A randomized controlled trial of mother–infant psychoanalytic treatment: I. Outcomes on self‐report questionnaires and external ratings

Abstract

Mother-infant relationship disturbances occur in three domains: maternal distress, infant functional problems, and relationship difficulties. They constitute common clinical problems. In Sweden, they are usually handled by nurses as part of public Child Health Centre care. Severe cases are referred to child psychiatry services. This randomized controlled trial compared two groups of mother-infant dyads in a Stockholm sample. One received only Child Health Centre care (the "CHCC" group) while the other received mother-infant psychoanalytic treatment plus CHCC (the "MIP" group). Eighty dyads of mothers and infants under 1½ years of age where the mothers had serious concerns about themselves in their role as mothers, their infants' well-being, or the mother-baby relationship were randomly selected for either the MIP or the CHCC group. The primary outcomes were mother-reported depression, mother-reported infant functional problems, and interviewer-based relationship assessments, all at 6 months after joining the project. Secondary outcomes were mother-reported stress and general psychic distress, externally rated video-recorded interactions, and the consumption of healthcare at the CHC, again all after 6 months. Intent-to-treat analyses of Treatment × Time effects significantly favored MIP treatment for maternal depression, mother-infant relationships, and maternal sensitivity. Effects were nearly significant on maternal stress, but nonsignificant on mother-reported infant functional problems, general psychic distress, maternal interactive structuring and nonintrusiveness, infant responsiveness and involvement, and healthcare consumption. MIP treatment improved mother-infant relationships and maternal sensitivity and depression, all of which are known to influence child development. If effects persist and are reproduced, MIP treatment holds promise for more widespread use.

Inter-rater reliability and aspects of validity of the parent-infant relationship global assessment scale (PIR-GAS)

“…However, their external rating was not blinded with respect to admission or discharge assessment, which may affect the reported intraclass correlation. Moreover, the sample in Salomonsson et al [20] was not comparable to ours, as their PIR-GAS mean scores considerably differed to mean score reported in our sample. Therefore, the results cannot be directly compared with each other.…”

“…We do not invalidate these findings with our study, but we questioned the equivalence of a 10-minute rating to a ‘full-information’ condition and did not find evidence that both measures can be used interchangeably. This issue was more closely addressed by the study of Salomonsson et al [20], who reported a high intraclass interrater reliability. However, their external rating was not blinded with respect to admission or discharge assessment, which may affect the reported intraclass correlation.…”

“…Our study design was primarily motivated by the paper of Aoki [19], which implied that a PIR-GAS rating could be based on a 10-minute video interaction sample by ‘blinded coders’. A first investigation between a PIR-GAS ratings based on full clinical information and a 10-minute-excerpt of a clinical interview with the mother was performed by Salomonsson and Sandell [20] who observed a high intra class reliability. However, the PIR-GAS rating of an external rater was based on a interview recording, and the pre-post treatment status was not covered.…”

Mary Ainsworth’s legacy: a systematic review of observational instruments measuring parental sensitivity

“…The 3rd edition of the EA sensitivity scale shows meaningful relations with child attachment security in risk samples in Western countries (Oppenheim, Koren-Karie, Dolev, & Yirmiya, 2012;Van IJzendoorn et al, 2007) and in a non-Western country (John, Morris, & Halliburton, 2012, in India). The sensitivity scale also relates to parental attachment state of mind (Aviezer, Sagi, Joels, & Ziv, 1999;Coppola, Cassibba, & Costantini, 2007;Edelstein et al, 2004), and has been shown the ability to detect changes in maternal sensitivity following intervention (e.g., Salomonsson & Sandell, 2011).…”

Treatment – Mother–infant relationship psychotherapy

“…To facilitate the development of more adaptive parenting by the mother, Fraiberg believes that it is important to address the mother's unresolved attachment conflicts as well as more secure and less disorganised attachment between the mother and her infant. A recent randomised-controlled trial of infantmother psychoanalytically informed treatment has shown that this treatment is effective in lowering maternal depression symptoms and in improving the relationship between the mother and infant [27].…”