Baby worries : a randomized controlled trial of mother-infant psychoanalytic treatment

Abstract

Aims: This thesis had three aims. (1) To explore a new treatment method of baby worries or mother-infant relational disturbances; mother-infant psychoanalytic treatment (MIP). The exploration focused on clinical applicability and underlying theory. (2) To investigate a method of assessing infant functioning by a mother-report questionnaire on infant social and emotional functioning. (3) To compare outcomes of MIP treatments with the usual Child Health Centre care (CHCC) in a randomized controlled trial (RCT) that included investigating moderating effects of patient and treatment factors.

Material/Methods: Aim (1) was approached by investigating tape-recorded single-case vignettes of MIP treatments from the perspectives of psychoanalytic and semiotic theory and infant behavioural research. Aims (2) and (3) were approached by an RCT with a quantitative between-group comparison of MIP and CHCC. The sample consisted of 80 mothers and infants below 1.5 years, where the mother reported baby worries. They were recruited from Child Health Centres in Stockholm, or advertisements at parenting internet sites and the delivery ward and the nursing centre of the Karolinska University Hospital. The dyads were randomized to CHCC or MIP. MIP treatments were conducted by psychoanalysts within the Mother-Infant Psychoanalytic Project of Stockholm (MIPPS). Follow-up assessments were made after six months.

Instruments: The Ages and Stages Questionnaire: Social Emotional (ASQ:SE), the Emotional Availability Scales (EAS), the Edinburgh Postnatal Depression Scale (EPDS), the General Severity Index (GSI) of the Symptom Check List-90, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS), the Swedish Parental Stress Questionnaire (SPSQ), CHC and paediatrician records, and patient and treatment factors collected during interviews.

Results: (1) The theoretical discussion of MIP treatment focused on how analyst and baby communicate. Infant research findings seemed to support clinical experiences that an infant may understand the emotional aspects of the communication with the analyst. Semiotic theory was used to describe the different communicative levels. Psychoanalytic theory was used to explicate the therapeutic action of MIP. It was found to consist in the analyst s holding or metabolizing the anxieties of mother and baby, and in translating their communication into more comprehensible messages. Finally, it was found that therapeutic experiences with mothers and infants may widen the therapist s sensitivity to the non-verbal layers of adult patients in treatment. (2) The methodological study of the questionnaire on baby functioning, the ASQ:SE, was performed on the sample s pre-treatment scores. It demonstrated the close links of the ASQ:SE with mother-reported psychological distress (EPDS, GSI, SPSQ) but not with external ratings of baby functioning (EAS, PIR-GAS). This was especially the case for depressed mothers. The study pointed at problems with measuring infant functioning in clinical samples and to the need of developing valid instruments. (3) The RCT showed that MIP, as compared with CHCC, yielded significantly better Treatment by Time effects on the EPDS, maternal sensitivity (EAS), and the PIR-GAS, nearly significant effects on the SPSQ, and non-significantly better effects on the ASQ:SE, the GSI, and the remaining EAS dimensions. Qualitative assessments, so-called ideal types, of mothers and babies made pre-treatment were shown to moderate outcomes. Participator mothers improved their sensitivity (EAS) to a significantly greater extent from MIP than from CHCC. A contrasting but non-significant pattern was found among the Abandoned mothers. Affected babies improved their PIR-GAS scores, and their mothers improved their sensitivity (EAS), significantly more from MIP than from CHCC.

Conclusions: MIP seems well suited for mothers intent on participating in psychoanalytic work and who feel they somehow play a part in the baby worries. For those who are anxious or in partner conflict, therapy needs to be more supportive. Affected babies seem more helped by MIP than by CHCC, probably due to MIP s direct baby address. Further studies need to compare the clinical efficacy and theory of MIP with other treatment modes. Its long-term effects also need to be investigated.