting foster mothers' acceptance of their babies, and the extent to which foster mothers believed they could influence their infants' development. Specifically, autonomous foster mothers of babies placed before 12 months of age were more accepting and more likely to believe they could influence their infants' development compared to autonomous foster mothers of babies placed after 12 months of age, a pattern not seen for nonautonomous foster mothers. These results converge with other findings suggesting that timing of placement in foster care, and foster mothers' states of mind, are important to the developing foster mother–child relationship. ©2002 Michigan Association for Infant Mental Health.     

Paradox of Parental Involvement in Sexual Health and Induced Abortions Among In-school Female Adolescents in Southwest Nigeria

Prevalent early sexual initiation and unprotected sex involvement with various partners create dilemmas for adolescents and their parents. This article explores parents' involvement in their adolescents’ sexual and reproductive health, particularly with respect to terminating unintended pregnancies. This was done to gain an understanding of the dynamics of parental involvement in resolving anxieties concerning unintended pregnancy and the reasons for seeking induced abortions. The study used a mixed method approach, and 460 female students aged 13–20 years completed the self-administered questionnaire. Thirty-three parents who had an adolescent daughter in school and 31 female adolescents participated in eight different focus group discussion sessions, respectively. A quarter of the respondents had been pregnant at least once. All the females who had ever become pregnant had tried to terminate the pregnancy. Few (9 %) had used contraception at their last sexual intercourse. Twenty nine percent of the respondents had discussed sexual matters with their parents and 82 % preferred discussing such matters with their mothers. In the qualitative findings, some of the parents reported not having been involved in or supportive of terminating their daughter's pregnancy, but confirmed that some mothers had reasons to support induced abortions. Major reasons for mothers' involvement in their daughters' induced abortions were to avoid the social stigma, disruption of schooling and financial stress associated with unintended pregnancy. Resolving conflicting parental interests and values concerning adolescent sexuality and induced abortions is essential for promoting adolescent sexual health in Nigeria.     

Impact of mother interactive style on infant affect among babies exposed to alcohol in utero

This study examined the ability of infants prenatally exposed to alcohol to regulate their affect during and after a stressor. Specifically, the Still‐Face Paradigm (Tronick, Als, Adamson, Wise, ' Brazelton, 1978) was used as a stress induction paradigm to assess both mother‐infant interaction and infant self‐regulation. In addition to the mothers' interactive style, the effect of mothers' drinking during and after pregnancy on the infant was explored. Participants were 76 six‐month‐old infants and their mothers. Infant affect and maternal interaction style was coded second‐by‐second for the 6 min of the Still‐Face Paradigm. Results indicated that infants whose mothers made fewer attempts at engaging them during the play portion of the still‐face (e.g., either watched their infant or paid minimal attention to their infant) showed greater negative affect in contrast to infants whose mothers played in an interactive manner. A gender effect was found among female infants. That is, female infants whose mothers drank more during pregnancy showed greater negative affect. The study demonstrates the possibility of early identification of negativity in infants with prenatal alcohol exposure. The impact of mother‐child relationship on emotional regulation of infants prenatally alcohol exposed may be a target of future intervention and further study.     

Depression in the early postpartum period and attachment to children—in mothers of NICU infants

Depression in early puerperium was evaluated in terms of maternal attachment in mothers of children admitted to the neonatal intensive care unit (NICU) in comparison to a control group of mothers of full‐term infants. A survey including Zung's self‐rating depression scale (ZSDS), a postpartum maternal attachment scale and items addressing the mother's feelings and peripheral conditions was conducted on mothers of children admitted to the NICU. Among the 153 mothers who gave valid responses, positive ZSDS scores of over 40 were seen in 61.8%. In terms of the children's disorder, strong depressive tendency was noted among mothers of low birth weight infants. Significant correlation was noted between the ZSDS and the ‘core maternal attachment’ (negative correlation) and ‘anxiety regarding children’ (positive correlation) subscales of postpartum maternal attachment. Path analysis revealed the father's positive reaction in learning of the pregnancy resulted in elevation of the ‘core maternal attachment’ score, in contrast to the control group mothers. Copyright © 2003 John Wiley & Sons, Ltd.     

Adult attachment styles,early relationships,antenatal attachment,and perceptions of infant temperament: A study of first‐time mothers

We explored the relative contributions of first‐time mothers’romantic attachment styles and early relations with their own mothers to the prediction of infant temperamental difficulty. A mediating role for mother's attachment to the unborn baby was assumed. In a prospective longitudinal study of 115 mothers of healthy babies, a structural model was delineated according to a conception of maternally reported infant temperament as a reflection of basic aspects of the mother's personality and mother‐infant relationships. Mothers’experiences with their own mothers as supportive and nonintrusive differentiated between securely and insecurely attached participants. Security of attachment was found to facilitate antenatal attachment and perceptions of the 4‐month‐old infant as easier. Findings indicate that the effects of the mothers’romantic attachment styles on their perceptions of temperamental difficulty are mediated by their antenatal attachment. Moreover, the pattern of findings obtained suggests a link among mothers’history of relationships, romantic attachment styles, and caregiving characteristics that is congruent with evolutionary theoretical assumptions.     

Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy

Previous research has provided inconclusive evidence regarding the neuropsychological difficulties of children born to mothers partaking in opioid or poly-drug use during pregnancy. Little is known about how these children fare as they get older. The present longitudinal study includes follow-up data on 45 children born to mothers who used heroin and poly-drugs and a group of 48 children without prenatal drug exposure. Most of the drug-exposed youths were placed in permanent foster or adoptive homes before one year of age. The youths (ages 17 to 21) were administered 10 neuropsychological tests. The drug-exposed youths had cognitive and fine motor functions within the normal range compared to population norms but performed significantly worse than the non-exposed group. There were indications of generally lower cognitive functions rather than specific problems with executive functioning. Lower mean birthweight in the risk group (619 grams mean difference, p < .001) only partially mediated the group differences in cognitive functioning. There was a tendency for youths who had few and early changes in their caregivers or who were born to mothers who had used the least number of different drugs during pregnancy to have the best cognitive scores. The study indicates that youths born to mothers who used multiple drugs during pregnancy are vulnerable relative to their peers within a wide range of cognitive functions. The vulnerability seems to be related not only to the mother’s drug use during pregnancy but also to factors such as birthweight and unstable parental care during infancy.     

Caregiving behavior and interactions of prenatally depressed mothers (antidepressant‐treated and non‐antidepressant‐treated) during newborn acute pain

This exploratory study aimed to examine time‐based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)‐medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second‐by‐second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother–infant interaction and infant pain and stress reactivity.     

Neonatal auditory evoked responses are related to perinatal maternal anxiety

Maternal stress and anxiety during pregnancy are related to negative developmental outcomes for offspring, both physiological and psychological, from the fetal period through early adolescence. This robust relationship is likely to be partly explained by alterations in fetal neurodevelopmental programming, calling for further examination of neurophysiologically-based cognitive markers that may be related to the altered structure–function relationships that contribute to these negative developmental outcomes. The current investigation examined the relationship between perinatal maternal anxiety and neonatal auditory evoked responses (AERs) to mother and stranger voices. Results indicated that neonates of low-anxiety mothers displayed more negative frontal slow wave amplitudes in response to their mother’s voice compared to a female stranger’s voice, while neonates of high-anxiety mothers showed the opposite pattern. These findings suggest that neonates of perinatally anxious mothers may demonstrate neurophysiologically-based differences in attentional allocation. This could represent one pathway to the negative psychological outcomes seen throughout development in offspring of anxious mothers.     

From the Same Planet: Reply to Commentaries

This reply offers clarification of the author's thesis. What was originally a reciprocal, pleasurable experience for each sex of mutual interpenetration with the preoedipal mother devolves into a split, gendered polarity. The specific form this takes for a boy—repudiation of identification with the mother and with maternal qualities—is seen to be detrimental to male development. I theorize a culturally normative, gender-specific neurosis caused not by maternal care but by the difficulty in male development of continuing to incorporate the surplus pleasures of maternal penetration given a problematic model of masculinity. My aim in “Unlawful Entry” is not to reverse gendered power relations but to forward their elimination.     

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.