RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS

There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship

New Beginnings for mothers and babies in prison: a cluster randomized controlled trial

Mothers in prison represent a high-risk parenting population. New Beginnings is an attachment-based group intervention designed specifically for mothers and babies in prison. This cluster randomized trial examined the outcomes for 88 mothers and babies participating in the New Beginnings program and 75 dyads residing in prisons where the intervention did not take place. Outcomes were measured in terms of parental reflective functioning, the quality of parent-infant interaction, maternal depression, and maternal representations. Mothers in the control group deteriorated in their level of reflective functioning and behavioral interaction with their babies over time, whereas the mothers in the intervention group did not. There were no significant group effects on levels of maternal depression or mothers' self-reported representations of their babies over time. An attachment-based intervention may mitigate some of the risks to the quality of the parent-infant relationship for these dyads

A psychotherapeutic baby clinic in a hostel for homeless families: practice and evaluation

A pilot baby clinic in a hostel for homeless families has been established to address the specific attachment and developmental needs of infants living in temporary accommodation. The aim of this study was to assess whether this clinic model was associated with more positive outcomes than mainstream community services in terms of infant development and parent-infant interactions

New beginnings: A time-limited, group intervention for high-risk infants and mothers

‘New Beginnings’ (NB) is a structured, manualized program that addresses the mother–baby relationship within a group format. The program, developed at the Anna Freud Centre (Baradon, 2009, 2013), works with the nuanced, cross-modal emotional interactions between mother and infant, tracking attunement and communication errors and emphasizing interactive repair. To this purpose, open (non-defended) and genuine transactions are privileged, confounding intergenerational transference expectancies of rejection and shaming by a ‘bad’ world in which the individual is not seen as a worthwhile person. NB aims to increase mentalization in relation to self, baby, and the relationship between them (Baradon, with Biseo, Broughton, James, & Joyce, 2016). This takes place via the content of sessions, group processes (between the adults, adults and babies and the baby-group) and personalization of the program. A reopening of epistemic trust – trust in the authenticity and personal relevance of interpersonally transmitted knowledge (Fonagy, Luyten, & Allison, 2015) – is seen as the product of the above, and the vehicle for the socialization of the babies into a more benign social context. This chapter will begin by setting out the basic structure and aims of the program, before going on to explain how the program was developed, how the program runs and its theoretical foundations in attachment and mentalizing. We will then describe how NB has thus far been evaluated, and will finish with a more detailed account of the implementation of the program

Development of atypical parental behavior during an inpatient family preservation intervention program

Since failed reunification is a detrimental outcome for children, particularly infants and toddlers, the aim of this study was to gain insight into support to families in multiple-problem situations to help them achieve sustainable good-enough parenting. Therefore, we examined outcomes of an assessment-based inpatient family preservation program. We prepared a thorough target-population description (n = 70) using file analysis. Next, we examined atypical parental behavior during the intervention using the Atypical Maternal Behavior Instrument for Assessment and Classification with a repeated measures design (n = 30). The family files revealed a great number of issues at the family, parent, and child levels, such as practical matters, problems in parent functioning and between parents, and difficulties in the broader environment. We found a significant decline in three dimensions of atypical parental behavior over time. This program has great potential in supporting vulnerable families in their pursuit of family preservation

‘What support would you find helpful?’ The relationship between treatment expectations, therapeutic engagement and clinical outcomes in parent-infant psychotherapy

The aim of this study was to investigate the impact of pre-treatment expectations on clinical outcomes and engagement in Parent-Infant Psychotherapy (PIP). Sixty-one mothers who were experiencing mental health difficulties and who were receiving PIP with their young infants participated in the study. A mixed-methodology was used to examine participants’ expectations through transformation content analysis of pre-treatment interviews; recurring themes were classified and quantified. Further statistical analyses explored relationships between the quantified themes of parental expectations and clinical outcomes and engagement in treatment. No significant correlation was found between expectations and engagement. One of the six clinical outcomes significantly correlated with parental expectations. Improved reflective functioning (RF) was predicted by participants describing expectations of wanting to improve their parent-infant relationship through the treatment, and expressing concerns about discussing their past experiences. These two expectations predicted improvements in RF independently and when combined. These results indicate that PIP may be more effective for some mothers than others and that assessing future clients’ expectations before beginning PIP may be beneficial