From birth, infants grow and develop in their capacity to show feelings, to communicate both verbally and through their gestures and facial expressions, to think, and to relate socially. We now know that early relationships affect how well infants develop, and that problems in an infant's early relationships are linked to later problems in social relationships, emotional health, thinking, and problem solving. Increasingly, parents seem to be recognizing the importance of their relationships with their infants, and when this is not going well, many seek help.

Fifty-eight mothers and infants participating in two infant-mother psychotherapeutic interventions in a comparative infant-mother clinical intervention study were followed six months after treatment ended. One treatment was an infant-led psychotherapy, Watch, Wait, and Wonder (WWW). The other was a more traditional mother-infant psychodynamic psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately five months. Results indicated that positive effects observed from the beginning to the end of treatment in both treatment groups in infant symptoms, parenting stress, and mother-infant interaction were maintained or improved further at six-month follow-up. Additionally, decreased maternal depression, gains in infant cognitive development and emotion regulation, and improved infant-mother attachment security or organization had been observed posttreatment only in the WWW group. Interestingly, between the posttreatment to follow-up period the PPT group also showed such gains. Thus, for these variables it would be more accurate to say that the outcomes were similar for the two treatment groups but change emerged at a different pace. Nevertheless, an advantage persisted in the WWW group in This research was supported by a grant from Health Canada National Health and Postdoctoral Award from the Ontario Mental Health Foundation to Mirek Lojkasek. The first three authors played equal roles in the planning and execution of this research. We are grateful to Melanie Barwick for her collaboration on a part of this study as well as to Myrna Brown, Samantha Callender, Heather Davidson, Heather MacDonald, and Mirella Pugliese for their careful attention to detail in coordination, data collection, and coding and to Lennox White for audiovisual assistance. We are indebted to Susan Goldberg and Jane Washington for coding the Strange Situation videotapes. We also are deeply indebted to the families whose cooperation provided the data on which this study was based. Direct correspondence to: Nancy J. Cohen, Hincks-Dellcrest Institute, 114 Maitland Street, Toronto, Ontario, Canada M4Y 1E1; e-mail: nancy.cohen @utoronto.ca. • N. J. Cohen et al.relation to mothers' comfort dealing with infant behaviors and their ratings of parenting stress which improved more in this group from the end of treatment to follow-up. The direct inclusion of the infant as an initiator in WWW was set forth as an explanation of differentially timed treatment effects.RESUMEN: A 58 madres y sus infantes que participaron en dos intervenciones sicoterapéuticas dentro de un estudio de intervención clínico comparativo, se les dio seguimiento durante los seis meses posteriores al tratamiento. Uno de los tratamientos fue la sicoterapia guiada por el infante, de Observar, Esperar y Preguntarse (WWW). La otra fue una sicodinámica sicoterapia materno-infantil más tradicional (PPT). Los infantes tenían entre 10 y 30 meses al principio del tratamiento, el cual se llevó a cabo en...

There is general acceptance that the intergenerational repetition of relational patterns is transmitted within the interactions between mother and infant. The highly invested nature of the mother‐infant relationship makes it a prime arena for the playing out of unresolved relational conflicts of the mother. This occurs through the mother's responses to her infant in which she projects into the infant certain disavowed but highly invested positive or negative attributes. This leads to the interactional re‐creation of a whole relational system reflecting the mother's current and past relationship experiences. When a mother's conflictual past is unresolved and unmitigated by current relationships, her interactions with her infant are more driven by such perceptions than by real appraisal of the infant's actual attributes. The sleeping, eating, and behavioral management problems of infancy are often manifestations of such situations. A deceptively simple set of instructions to the mother, to become a nonintrusive observer of her infant and only interact at the infant's initiative, allows a role for the infant's initiative in changing interactions and thus potentially changing a relational system.

Four intervention models that aim to reduce problematic caregiver-infant relationships are reviewed within the context of attachment theory. These models include support, guidance, psychotherapy and infant-led psychotherapy. Most empirical research has evaluated support and guidance and a few studies have evaluated psychotherapy. The bulk of these studies report improvements in the caregiver-infant relationship and the infant's developmental outcome, suggesting a variety of interventions may be effective. However, although it is agreed that infants actively contribute to their relationships and development, and that in infant intervention changes in the caregiver-infant relationship are essential, only a few interventions directly include the infant and work with the caregiver-infant dyad. Most interventions work with the more verbal partner, the caregiver. Future research is needed to address the specific gains Preparation of this manuscript was partially supported by a grant from the Ontario Ministry of Community and Social Services, Children's Services Branch.

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