The mothers and toddlers program, an attachment‐based parenting intervention for substance‐using women: Results at 6‐week follow‐up in a randomized clinical pilot

Abstract

Previously, we reported posttreatment findings from a randomized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years (N.E. Suchman, C. DeCoste, N. Castiglioni, T. McMahon, B. Rounsaville, & L. Mayes, 2010). The Mothers and Toddlers Program (MTP) is a 12-session, weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting. In a randomized pilot study, 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were randomized to the MTP versus the Parent Education Program (PE), a comparison intervention that provided individual case management and developmental guidance. At the end of treatment, mothers in the MTP condition demonstrated better reflective functioning, representation quality, and caregiving behavior than did mothers in the PE condition. In this investigation, we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up. Recently, we also identified two components of parental reflective functioning: (a) a self-focused component representing the parent's capacity to mentalize about strong personal emotions (e.g., anger, guilt, or pain) and their impact on the child and (b) a child-focused component representing the parent's capacity to mentalize about the child's emotions and their impact on the mother (N. Suchman, C. DeCoste, D. Leigh, & J. Borelli, 2010). In this study, we reexamined posttreatment outcomes using these two related, but distinct, constructs.

The state of evidence-based parenting interventions for parents who are substance-involved

“…In a pilot study examining MTP in a small sample of 14 substance-involved mothers of toddlers who ranged in age from 12 to 36 mo, preliminary pre-postcomparisons indicated that MTP was effective in increasing mothers' reflective functioning, sensitivity to child cues, and responses to child distress (12). These mechanisms of change also improved mothers' depressive symptoms, abstinence from drugs, and responsive caregiving to their children's cues as well as their children's clarity of cues immediately posttreatment and at 6-wk follow-up in a sample of 47 substanceinvolved mothers of young children (i.e., ranging in age from birth to 36 mo) who were randomized to MTP or a parent education program (13,70).…”

“…Further, repeated exposure to addictive substances likely reduces parents' dopaminergic response to stress, resulting in vulnerability to negative emotions and extreme distress when caring for distressed children. Such experiences can trigger relapses for parents who are substance-involved (13). Given the powerful nature of the dopaminergic system, interventions meant to change parenting behaviors in substance-involved families will need to be particularly potent.…”

“…This program can serve as an adjunct to individual substance abuse treatment and was developed to improve caregiving behavior by intervening at the level of maternal reflective functioning and representation quality (69). Within regard to reflective functioning, this intervention addresses mothers' ability to identify and downregulate their own distressing emotions as well as their ability to recognize and empathize with their children's emotions and needs (13,70). In a pilot study examining MTP in a small sample of 14 substance-involved mothers of toddlers who ranged in age from 12 to 36 mo, preliminary pre-postcomparisons indicated that MTP was effective in increasing mothers' reflective functioning, sensitivity to child cues, and responses to child distress (12).…”

Promoting Protective Factors and Strengthening Resilience

“…MTP is an attachment-based parenting intervention designed to enhance parent-child relationships by improving maternal refl ective functioning and the quality of the mother's mental representations of the child (e.g., being fl exible and balanced as opposed to infl exible and distorted). Researchers at Yale University School of Medicine recently reported the results of a pilot study involving 47 mothers who were enrolled in substance abuse treatment and caring for a child aged birth to 3 years (Suchman et al 2010(Suchman et al , 2011. Mothers were randomly assigned to participate in 12 weekly sessions of MTP or a comparison parenting education intervention.…”

The development of a scale for tuned‐in parenting

“…Numerous intervention programmes have been designed to improve parental sensitivity in at-risk dyads, and many of these use video interactions as the primary source of data Marvin, Cooper, Hoffman, & Powell, 2002;McDonough, 2005;Sadler, Slade, & Mayes, 2006;Suchman, Decoste, McMahon, Rounsaville, & Mayes, 2011). The Tuned-InParenting Programme (TIP) is a video-interaction group intervention for parents and infants at a targeted level of intervention (Priddis & Wells, 2010Priddis, Wells, Dore, Booker, & Howieson, 2008).…”