Outcome evaluation in brief mother-infant psychotherapy: A preliminary report

Abstract

The emerging field of mother‐infant psychotherapy lends itself particularly well to objective measures of change. The improvements are often rapid, involving symptom relief or removal. These improvements can be related to subjective change in mothers and to modifications of various interactive variables. We examined changes due to brief therapy (maximum of 10 sessions) in cases of functional and behavioral disturbances in children less than 30 months old. Evaluations were done before treatment and at 1 week, 6 months, and 12 months after therapy. The outcome measures were changes in the infant's symptoms, the mother's representations, and the behavioral interactions between mother and infant. One group of mothers and infants was seen in a form of psychodynamic brief psychotherapy developed in our Center, and a control group was seen in a noninterpretive form of therapy called interactional guidance. This progress report includes the initial 38 mother‐infant dyads who have completed the first three evaluations. Results indicate that the major changes are seen in symptom relief or removal; interactions change in the direction of becoming more “harmonious,” with mothers becoming less intrusive and infants being more cooperative. A better identification between mothers and infants is seen in the measures of the mothers' representations. No major differences between the two forms of therapy have yet appeared. To date, pretreatment predictions show little correlation with actual outcomes. Change proved to be durable, even showing some improvement in the 6‐month follow‐up evaluations. Results are discussed from the point of view of (1) the challenge of an objective, quantitative evaluation of subjective changes; (2) the issue of specificity of modes of treatment; (3) the difficulties of outcome predictions; (4) the remarkable opportunities for prevention of psychic disturbances in infancy; and (5) the relational nature of early disturbances.

Predictors of outcome in infant and toddlers functional or behavioral disorders after a brief parent–infant psychotherapy

“…The study population presented similar characteristics to those observed in previous similar studies using a similar therapeutic approach [13,42], in particular a large proportion of sleep disturbances (the most frequent symptom in the present population) and the existence of co-morbidity (presence of behavioral disturbances, functional disturbances and/or emotional difficulties), which was observed in the present study for nearly two-thirds of the children [25,33,39,46]. There was also a large proportion of anxious and, to a lesser extent, depressive symptoms among the mothers [8,22], as well as an association between the mental state of the mother and difficulties experienced by the child (in particular prior to the start of the therapy, and in case of behavioral disorders in the child).…”

“…The repercussions of the child's symptoms on the family are also assessed with a score from 1 to 5. The presence of a problem in any given domain was registered if the SCL subscore was greater than 2.5 [threshold chosen in accordance with the results obtained by Cramer et al (1990)]. …”

“…The parent-child therapies have in common to target parent-child relationships [9,20,21,30,32], despite different points of entry into the family system: representations, behaviors, or a combination of the two. The psychodynamic psychotherapies focus on the mother's representations concerning the child [13,17,29]: the therapist works on mother's projections onto the child, in particular on a core conflictual relationship with the child and a similar conflict in the mother's past history, in order to increase the mother's ability to differentiate her child from herself and to respond accurately to her child's needs. The behavior-oriented therapies, such as interactional guidance, aim to directly modify mother-infant interactions, without any reference to the mother's past history [35]: videotaped interactions of mother and infant are used by the therapist to help the mother recognize positive interactions and to develop appropriate responsiveness and confidence in her parenting role.…”

“…The outcomes of these therapies have been generally positive, even 6 months or more after the end of the treatment [9,10,13,31,42]. In a population of children aged 30 months or less with functional or behavioral disorders, Robert-Tissot et al [42] compared infant-parent psychodynamic psychotherapy and interactional guidance.…”

Psicoterapia breve pais-bebê: revisando a literatura

“…Os estudos descritos por Cramer [41][42][43] avaliaram os efeitos da psicoterapia breve para a melhora dos sintomas do bebê, da qualidade da interação mãe-bebê e da autoestima materna. Seus estudos, realizados na Suíça, consistiram no atendimento de diversas famílias com bebês entre 6 e 30 meses de vida.…”