Using parent-infant dyads as models for interpreting the parallel process

Studies indicate that parents replicate with the therapist the behaviors and perceptions they experience with their infants. During parent-infant therapy, the therapist may validate perceptions by comparing the parent's behaviors with verbal disclosures. A similar phenomenon occurs in psychotherapeutic supervision. Therapists in training tend to replicate with the supervisor the interactions of their patients, a phenomenon labeled parallel process.This paper suggests that parent-infant interaction may provide insight into the therapistpatient and therapist-supervisor relationships. Understanding the parallel process that occurs during parent-infant therapy may help the therapist explore the patient's perceptions and resolve conflict.     

Subjectivity in parent-infant relationships: A discussion of internal working models

Bowlby (1969/1982, 1973, 1980) has proposed that internal working models of self and other are psychic structures that guide an individual's subjective experience of and responses to others in important relationships. They are termed “working” models because they are believed to be dynamic mental representations that are modifiable, although they are presumed to become more resistant to change after the early years. This paper reviews Bowlby's construct of internal working models, including some recent empirical evidence usefully explained by the construct. The authors apply the construct of working models to parents' subjective experiences of their infants and review some preliminary evidence that suggests that parental working models of their infants are present even prior to the infants' birth and influence the parents' perception and interpretation of the infants' characteristics and behaviors. The authors then consider the development of infants' working models of self and other in the context of parental attributions. They conclude that subjectivity in parent-infant relationships is an exciting and promising area for investigation, although, at present, future progress is limited by problems of measurement. A brief discussion of directions for future research is included.     

Interventions with video feedback and attachment discussions: Does type of maternal insecurity make a difference?

Parents' insecure representations of attachment are associated with lower parental sensitivity and insecure infant–parent attachment relationships, leading to less optimal conditions for the children's socio-emotional development. Therefore, two types of short-term intervention were implemented in a group of lower middle-class mothers with an insecure representation of attachment as assessed with the Adult Attachment Interview. In one group of mothers, the intervention efforts were directed at promoting maternal sensitivity by means of written information about sensitive parenting and personal video feedback. In the other group, additional discussions about the mothers' early attachment experiences took place, aiming at affecting the mothers' attachment representation. The interventions were implemented during four home visits between the 7th and the 10th month after the baby's birth. Preliminary results on 30 mothers pointed at an intervention effect: Mothers in both intervention groups were more sensitive at 13 months than mothers in a control group, t(28) = −2.3, effect size d = .87, p = .01. Mothers who were classified as insecure dismissing tended to profit most from video feedback, whereas mothers who were classified as insecure preoccupied tended to profit most from video feedback with additional discussions about their childhood attachment experiences, F(1,16) = 1.9, d = .65, p = .19. © 1998 Michigan Association for Infant Mental Health     

Conceptual and methodological issues in the study of Internal Representation: A commentary on Infant Mental Health Journal,volume 10.3

This commentary raises issues about the current state of research on internal representation, using the Special Issue of the Infant Mental Health Journal on “Internal Representation and Parent-Infant Relationships” as a point of departure. Current research is praised for its emphasis on subjectivity and intersubjectivity in relationships, for integrating viewpoints from a variety of disciplines, and for the development of innovative investigatory approaches. At the same time, however, an overemphasis on quantitative methods is cited as possibly raising the risk of prematurely limiting an investigation of these issues that is broad-based enough to reflect their intricacy in actual experience. Instead, a more varied approach is sought, in which operationalizability is viewed as one of many potential sources of methodological validity rather than as the most important one. More purely clinical and theoretical approaches are particularly appropriate to the study of internal representation and intrafamilial relationships because access to personal, interior experience must rely on such forms as language and the techniques of clinical inquiry.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

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).     

Rrepresentations of trauma in infancy: Clinical and theoretical implications for the understanding of early memory

Understanding the nature of the infant's internal experience is a crucial prerequisite for delineating the developmental effects of an early trauma. In addition, to the extent that internal representations of a trauma can be traced over time, traumatic experiences present unique opportunities for the study of early memory. This article will describe case vignettes of children who experienced a trauma in the preverbal period and who evidenced forms of memory of their trauma at subsequent points in time. In conjunction with the clinical material, developmental research bearing on the types of early memories described will be discussed. The clinical data, reinforced by research findings, indicate that preverbal children, even in the first year of life, can establish and retain some form of internal representation of a traumatic event over significant periods of time. The specificity and enduring nature of the internal representations suggest that specific therapeutic interventions over and above general comforting will be required if an infant is to maximally recover from a trauma. The clinical findings have relevance for a number of issues currently under debate in the area of infant memory, including the role of reminders in memory retention, the nature of early memory systems, and the development of autobiographical memory. ©2002 Michigan Association for Infant Mental Health.     

Dysregulated Motherhood: Exploring the Risk Features in a Mother’s Caregiving Representations

In the case of a mother with dysregulating attachment experiences and current enrolment in a parent-infant psychotherapy process, we explored which insecure, hostile/helpless, and prementalizing risk features were similar in her attachment and caregiving representations; which risk features were specific to her caregiving representations; and how these theory-defined features overlapped in detecting caregiving risks. Risk features in the attachment representations were assessed from the adult attachment interview and risk features in the caregiving representations from written psychotherapy notes. We found similar insecure (preoccupied and disorganized), prementalizing and hostile/helpless instances from both the attachment and the caregiving representations. However, confusion between self and child, greater variance in lapses into prementalizing, and specific and concrete fears and helplessness were unique to the caregiving representations. Hostile/helpless instances were found in tandem with almost all insecure and prementalizing instances, indicating this conceptualization captured risks in the caregiving representations most comprehensively. Fearful and helpless caregiving representations occurred somewhat independently from other risk conceptualizations, suggesting they need to be identified as independent phenomena. The results imply that detecting specific manifestations of intergenerational risks from caregiving representations is possible.     

Relationship disruption stress in human infants: a validation study with experimental and control groups

The current study examined whether the psychological stress of the still-face (SF) task (i.e. stress resulting from a parent's unresponsiveness) is a valid laboratory stress paradigm for evaluating infant cortisol reactivity. Given that factors external to the experimental paradigm, such as arriving at a new place, may cause an elevation in cortisol secretion; we tested the hypothesis that infants would show a cortisol response to the SF task but not to a normal FF task (control). Saliva was collected for cortisol measurement from 6-month-old infants (n?=?31) randomly assigned to either a repeated SF task or to a continuous FF task. Parent-infant dyads were videotaped. Salivary cortisol concentration was measured at baseline, 20, and 30?min after the start of the procedure. Infant salivary cortisol concentrations showed a significant increase over time for the SF task but not for the FF task. The results provide new evidence that the repeated SF task provides a psychological challenge that is due to the SF condition rather than to some non-task related factor; these results provide internal validity for the paradigm. The study offers new insight into the role of parent-infant interactions in the activation of the infant stress response system.     

Relations between dynamics of parent-infant interactions and baseline EEG functional connectivity

Parent-infant interactions are one of the most critical and enduring aspects of infants’ experience. Qualities of parent-infant interactions are related to social-emotional and cognitive developmental outcomes, yet how parent-infant interactions shape the functional organization of the brain is only beginning to be understood. Functional connectivity provides information about how brain regions communicate. Patterns of functional connectivity, thus far understudied in infants, have emerged as markers of abnormalities in the organization of the brain in at-risk infants as well as individuals with neurodevelopmetnal and neurodegenerative disorders. The current study sought to inform our understanding of relations between qualities of parent-infant interactions and functional connectivity. We report relations between responsiveness, reciprocity, and emotional tone and functional connectivity in theta, alpha, beta, and gamma in infants ranging from 6 to 11 month of age (N = 51). Results showed frontal-posterior connectivity in theta was inversely related to all three dimensions of parent-infant interactions. Gamma and alpha connectivity were positively associated with responsiveness and emotional tone, respectively. Results are discussed in the context of the experience-dependent nature of brain development, emphasizing how parent-infant interactions might be leveraged to structure early organization of the brain to foster healthy social-emotional and cognitive developmental outcomes.     

Relationship assessment in infant mental health

Infant-caregiver relationships are the crucial context for infant development and psychopathology. Considerable evidence suggests that infants may construct qualitatively different relationships with different caregivers. For these reasons, infant-caregiver relationships should be a centerpiece of assessment in infant mental health. We advocate assessing infant relationships with all important caregivers in both clinic based and naturalistic settings. In this article we describe our approach, which attends both to the external component of the relationship, behavioral interaction, as well as the internal component of the relationship, subjective experience. By integrating results from assessments of these two components, we determine both level of relationship adaptation and the specific domains of strengths and weaknesses. © 1997 Michigan Association for Infant Mental Health     

The effects of traumatic experiences on the infant–mother relationship in the former war zones of central Mozambique: The case of madzawde in Gorongosa

This article addresses the ways in which years of war and periods of serious drought have affected the cultural representations of the populations in Gorongosa District, Mozambique. In the wake of these events different cultural and historical representations have been disrupted, leaving the members of these communities with fragmented protective and resilience factors to cope effectively. Emphasis is placed on the disruption of madzawde, a mechanism that regulates the relationship between the child (one to two years of life) and the mother, and the family in general. The war, aggravated by famine, prevented the populations from performing this child‐rearing practice. Nearly a decade after the war ended, the posttraumatic effects of this disruption are still being observed both by traditional healers and health‐care workers at the district hospital. The results suggest that this disruption is affecting and compromising the development of the child and the physical and psychological health of the mother. An in‐depth understanding of this level of trauma and posttraumatic effects is instrumental in making a culturally sensitive diagnosis and in developing effective intervention strategies based on local knowledge that has not been entirely lost but is nonetheless being questioned. ©2003 Michigan Association for Infant Mental Health.     

The child as held in the mind of the mother: The influence of prenatal maternal representations on parenting behaviors

Using a longitudinal design, this study examined the relationship of a mother's prenatal representation of her child and her parenting behavior with that child at 1 year of age in a sample of women who were either exposed or not exposed to intimate partner violence (IPV) (N = 164; M child age = 1.1 years, SD = .11 years; 52% male). Controlling for prenatal IPV, a MANCOVA analysis revealed that prenatal representational typology was significantly related to parenting behavior 1 year postpartum. Mothers whose representations were affectively deactivated (disengaged) were more behaviorally controlling with their children. Mothers whose representations were affectively overactivated (distorted) were more hostile with their children. Mothers with balanced representations demonstrated more positive parenting. Exposure to IPV did not moderate this relationship. There was no direct association between prenatal or postnatal IPV and parenting behavior. These findings suggest that prenatal representations influence postnatal parenting behavior in significant and theoretically consistent ways and that this relationship functions similarly for both abused and nonabused women. Results add to the growing literature that internal representations serve to guide behavior throughout development and suggest that maternal working models may be one important link in the intergenerational transmission of attachment relationships.     

On Attachment to Internal Objects

This paper considers some clinical implications of attachment theory from the perspective of the theory of internal object relationships and the unconscious phantasies that derive from such relationships. The paper focuses on the contributions of Bowlby and his followers, particularly Mary Main, who has developed a language-based methodology to study representational processes in adults and children, bridging the gap between the systematic study of human behavior and clinical psychoanalysis. The theory of inherent role responsiveness in the internal object world—mental representations of self and other in interaction and externalized in complementary role relationships through exchanges of unconscious and conscious messages—is presented as the psychoanalytic complement of Bowlby's theory of internal working models of attachment. Role responsiveness occurs internally as well as externally, so that one can speak of attachment to phantasy objects as well as external objects. Clinical examples illustrate how the therapist, through maintaining a free-floating responsiveness to the patient's enactments, may reconstruct the internal working models of attachment and their origins in the transference. The paperthus illustrates the way in which the origins of phantasy derive from the wished for and feared states related to early experiences of felt security, or lack of it, in relation to the attachment objects, thereby integrating the psychoanalytic theory of phantasy with attachment theory.     

The impact of words on children with ADHD and DAMP Consequences for psychoanalytic technique

Children with attention-defi cit/hyperactivity disorder (ADHD) and disorder of attention, motility control, and perception (DAMP) are often sensitive to the analyst's interventions. This is not always due to the literal import of the intervention. The children sometimes react as if the words were dangerous concrete objects, which they must physically fend off. The author traces this phenomenon to the child's unstable internal situation. A bad, un-containing internal object is easily awakened and threatens to expel the analyst's words independently of their content. This results in violent clinical situations. Infant research and psychoanalytic work with infants and mothers evince how a complex semiotic process develops between mother and baby. The prerequisite for this process to get started and maintained is a secure external object, which gradually is internalized. Findings from developmental research and clinical infant work are used to illuminate analytic work with children with ADHD and DAMP. Vignettes demonstrate how important it is for the analyst to phrase interpretations after having gauged the state of the analysand's internal object as well as his/her own countertransference. If this is overlooked, the psychoanalytic dialogue easily capsizes. The author provides some technical recommendations on the psychoanalysis of these children. As part of the theoretical discussion he raises the general question of how the representations, which the baby forms in interaction with the mother, and the analysand forms in interaction with the analyst, should be classifi ed. Rather than dividing them into bipartite thing- or word-presentations (Freud), the author suggests C. S. Peirce's tripartite semiotic classifi cation in that the baby forms representations of icons, indices, and symbols.     

Searching for Positive Aspects of Excessive Reassurance-Seeking

We investigated positive aspects of excessive reassurance-seeking in interpersonal relationships. Previous studies have emphasized that excessive reassurance-seeking leads to interpersonal rejection by significant others. However, Fowler & Gasiorek (2017) suggested that excessive reassurance-seekers tend to make efforts to maintain relationships with their romantic partners, and that these efforts affect their own satisfaction with the relationships. We investigated whether the findings of Fowler and Gasiorek in students could be replicated in general heterosexual couples (N = 437 couples). Data were analyzed using the modified actor–partner interdependence model. Results indicated that excessive reassurance-seeking had no actor or partner effects on the efforts to maintain the relationships, which predicted relational satisfaction. However, the actor and partner effects of excessive reassurance-seeking on relational satisfaction through the efforts to maintain the relationships differed according to the relational duration. These findings, despite certain inconsistencies with Fowler and Gasiorek, suggest that excessive reassurance-seeking might have positive effects on relationships.     

Children's internal representations,empathy, and fantasy play: a validity study of the SCORS-Q

The authors investigated relationships among internal representations, empathy, and affective and cognitive processes in fantasy play to test the validity of the Social Cognition and Object Relations Scale Q-Sort (SCORS-Q; D. Westen, 1995) with children. Eighty-six 8-10-year-olds were administered 8 Thematic Apperception Test cards, a standardized play task, and a self-report empathy measure. Teachers rated children's empathy and helpfulness. As predicted, internal representations were related to empathy, helpfulness, and quality of fantasy play. Developmental differences on the SCORS-Q were consistent with object relations theory and with results from the original SCORS. The findings support the value of internal representations as a means of understanding children's interpersonal functioning and contribute to the validity of the SCORS-Q for use with children.     

Dyadic synchrony in parent–child interactions: A link with maternal representations of attachment relationships

The study examined the relation between maternal representations of attachment relationships from childhood and current parent–child interactions with their own preschool aged children. Thirty-six mother–child dyads were recruited from a community sample. The Adult Attachment Interview was converted into a questionnaire (AAIQ) and used to classify mothers as either “secure” or “insecure.” The mother–child dyads then engaged in a 20-min, videotaped play interaction task. The quality of maternal representations of attachment relationships was related to the degree of dyadic synchrony, as well as maternal affect and style of relating. Secure mothers and their children engaged in a more fluid, synchronous process of give-and-take than insecure mothers and their children. In addition, secure mothers expressed more warmth and affection, and their style of relating was less intrusive and more encouraging of child autonomy than insecure mothers. Children of secure mothers sought closer contact and were more compliant than children of insecure mothers. These interaction patterns were uniquely related to maternal representations of attachment, independent of maternal age, education and SES. There were no differences in these patterns of relating between mothers who had experienced loving relationships in childhood (continuous secure) and mothers who had come to terms with unloving and painful childhood relationships (earned secure). Therefore, rather than the quality of childhood histories, it was the manner in which these early experiences were mentally organized and integrated in adulthood that was significantly related to current parent–child interaction patterns. Finally, these differences in parent–child interaction patterns that were apparent on the observational measure were in contrast to information obtained from a maternal self-report measure. © 1997 Michigan Association for Infant Mental Health     

Inhibition of Internal Attention to Positive and Negative Representations in Dysphoria

We developed the Internal–External Attention‐Switching Task, which measures the ability to inhibit internal attention and the ability to remove inhibition of internal attention. The Internal–External Attention‐Switching Task was administered to a sample of dysphoric and non‐dysphoric undergraduate or graduate students (N = 44). Difficulty in both inhibition of internal attention to negative representation and removal of this inhibition were shown to be general. Importantly, however, dysphoric individuals could not maintain internal attention or remove inhibition of internal attention to positive representations as easily as non‐dysphoric individuals could. Therefore, reduced attention to positive representations in dysphoric individuals may enable maintenance of their depressive mood.