Mental health articles

Application to infant–parent interventions Attachment theory grew and developed out of ideas and observations arising
from both the internal world (psychoanalytic theory) and what can be observed
and measured (developmental psychology, ethology). Similarly, infant–parent
therapies can be understood as working across both the domains of observed
behaviours and interactions between infant and parent, and their existing and
developing ‘internal representation of relationships’.
Fraiberg, Adelson and Shapiro’s (1975) seminal paper ‘Ghosts in the
Nursery’ outlined an approach to disturbances in early relationships based on
the assumption that such difficulties are manifestations in the present of
unresolved parental conflicts, usually with their caregivers. To protect herself
from experiencing or re-experiencing distress or trauma, the caregiver restricts
her attention and reflection both on her own inner state and on that of her infant.
This leads to restrictions in responsiveness to the infant, which Fraiberg (1980)
proposed were amenable to interventions focused on what was observed
between, but going on inside, both members of the dyad.
Attachment-based, infant–parent therapy has been significantly developed
and researched by Alicia Lieberman and her colleagues (Lieberman & Zeanah,
1999).
Another significant approach to work with the infant–parent dyad, and
informed by both psychoanalytic ideas and attachment theory, is the ‘Watch,
Wait and Wonder’ program. This intervention emphasises the infant as an active
participant in the interaction, current difficulties and the process of change,
moving away from Fraiberg’s original notion of the infant as a stimulus or
catalyst for psychological change in the parent.
The therapy ‘allows the infant his own therapeutic space through enabling him, in the presence of his mother, to play and/or act out his own concerns’
(Muir, Lojkasek & Cohen, 1999, p. 16). The parent is asked to sit with and
‘follow’ the infant’s lead in interaction and play. This is a way of instructing the
parent in aspects of providing a secure, responsive base for the child. The
structure of the therapy sessions provides time for the parent and therapist to
reflect on what has happened during the session and potentially to make links
between the behaviour of the infant with the parent, the parents’ responses and
their own inner world of feelings and memories (Muir et al., 1999).
Daniel Stern (1985, 1995) has elaborated a theory of self-development based
on data from infant research rather than clinical observation. His work includes
the notion of ‘internal working models’ of relationships and schemata to describe
‘ways of being with’ that begin and are encoded in our earliest relationships.
This overlaps with and expands ideas emerging from attachment theory and
research.
In his book The motherhood constellation: A unified view of parent–infant
psychotherapy, Stern (1995) articulates a range of approaches to infant–parent
intervention, variously focusing primarily on behaviour (McDonough’s
Interaction Guidance) or on internal working models of relationships (Parent
Infant Psychotherapy). He concludes that at this highly fluid life stage (infancy
and early parenthood), interventions with a focus on either observed behaviour
between infant and parent or internal representations and the parental past will
be effective in changing experience and behaviour. He also summarises
commonalities in approaches to parent–infant work.
Further examination of a range of approaches to parent–infant relationship
problems, all informed to some extent by attachment theory, is provided in
Sameroff, McDonough and Rosenblum (2004).

Tags: infant, intervention