Mental health articles

Therapeutic interventions for high-risk families Relationship-based therapeutic work with high-risk families can take a number
of forms and may be longer term. It takes time to establish a relationship, in particular when, as mentioned previously, these families have suffered
disappointment, at least, from various agencies and systems.
For the infant mental health worker, the infant–parent relationship provides the primary context for therapeutic intervention to occur. The Bruschweiler- Stern and Stern model (1989) for intervention provides a framework for assessment and working with the family, taking note of the parent’s representations as well as the interaction between infant and parent, and working flexibly with both.
Changing one element of the system influences the whole system. Therapy (changing internal representations) may be a longer term goal in high-risk environments. Changing overt behaviours, for example, teaching a parent how to wrap and settle her baby, may lead to changed internal representations of both
infant and parent. This enables the development of the infant’s selfrepresentation
of being effective in getting help when needed and the parent’s
representations of being able to meet her infant’s needs. She becomes more able to see her infant needing her help rather than just being demanding.
McDonough (2004) suggests that the therapeutic stance taken by the
Interaction Guidance approach, in conjunction with the use of brief video-taped interactions between infant and parent, provides parents with an opportunity to
learn about and reflect on the infant, themselves and their interaction.
McDonough (2004) emphasises that the focus on ‘observable interactions
between the baby and caregiver serves as the early therapeutic focus and, as such, serves as the therapeutic port of entry’ (p. 79), thus, agreeing with Bruschweiler-Stern and Stern (1989) that whatever the initial focus, there is an
opportunity in infant–parent therapy to change internal models as well as
observable behaviour and interactions.
Another approach with high-risk families is based on attachment theory and referred to as the ‘Circle of Security’ (Marvin, Cooper, Hoffman & Powell, 2002).
The group-based intervention of 20 weeks consists of parent education and psychotherapy designed to shift patterns of attachment and caregiver
interactions to more appropriate developmental pathways in high-risk
parent–infant dyads, initially with teenage parents.
See Marvin et al. (2002) for details of the conceptual background of the
protocol and the protocol itself.

Tags: interventions