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.     

A slow unfolding – at double speed: reflections on ways of working with parents and their young children within the Tavistock clinic's under fives service

This paper describes clinical work carried out as part of the Tavistock Clinic Under Fives Service, which offers brief focused psychoanalytically based interventions to families with young children, as well as longer-term work. It elaborates psychoanalyst Annette Watillon's idea that it is the dramatic way in which children enact their (and their family's) predicament in the consulting room which speeds up the process of change. The author clusters clinical cases into three categories, each cluster representing a different kind of ‘dramatic’ enactment and leading to a different kind of intervention relating to the therapist's role, the structure of the interventions and the ‘ports of entry’ for the work. The categories are defined as: ‘child-led drama’ with the therapist in the role of ‘therapeutic observer’; ‘internal parental drama’ with the therapist in the role of ‘therapeutic consultant’; and ‘external parental drama’ with the therapist in the role of ‘therapeutic modulator’. The author defines these categories, illustrating each category with clinical examples.     

Immediate Effect of Training at the Onset of Reaching in Preterm Infants: Randomized Clinical Trial

The authors' aim was to investigate the immediate effect of a single specific training session (serial varied practice), of short duration on the kinematic parameters of reaching, in the period of the emergence of the skill in preterm and low birth weight infants. The study included 16 infants of both sexes, born at a mean gestational age of 32.13 (±1.36) weeks and mean birth weight of 1720.94 (±358.46) g. The infants were randomly divided into 2 groups: experimental and control. The experimental group was given a 5-min training session in reaching, while the control group received no training. The results showed significant differences in peak velocity in the intra (Z = –2.10, p = .036) and intergroup (U = 9.00, p = .016) evaluations, which decreased in the experimental group after training. Cohen's d test for clinical relevance suggested that the specific, short duration training proved effective in promoting slower reaches, with greater adjustment and lower number of units of movement. These results are positive for preterm infants given that these parameters more closely resemble the typical development of mature reaching behaviors in term infants, which suggests that this protocol of reaching training (serial varied practice) could be used as an evidence-based intervention strategy.     

Tonal synchrony in mother–infant interaction based on harmonic and pentatonic series

This study reports the occurrence of ‘tonal synchrony’ as a new dimension of early mother–infant interaction synchrony. The findings are based on a tonal and temporal analysis of vocal interactions between 15 mothers and their 3-month-old infants during 5 min of free-play in a laboratory setting. In total, 558 vocal exchanges were identified and analysed, of which 84% reflected harmonic or pentatonic series. Another 10% of the exchanges contained absolute and/or relative pitch and/or interval imitations. The total durations of dyads being in tonal synchrony were normally distributed (M = 3.71, SD = 2.44). Vocalisations based on harmonic series appeared organised around the major triad, containing significantly more simple frequency ratios (octave, fifth and third) than complex ones (non-major triad tones). Tonal synchrony and its characteristics are discussed in relation to infant-directed speech, communicative musicality, pre-reflective communication and its impact on the quality of early mother–infant interaction and child's development.     

关于低出生体重儿生长模式的思考

低出生体重儿发生率是衡量社会发展和妇幼保健状况的重要指标。低出生体重不仅直接增加新生儿死亡率和儿童早期的患病率,而且与儿童的远期预后密切相关。本文从低出生体重儿的生长特点、生长追赶的利弊以及营养管理等方面,探讨适于低出生体重儿的最佳生长模式,以求改善这一特殊群体的近期健康和远期生活质量。     

Categorization and understanding of facial expressions in 4‐month‐old infants

This study examined whether 4‐month‐olds (N = 40) could perceptually categorize happy and angry faces, and show appropriate behavior in response to these faces. During the habituation phase, infants were shown the same type of facial expressions (happy or angry) posed by three models, and their behavior in response to those faces was observed. During the test phase immediately after the habituation phase, infants saw a novel emotional expression and a familiar expression posed by a new model, and their looking times were measured. The results indicated that, although 4‐month‐olds could perceptually categorize happy and angry faces accurately, they responded positively to both expression types. These findings suggest that, although infants can perceptually categorize facial expressions at 4 months of age, they require further time to learn the affective meanings of the facial expressions.     

Emergence of amae crying in early infancy as a possible social communication tool between infants and mothers

Amae is defined as “wishing to be loved (Scheidlinger (1999). The Journal of the American Academy of Psychoanalysis, 27(1), p. 91)”. Amae crying is known as crying of infants when seeking intimate emotional communication with caregivers. The objective of this study was to delineate when and how amae crying emerges in early infancy. Crying episodes of four infants were observed bimonthly, in the natural context of their homes, from birth to 6 months of age, for approximately 60 min per session. Crying episodes (total = 275) as determined by two coders were analyzed with respect to several behavioral measures. Results indicated that amae crying emerged at the age of 2 months, and consistently accounted for 30–40% of the total crying episodes after the ages of 3 months. Amae crying could be accurately identified when infants were not in acute discomfort and had already got the attention of their mothers. At such times, infants did not shed tears, cried with a fussy voice, and frequently looked at their mothers. Mothers responded to amae crying more promptly than they did to other types of crying behaviors. It is concluded that 3 months of age, when infants probably begin to use crying as a social communication tool is a major turning point for crying behavior from the perspective of its biological and social roles. It is suggested that amae crying might play an important role in strengthening and encouraging mother–infant interactions.     

Dyadic co-regulation,affective intensity and infant's development at 12 months: A comparison among extremely preterm and full-term dyads

Extremely low gestational age children (ELGA, born below 28 weeks of GA) represent the most at-risk preterm group in terms of survival, developmental sequelae and rates of impairment and cognitive delays. However, the impact of an extremely preterm birth on mother–infant co-regulation and affective intensity which may affect early infant's development has not been investigated. Based on a relational dynamic system approach, our study aimed to investigate the quality of co-regulation and affective intensity during spontaneous play interaction in 20 mother–infant ELGA dyads compared to 20 full-term (FT) dyads at 12 months (corrected age for ELGA infants). Relationships between the quality of dyadic co-regulation and the infant's level of cognitive, motor and language development were also investigated. The quality of dyadic co-regulation was assessed using the Revised Relational Coding System (R-RCS) by Fogel et al. (2003), the mothers’ and infants’ affective intensity was coded using a coding system by Lunkenheimer, Olson, Hollenstein, Sameroff, and Winter (2011). Infants’ development was assessed using the Bayley Scales (BSID-III, 2006). With respect to FT dyads, ELGA dyads were characterised by less frequent symmetric and more frequent unilateral co-regulation patterns and by less positive and more neutral affective intensity of both infants and mothers. Cognitive, motor and language scores were lower in ELGA infants than in FT infants. Symmetrical co-regulation was related to motor scores in ELGA infants, and to cognitive scores in FT infants. Our findings contribute to the literature by demonstrating the difficulties of ELGA mother–infant dyads at 12 months in sharing the symmetric co-regulation and positive affective intensity and how symmetric co-regulation is strictly related to motor development in ELGA infants. Based on these findings, intervention programmes to foster joint attention, active involvement and positive affective intensity in ELGA dyads and infants’ development in the first year of life should be designed.     

A dynamic system analysis of dyadic flexibility and stability across the Face-to-Face Still-Face procedure: Application of the State Space Grid

The Face-to-Face Still-Face (FFSF) paradigm allows to study the mother–infant dyad as a dynamic system coping with social stress perturbations. The State Space Grid (SSG) method is thought to depict both flexibility and stability of the dyad across perturbations, but previous SSG evidence for the FFSF is limited. The main aims were: (1) to investigate mother–infant dyadic flexibility and stability across the FFSF using the SSG; (2) to evaluate the influence of dyadic functioning during Play on infant Still-Face response and of infant stress response in affecting dyadic functioning during Reunion. Forty 4-month-old infants and their mothers were micro-analytically coded during a FFSF and eight SSG dyadic states were obtained. Dyadic flexibility and attractor states were assessed during Play and Reunion. Infants’ stress response was coded as negative engagement during the Still-Face episode. Two dyadic states, “maternal hetero-regulation” and “affective mismatch”, showed significant changes in the number of visits from Play to Reunion. During Play “maternal positive support to infant play” emerged as attractor state, whereas during Reunion a second attractor emerged, namely “affective mismatch”. Dyadic affective mismatch during Play correlated with infants’ negative engagement during Still-Face, whereas infants’ response to Still-Face resulted in minor social matching during Reunion. Findings provide new insights into the flexible, yet stable, functioning of the mother–infant dyad as a dynamic system. Evidence of a reciprocal influence between dyadic functioning and infant social stress response are discussed.