Parents' convergence on sharing and marital satisfaction,father involvement,and parent–child relationship at the transition to parenthood

This study examines determinants of father involvement, the parents' convergence on marital satisfaction, and mothers' and fathers' interactive behavior in dual‐earner families at the transition to parenthood. Sixty dual‐earner Israeli couples and their five‐month‐old firstborn child were interviewed and videotaped in infant–mother and infant–father interactions. Interactions were coded globally for 21 interactive behaviors and composited into measures of parent sensitivity and infant readiness to interact. Five determinants of each parent's involvement in house and childcare were assessed as predictors of parent–infant interactions: the sharing of household and childcare responsibilities, the amount of time each parent spends with the infant during the week and on weekends, and the range of childcare activities the parent typically performs. Marital convergence was indexed by the absolute difference score between mothers' and fathers' marital satisfaction. Father sensitivity was related to the sharing of household and childcare responsibilities, to the amount of time the father spends with the child on weekends (but not during the week), to the range of childcare activities father performs, and to marital convergence. Mother sensitivity was related only to the sharing of responsibilities between spouses. The range of the father's childcare activities predicted maternal interactive sensitivity. Infant readiness to interact with the father, but not with the mother, was related to the sharing of childcare responsibilities, to the range of father's childcare activities, and to marital convergence. Results further specify the differential associations between the marital and the parent–child relationship for mothers and fathers and point to the importance of the father's instrumental involvement in childcare to the development of fathering. © 2000 Michigan Association for Infant Mental Health.     

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.     

DEVELOPMENT OF THE PARENT‐CHILD PLAY SCALE FOR USE IN CHILDREN WITH FEEDING DISORDERS

The Parent‐Child Play Scale was developed as a scale that complements the Parent‐Child Feeding Scale, created by I. Chatoor et al. (1997), to evaluate mother–infant/toddler interactions in two different caregiving contexts of a young child's everyday life, specifically play and feeding. This Play Scale can be used with infants and toddlers ranging in age from 1 month to 3 years and provides reliable global ratings of mother–child interactions during 10 min of videotaped free‐play in a laboratory setting. The scale consists of 32 mother and infant/toddler interactive behaviors which are rated by trained observers from videotaped observations. Four subscales are derived: Dyadic Reciprocity, Maternal Unresponsiveness to Infant's/Toddler's Cues, Dyadic Conflict, and Maternal Intrusiveness. Construct validity and interrater and test‐retest reliability of the Play Scale have been demonstrated. This Play Scale discriminates between children with and without feeding disorders as well as between children with different subtypes of feeding disorders as defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) (Feeding Disorder of State Regulation, Feeding Disorder of Caregiver‐Infant Reciprocity, and Infantile Anorexia). It can be used for research or clinical practice in the diagnosis and treatment of early feeding problems, to assess the pervasiveness of mother–infant/toddler difficulties and to monitor changes following therapy.     

Disorders of excessive crying,feeding, and sleeping: The Munich Interdisciplinary Research and Intervention Program

The Munich Interdisciplinary Research and Intervention Program (MIRIP 1991) is an inter-disciplinary diagnostic and intervention service for families with regulatory disturbed infants (excessive crying, feeding/sleeping disturbances, disturbances of attachment/exploration, disturbances of autonomy/control). In addition, the systematic collection of data serve to investigate the etiology, clinical course, and possible treatments of regulatory problems in infancy. The program is based on a systemic model of early developmental psychopathology. Diagnostic procedures include a semistructured clinical interview, a developmental neuropediatric examination; behavioral diaries; questionnaires on infant temperament, the mother's psychological condition, marital satisfaction, and social support; and videotaped mother–infant interactions in age-related contexts. As is evident from the data analysis, regulatory disturbances in infancy may be associated with (1) maladaptive regulatory patterns in several domains (e.g., excessive crying and disturbed sleep-wake organization), (2) high maternal distress and multiple psychosocial risk factors, and (3) considerable distress of the early mother/parent–infant relationship and communication. Interaction-centered infant–parent psychotherapy is an interdisciplinary, multidimensional therapeutic approach for families with regulatory disturbed infants. It targets upon dysfunctional patterns of mother/parent–infant communication. Particular emphasis is put on restoring the parents' intuitive capacities. The approach has proved to be effective within short time periods and aims at preventing later developmental problems. © 1998 Michigan Association for Infant Mental Health     

FLEXING THE FRAME: CONTEMPLATING THE USE OF MULTIPLE PORTS OF ENTRY IN PARENT–INFANT PSYCHOTHERAPY

Multirelational interventions are well described in the psychoanalytic parent–infant literature. Daniel Stern (1995) originally suggested and described five “ports of entry” that may be employed to access the multiperson parent–infant clinical system. Other authors have elaborated and extended Stern's original list of ports of entry. The impact of using multiple ports of entry on the psychoanalytic frame, however, is largely neglected in the parent–infant psychotherapy literature. Danielle Quinodoz's (1992) four facets of the psychoanalytic setting are used to structure a discussion of how the multiplicities associated with parent–infant psychotherapy may impact the frame. The article argues strongly for a necessary flexing of the psychoanalytic frame to establish therapeutic alliances. A fifth facet, that of psychoanalytic mindfulness, is offered as a counterbalance to the risks associated with excessive flexing of the frame, particularly in relation to Quinodoz's fourth facet of “refraining from ‘doing.’” This article relies on case material to illustrate the issues under discussion. Further engagement and debate are invited.     

Infant–mother and infant–father synchrony: The coregulation of positive arousal

To examine the coregulation of positive affect during mother–infant and father–infant interactions, 100 couples and their first‐born child were videotaped in face‐to‐face interactions. Parents' and infant's affective states were coded in one‐second frames, and synchrony was measured with time‐series analysis. The orientation, intensity, and temporal pattern of infant positive arousal were assessed. Synchrony between same‐gender parent–infant dyads was more optimal in terms of stronger lagged associations between parent and infant affect, more frequent mutual synchrony, and shorter lags to responsiveness. Infants' arousal during mother–infant interaction cycled between medium and low levels, and high positive affect appeared gradually and was embedded within a social episode. During father–child play, positive arousal was high, sudden, and organized in multiple peaks that appeared more frequently as play progressed. Mother–infant synchrony was linked to the partners' social orientation and was inversely related to maternal depression and infant negative emotionality. Father–child synchrony was related to the intensity of positive arousal and to father attachment security. Results contribute to research on the regulation of positive emotions and describe the unique modes of affective sharing that infants coconstruct with mother and father. ©2003 Michigan Association for Infant Mental Health.     

Infant visual habituation and parental psychological distress

Research is equivocal concerning the relationship between parental psychological distress and infant cognitive functioning. Four potential limitations of the literature are addressed: reliance on mothers' but not fathers' psychological distress, use of categorical measures of psychological distress, use of standardized measures of infant cognitive functioning, and failure to take into account potential gender differences. Ninety‐nine twin pairs and both their mothers and fathers were assessed. Infants cognitive functioning was assessed using an infant‐controlled habituation–recovery–dishabituation task. Maternal and paternal psychological distress was assessed using the Symptom Check List‐90‐Revised. No gender differences were obtained for infant visual information‐processing abilities or parental psychological distress. Maternal and paternal psychological distress was related to female visual encoding abilities only. It was concluded that parental psychological distress might degrade parent–infant interactions. Characteristics of girls when faced with parents exhibiting psychiatric difficulties may exacerbate difficulties of parent–infant interactions, thereby hindering the full development of cognitive abilities involved in the process of habituation. A need exists to examine the relationship between parental psychological distress and infant visual attention separately for girls and boys. ©2001 Michigan Association for Infant Mental Health.     

The function of language in parent‐infant psychotherapy

Parent‐infant psychotherapy, a rather new field in psychoanalysis, raises questions of how to conceptualize the clinical process. Previous publications have used semiotic concepts to account for the therapist's non‐verbal communication and investigated the countertransference, including what the baby might grasp of its variations. The present paper focuses on another argument for using verbal interventions to a baby in therapy; they present him with a symbolic order that differs from that of the parent. The qualitative difference between the parent's and the analyst's address is conceptualized by Dolto's term parler vrai. The therapeutic leverage is not the analytic interventions' lexical content but their message that words can be used to expose conflicts. Thereby, one can transform warded‐off desires into demands that can be negotiated with one's objects. The reasons why this address catches the baby's attention are discussed. A prerequisite for such attention is that the infant brain is prewired for perceiving words as a special communicative mode. Relevant neuroscientific research is reviewed in regard to this question. The presentation relies on concepts by Dolto, Lacan and Winnicott and findings from neuroscience and developmental psychology. It also briefly discusses Chomsky's linguistic concepts in relation to these therapies.     

Maternal sensitivity behavior and infant behavior in early interaction

Maternal sensitivity behavior and infant behavior in early interaction were investigated among 57 Finnish mother–child pairs. Their interaction was video‐recorded at home in free‐play situation when the infants were 3 months and 12 months of age, and evaluated using the Parent–Child Early Relational Assessment Scale (PCERA). Maternal sensitivity behavior was mainly related to infant's positive aspects of mood, social and play behavior, and visual contact, both at 3 months and 12 months of age. Even though maternal sensitivity behavior correlated to infant behavior at 3 months and 12 months, infant behavior at 3 months of age contributed to later maternal sensitivity behavior. ©2001 Michigan Association for Infant Mental Health.     

Six‐month follow‐up of two mother–infant psychotherapies: Convergence of therapeutic outcomes

Fifty‐eight mothers and infants participating in two infant–mother psychotherapeutic interventions in a comparative infant–mother clinical intervention study were followed six months after treatment ended. One treatment was an infant‐led psychotherapy, Watch, Wait, and Wonder (WWW). The other was a more traditional mother–infant psychodynamic psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately five months. Results indicated that positive effects observed from the beginning to the end of treatment in both treatment groups in infant symptoms, parenting stress, and mother–infant interaction were maintained or improved further at six‐month follow‐up. Additionally, decreased maternal depression, gains in infant cognitive development and emotion regulation, and improved infant–mother attachment security or organization had been observed posttreatment only in the WWW group. Interestingly, between the posttreatment to follow‐up period the PPT group also showed such gains. Thus, for these variables it would be more accurate to say that the outcomes were similar for the two treatment groups but change emerged at a different pace. Nevertheless, an advantage persisted in the WWW group in relation to mothers' comfort dealing with infant behaviors and their ratings of parenting stress which improved more in this group from the end of treatment to follow‐up. The direct inclusion of the infant as an initiator in WWW was set forth as an explanation of differentially timed treatment effects. ©2002 Michigan Association for Infant Mental Health.     

Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features,maternal mental state,and observed interaction

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother–infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother–infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self-as-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother–Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother–infant interaction. Implications for research and clinical practice are discussed.     

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.     

Evaluation of a Parent‐Based Intervention for At‐Risk Adolescents

This study evaluated the effectiveness of a parent‐based intervention, the Parent Project, among 84 parents of at‐risk youth. Results indicated improvements in child management, family involvement, parent–child affective quality, substance use rules communication, and parental self‐efficacy at a 10‐week follow‐up.     

The significance of reflective supervision for infant mental health work

Parent–infant work is inherently relational and occurs in the intersubjective space between parent, infant, and worker. This space can be charged with primitive, unmet needs of both parent and infant, and this in turn can trigger these same states in the worker. The challenge for workers is to remain open to being affected by and responsive to these feeling states when their own early and possibly preconscious responses and coping strategies are being stirred. If these remain out of awareness, they can manifest as avoidance and denial, and this can be reflected in the system and result in limited service delivery. This article emphasizes the significance of reflective supervision for parent–infant work and suggests that it needs to be an integral part of the system of service delivery. I am grateful to the infant mental health workers who allowed me to use examples of their work in this article, and thank Dr Jon Jureidini for his encouragement and support.     

Synchrony in the Triad: A Microlevel Process Model of Coparenting and Parent‐Child Interactions

Guided by a microanalytic approach to the study of relationships, we assessed parent, infant, and coparental behaviors during triadic interactions in 94 parents and their 5‐month‐old firstborn child. Relational behaviors in each family subsystem—mother‐infant, father‐infant, and coparenting—were microcoded. Marital satisfaction and infant temperament were self‐reported. No differences were found in the infants' behavior toward mother and father or in the time spent with each parent. Mothers' and fathers' relational behavior during parent‐infant episodes were generally comparable, yet mothers vocalized more and the latency to father's displaying positive affect was longer. Conditional probabilities indicated that under conditions of coparental mutuality, fathers showed more positive behaviors than mothers. Lag‐sequential analysis demonstrated that change in the infant's social focus between parents followed change in coparental behavior. Fathers' coparental mutuality was independently predicted by maternal behavior during mother‐child episodes, father marital satisfaction, and infant difficult temperament, whereas mothers' coparental mutuality was only linked with fathers' relational behavior. Results highlight the importance of including a microlevel perspective on the family system at the first stages of family development.     

Mothers' and fathers' speech to infants in a teaching situation

The purpose of this study was to compare mothers' and fathers' speech to their preverbal infants in a teaching situation. Thirty-two parents of 16 8-month-olds were asked to teach their infants to put a small cube into a cup. Infant Gender (2) x Birth Order (2) x Parent (2) analyses of variance were performed with repeated measures on parent. Results indicated that fathers issued more utterances and used more words per utterance than did mothers. Although there was no difference in the proportion of imperatives used by mothers and fathers, fathers' imperatives were significantly longer than mothers'; this difference was not evident for utterances that contained indirect instructions. Mothers tended to use more exact repetitions. There were differences in parental speech related to infant gender: Parents directed more utterances, particularly utterances that contained negative statements, imperatives, and exhortations, to girls than to boys. Infant Gender x Parent effects for imperatives and exhortations indicated that these differences were especially true for fathers. Overall, it appeared that fathers made greater efforts to control the situation and to direct their infants' behavior, which might have reflected mothers' and fathers' different perceptions of both their infants' ability and their own role as teachers.     

Videotaping as a therapeutic tool in psychodynamic infant– parent therapy

This paper describes an infant–parent therapy technique that involves the videotaping of the sessions, with subsequent reviewing and discussion with the mother. The technique has been designed as a part of psychodynamic therapeutic work with infant–parent dyads. It is based on a concept of the centrality of maternal past and current experience and associated representations in the pathogenesis of the relational pathology. Videotape replay provides an accelerated access to early maternal memories and promotes enlightening awareness of the links between maternal past experience and present behaviors with her child, which can lead to insight and therapeutic change. The technique advances the development of the therapeutic alliance and thus facilitates successful use of other dyadic treatment modalities that can be used along with psychodynamic therapy. It lessens maternal feelings of being criticized by a therapist and, therefore, can be helpful when the maternal ability to develop a trusting relationship with a therapist is of particular concern. Pertinent theoretical and practical issues are discussed. The method is illustrated by excerpts from therapeutic work with a six‐month‐old boy and his mother. © 2000 Michigan Association for Infant Mental Health.     

Short‐term psychodynamic infant–parent interventions at Child health centers: Outcomes on parental depression and infant social–emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent–infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short‐term Psychodynamic Infant–Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social–Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers’ questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect‐sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.