Mother – infant group psychotherapy as an intensive treatment in early interaction among mothers with substance abuse problems

Abstract

In this article we present a novel method of outpatient care: brief, dynamic mother-infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother-infant relationship in this high-risk group. The clinical material is taken from 16 motherinfant dyads from six psychotherapy groups, which met weekly over six months from pregnancy to postpartum. The therapy process consists of 20-24 three-hour sessions. The basis of the therapy is to offer mothers experience of care, which they, in turn, can give to their infants. In this paper we analyse the core therapeutic elements that may contribute to better mothering and child development. They involve: the group providing a symbolic maternal lap, and the meeting of the mothers' and the infants' needs. It is hoped that this may offer the mothers a new experience within which to reappraise their early memories. This may help prevent them from projecting traumatic past experiences onto their infants. Our analyses show that in the therapy, mothers, feeling safe within the group, gradually experienced pleasure with their infants and their peers. These effects, according to the mothers, were the most noticeable. Brief dynamic mother-infant group psychotherapy seems to be a promising form of treatment for those substance-abusing women able to commit to outpatient care and examine the causes of their drug dependence. The groups may also be used as a diagnostic tool to detect problems in early mother-baby interaction.

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

“…Mothers' negative prenatal expectations of their motherhood may indicate a lack of sufficient maternal attachment and protectiveness toward the baby. On the other hand, excessively high expectations of one's own motherhood may depict the role assigned to the child as that of a savior of one's whole life as typically described among drug‐abusing mothers (e.g., Belt & Punamäki, 2007). When this idealization is shattered by the reality of a very needy and dependent little baby, the nonintegrated, painful childhood memories may be activated in the mother.…”

“…Our results add to previous findings (Belt et al, 2011 ; Belt & Punamäki, 2007) of the use of mother–infant PGT among drug‐abusing mothers, and suggest that this treatment may help these high‐risk mothers to build and maintain a more positive view of the infant. Our results also show that in the course of successful PGT, the representation of one's own mother‐as‐mother also may change more positively and persist after the end of therapy, which would help the mother to more easily relate to her child.…”

“…The PSS mothers did not have a systematic weekly participation schedule. The interventions are described in more detail elsewhere (Belt & Punamäki, 2007; Belt et al, 2011).…”

Interventions to address parenting and parental substance abuse: Conceptual and methodological considerations

“…Treating SA without addressing parenting leaves parents with insufficient skills for handling child behavior issues and makes them more vulnerable to drug relapse as a coping mechanism (Belt & Punamäki, 2007; Suchman et al, 2008; Whiteside-Mansell et al, 1999). Additionally, addressing parenting without addressing SA is likely futile as effective parenting requires a significant amount of emotional-regulation and intrinsic motivation, both of which are incompatible with drug and withdrawal states (Robinson & Berridge, 2003; George et al, 2012).…”

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug‐abusing mothers

“…There is a call for treatment programs that not only identify and assess perinatal substance abusers but also motivate them to better prepare for motherhood. Research has shown that most substance‐abusing women are willing to accept professional help to find a new identity as a successful mother rather than as a drug addict as far as appropriate treatment alternatives are available (Belt & Punamäki, 2007; Luthar, Suchman, & Altomare, 2007). The perinatal period poses a challenge for providing effective intervention programs for mother–infant dyads because addicted mothers often have a limited “time of soul‐searching,” and the infants are at high risk for physical and emotional problems (Howell, Heiser, & Harrington, 1999; Tronick et al, 2005).…”