From Interactive Regulation in Infancy to Relationship-Focused Interventions

In interaction with their mother, infants not only learn how human relationships work, but – on an even more basic level – the continuous bidirectional, interactive regulation between mother and infant shapes the infant’s socioemotional development. Coordinated interactions alternate with uncoordinated ones, the latter resulting in momentary ruptures during this dyadic exchange. Usually, these are quickly repaired. The mother’s capacity for engaging with her infant in a sensitive and appropriate manner is crucial for successful socioemotional development. On a transgenerational level, a mother will draw on her own relational experiences – embodied as implicit memory – when interacting with her baby. Thus, comprehensive and effective treatment of maternal postpartum disorders that often impair the mother’s interactive skills and capacity for maternal bonding is of great importance. One aim of modern mother-infant treatment is to target dysfunctional interactive patterns, often with the help of video feedback and microanalysis of behavioral observations. In this paper, after giving an overview of affective regulation in mother-infant dyads and the role of maternal factors and postpartum mental health, we describe relationship-focused approaches to mother-infant treatment. Our focus lies on video feedback and body-oriented interventions. We also explore classical as well as contemporary theoretical underpinnings in mother-infant research and how psychoanalytic concepts like containment and mentalization not only enrich approaches to mother-infant treatment but also adult treatment in general. We conclude that working with and expanding one’s own implicit relational knowledge is central for the therapeutic process and can be initiated by video-based interventions or by genuinely experiencing and reflecting on interactions in dyads and groups.

[1]  M. Bakermans-Kranenburg,et al.  Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline , 2022, Development and Psychopathology.

[2]  E. Tronick,et al.  From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study , 2022, Frontiers in Psychology.

[3]  P. Fonagy,et al.  Rupture and Repair in Mentalization-Based Group Psychotherapy , 2021, International Journal of Group Psychotherapy.

[4]  B. Beebe,et al.  Infant research and adult treatment revisited: Cocreating self- and interactive regulation. , 2020 .

[5]  Samantha J. Teague,et al.  The role of antenatal and postnatal maternal bonding in infant development: A systematic review and meta‐analysis , 2020, Social Development.

[6]  A. Scarinzi Ecology of the Brain. The Phenomenology and Biology of the Embodied Mind , 2020, Journal of the British Society for Phenomenology.

[7]  J. Barlow,et al.  Video feedback for parental sensitivity and attachment security in children under five years. , 2019, The Cochrane database of systematic reviews.

[8]  C. Reck,et al.  Emotional Stress During Pregnancy – Associations With Maternal Anxiety Disorders, Infant Cortisol Reactivity, and Mother–Child Interaction at Pre-school Age , 2019, Front. Psychol..

[9]  F. Schellevis,et al.  Correlates of prenatal and postnatal mother-to-infant bonding quality: A systematic review , 2019, PloS one.

[10]  I. White,et al.  The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. , 2019, The Journal of clinical psychiatry.

[11]  J. Goodman Perinatal depression and infant mental health. , 2019, Archives of psychiatric nursing.

[12]  Xin Huang,et al.  The short- and long-term effectiveness of mother-infant psychotherapy on postpartum depression: A systematic review and meta-analysis. , 2019, Journal of affective disorders.

[13]  S. Milanovic,et al.  Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. , 2018, Clinical psychology review.

[14]  H. Keller Universality claim of attachment theory: Children’s socioemotional development across cultures , 2018, Proceedings of the National Academy of Sciences.

[15]  Claire P Browne,et al.  Mentalization-based treatment and its evidence-base status: A systematic literature review. , 2018, Psychology and psychotherapy.

[16]  S. Foulkes Group Analytic Psychotherapy: Method and Principles , 2018 .

[17]  Mitho Müller,et al.  Disentangling the Dyadic Dance: Theoretical, Methodological and Outcomes Systematic Review of Mother-Infant Dyadic Processes , 2018, Front. Psychol..

[18]  M. Craske,et al.  Association of Persistent and Severe Postnatal Depression With Child Outcomes , 2018, JAMA psychiatry.

[19]  C. Dennis,et al.  The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review , 2017, Depression and anxiety.

[20]  A. Ferrari,et al.  A systematic review and meta-regression of the prevalence and incidence of perinatal depression. , 2017, Journal of affective disorders.

[21]  C. Colonnesi,et al.  Mind Matters: A Meta-Analysis on Parental Mentalization and Sensitivity as Predictors of Infant–Parent Attachment , 2017, Psychological bulletin.

[22]  P. Ramchandani,et al.  Fathers, fathering and child psychopathology. , 2017, Current opinion in psychology.

[23]  M. P. Lambregtse-van den Berg,et al.  Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-analysis , 2017, PloS one.

[24]  J. Belsky,et al.  Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children’s socio-emotional functioning , 2017, Attachment & human development.

[25]  P. Marshall,et al.  Embodiment and Human Development. , 2016, Child development perspectives.

[26]  B. Stubbs,et al.  Anxiety disorders in postpartum women: A systematic review and meta-analysis. , 2016, Journal of affective disorders.

[27]  E. Ierardi,et al.  Effectiveness of an Attachment-Based Intervention Program in Promoting Emotion Regulation and Attachment in Adolescent Mothers and their Infants: A Pilot Study , 2016, Front. Psychol..

[28]  A. Vingerhoets,et al.  A longitudinal study on the maternal–fetal relationship and postnatal maternal sensitivity , 2016 .

[29]  P. Trairatvorakul,et al.  Patterns of Attachment: A Psychological Study of the Strange Situation , 2016 .

[30]  P. Fonagy,et al.  Mentalization-based treatment for personality disorders: A practical guide. , 2016 .

[31]  E. Tronick,et al.  What Dyadic Reparation Is Meant to Do: An Association with Infant Cortisol Reactivity , 2015, Psychopathology.

[32]  Ulrich Sollmann Ulfried Geuter: Körperpsychotherapie – Grundriss einer Theorie für die klinische Praxis , 2015 .

[33]  B. Beebe,et al.  The Expanding World of Edward Tronick , 2015 .

[34]  C. Dayton,et al.  What is the container/contained when there are ghosts in the nursery?: Joining Bion and Fraiberg in dyadic interventions with mother and infant. , 2015, Infant mental health journal.

[35]  S. Lydersen,et al.  Video feedback compared to treatment as usual in families with parent–child interactions problems: a randomized controlled trial , 2015, Child and Adolescent Psychiatry and Mental Health.

[36]  N. Midgley,et al.  Parent-infant psychotherapy for improving parental and infant mental health. , 2015, The Cochrane database of systematic reviews.

[37]  C. Reck,et al.  Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding , 2015, Archives of Women's Mental Health.

[38]  C. Reck,et al.  Postpartum bonding: the role of perinatal depression, anxiety and maternal–fetal bonding during pregnancy , 2015, Archives of Women's Mental Health.

[39]  Silvina Mazaira [Postpartum psychiatric disorders]. , 2014, Vertex.

[40]  J. Goodier The Cambridge Handbook of Environment in Human Development , 2014 .

[41]  C. Reck,et al.  Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour , 2014, Archives of Women's Mental Health.

[42]  Suzanne Tough,et al.  Prenatal and Postnatal Maternal Mental Health and School-Age Child Development: A Systematic Review , 2014, Maternal and Child Health Journal.

[43]  E. Tronick,et al.  Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice , 2013 .

[44]  M. Hayat,et al.  A longitudinal study of maternal attachment and infant developmental outcomes , 2013, Archives of Women's Mental Health.

[45]  P. Fonagy,et al.  New Beginnings for mothers and babies in prison: A cluster randomized controlled trial , 2013, Attachment & human development.

[46]  P. Shaver,et al.  Beyond words : Parental embodied mentalizing and the parent infant dance , 2013 .

[47]  M. Hayat,et al.  The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women. , 2012, Research in nursing & health.

[48]  R. Feldman The Cambridge Handbook of Environment in Human Development: Parenting Behavior as the Environment Where Children Grow , 2012 .

[49]  Katherine Bain,et al.  'My baby cries for nothing' : mentalisation challenges in the face of negative countertransference when working with mothers who struggle to hold their babies in mind , 2012 .

[50]  Katherine Bain,et al.  'The Mothers Have Mercy for Me': Change in Parent-Infant Relationships through Group Psychotherapy , 2012 .

[51]  E. Tronick,et al.  Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period. , 2011, Infant mental health journal.

[52]  J. Belsky,et al.  When Words Just Won’t Do: Introducing Parental Embodied Mentalizing , 2011 .

[53]  M. Papoušek Resilience, strengths, and regulatory capacities: Hidden resources in developmental disorders of infant mental health. , 2011, Infant mental health journal.

[54]  Howard F. Andrews,et al.  The origins of 12-month attachment: A microanalysis of 4-month mother–infant interaction , 2010, Attachment & human development.

[55]  A. Gous The ghosts in the nursery , 2009 .

[56]  J. Bick,et al.  A Review of “Promoting Positive Parenting: An Attachment-Based Intervention” , 2009 .

[57]  C. Sohn,et al.  Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders , 2008, Acta psychiatrica Scandinavica.

[58]  J. Hoyer,et al.  Angststörungen in der Schwangerschaft und nach der Geburt: , 2008 .

[59]  Mark Olfson,et al.  Psychiatric disorders in pregnant and postpartum women in the United States. , 2008, Archives of general psychiatry.

[60]  Mary Target,et al.  The Rooting of the Mind in the Body: New Links Between Attachment Theory and Psychoanalytic Thought , 2007, Journal of the American Psychoanalytic Association.

[61]  S. Stuart,et al.  Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship , 2007, Development and Psychopathology.

[62]  G. Gergely,et al.  The parent-infant dyad and the construction of the subjective self. , 2007, Journal of child psychology and psychiatry, and allied disciplines.

[63]  C. Reck [Postpartal depression: possible effects on early mother-child interaction and psychotherapeutical treatment approach]. , 2007, Praxis der Kinderpsychologie und Kinderpsychiatrie.

[64]  Hyunjeong Shin,et al.  Predictors of maternal sensitivity during the early postpartum period. , 2006, Journal of advanced nursing.

[65]  Tracy E. Moran,et al.  Maternal depression: A review of relevant treatment approaches for mothers and infants. , 2006, Infant Mental Health Journal.

[66]  I. Brockington,et al.  Severe disorders of the mother–infant relationship: definitions and frequency , 2006, Archives of Women's Mental Health.

[67]  Barbara L. Cannella Maternal-fetal attachment: an integrative review. , 2005, Journal of advanced nursing.

[68]  Eric Krotkov,et al.  Focusing , 2004, International Journal of Computer Vision.

[69]  Neil H. Altman,et al.  Affect Regulation, Mentalization, and the Development of the Self. , 2003 .

[70]  Femmie Juffer,et al.  Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. , 2003, Psychological bulletin.

[71]  B. Beebe Brief mother–infant treatment: Psychoanalytically informed video feedback , 2003 .

[72]  C. Trevarthen,et al.  Infant intersubjectivity: research, theory, and clinical applications. , 2001, Journal of child psychology and psychiatry, and allied disciplines.

[73]  E. Muir,et al.  WATCH, WAIT, AND WONDER: TESTING THE EFFECTIVENESS OF A NEW APPROACH TO MOTHER-INFANT PSYCHOTHERAPY , 1999 .

[74]  E. Kandel,et al.  Biology and the future of psychoanalysis: a new intellectual framework for psychiatry revisited. , 1999, The American journal of psychiatry.

[75]  J. Cohn,et al.  Gender differences in emotional expressivity and self-regulation during early infancy. , 1999, Developmental psychology.

[76]  E. Tronick,et al.  Emotional characteristics of infants associated with maternal depression and anxiety. , 1998, Pediatrics.

[77]  D. Stern,et al.  Dyadically expanded states of consciousness and the process of therapeutic change , 1998 .

[78]  D. Stern,et al.  IMPLICIT RELATIONAL KNOWING: ITS ROLE IN DEVELOPMENT AND PSYCHOANALYTIC TREATMENT , 1998 .

[79]  T. Anders The Motherhood Constellation: A Unified View of Parent-Infant Psychotherapy , 1997 .

[80]  J. Cohn,et al.  The timing and chronicity of postpartum depression: Implications for infant development. , 1997 .

[81]  Marinus H. van IJzendoorn,et al.  Sensitivity and attachment: a meta-analysis on parental antecedents of infant attachment. , 1997, Child development.

[82]  M. Papoušek,et al.  Persistent crying and parenting: Search for a butterfly in a dynamic system , 1995 .

[83]  M. S. Cranley The Origins of the Mother-Child Relationshp-A Review , 1993 .

[84]  T. Field Infants of depressed mothers , 1992, Development and Psychopathology.

[85]  H. Papoušek,et al.  Innate and cultural guidance of infants integrative competencies: China, The United States, and Germany , 1991 .

[86]  E. Tronick Emotions and emotional communication in infants. , 1989, The American psychologist.

[87]  H. Papoušek,et al.  Intuitive parenting: A dialectic counterpart to the infant's integrative competence. , 1987 .

[88]  J. Woodroffe,et al.  A learning experience. , 1987, New Zealand hospital.

[89]  D. Wesner,et al.  Notes on infant psychotherapy , 1980 .

[90]  T. Brazelton,et al.  The infant's response to entrapment between contradictory messages in face-to-face interaction. , 1978, Journal of the American Academy of Child Psychiatry.

[91]  F. Kline Group-Analytic Psychotherapy: Method and Principles , 1977 .

[92]  D. Stern,et al.  Engagement-Disengagement and Early Object Experiences , 1977 .

[93]  D. Winnicott The Child, The Family And The Outside World , 1964 .