Parent infant work is an intervention which supports increased mentalising and reflective functioning in the parent. The focus of the sessions is the relationship between the parent and child and attention is given to the moment by moment interaction between them, especially the meaning of the child’s communications. Parents are encouraged to understand the behaviour of the child as a ‘window’ to the child’s mental state and experience, as a separate, but dependent, person. The parent is also encouraged to reflect on their own feelings and reactions to their child’s communications and/or behaviour ‘in the moment’, to better understand their own experience of being a parent and how this impacts on their relationship with their child.
Parenting a young infant or child is challenging for most parents, as the intimacy of the relationship and the high levels of need and dependency of the baby elicits strong emotional reactions, both positive and negative. Parents differ in their ability to manage this challenge based on their own personal characteristics and the context in which they parent.
The parent’s own early attachment experiences and adult attachment strategy will impact on their ability both to both understand and to regulate the affective states of their child and themselves, especially under stress. Parents who were endangered, neglected or traumatised as children, and who perhaps also experienced unresolved losses, are particularly likely to find the demands of parenting difficult and they may develop a negative attitude towards caring for their child. They may for example, withdraw from or punish what they perceive as the excessive neediness of the child or they may seek to control the behaviour of the child, in order to reduce their fearful perception of the child being in control.
Assessing the parent’s reflective functioning alongside their attachment strategy using the Parent Development Interview (Aber et al 2004) is key to understanding their ability to mentalise and also to identify the particular difficulties a parent may have in relating to their child. Once this is better understood therapeutic sessions can focus on both enhancing the mentalising ability of the parent and also addressing any distortions of thinking or perception the parent may have about the child. Parents can be helped to separate their projected image of the child from the ‘reality’ of the child’s communications in the moment.
Parent infant work is a powerful intervention as it focuses on the relationship between parent and baby rather than individual functioning. It also addresses historical perspectives as well as unconscious processes, in order to challenge intergenerational patterns and promote reflective thinking in the parent, to support more positive interactions and future change.
The aims of parent infant work are:
•To enable the parent to reflect upon states of mind in themselves, in their infant and in the relationship between them.
•To enable parents to recognise their infant as a dependent person with a developing mind.
•To enable the parent to moderate and regulate their own and their infant’s mental states.
•To interrupt the repetition of intergenerational patterns of relating and diminish traumatic impact on the baby/child.
•To promote positive attachment behaviours between the baby and his parents.
Following an initial assessment interview where the parent undergoes a Parent Development Interview, with additional questions about their childhood attachment history and a CARE-Index Screen which examines the current interaction between parent and infant, at least eight sessions are planned, usually taking place weekly, although the later sessions may take place fortnightly, if appropriate.
Sessions usually take place in the parent’s home or other safe and neutral venue and last one hour.
Juliet Kesteven has much relevant experience of delivering parent infant therapeutic sessions. She is a qualified social worker with additional psychological training including psychoanalytic and psychodynamic theory. She has over 20 years of experience of working closely with parents and infants both in clinical and community settings and has delivered training to health professionals and diploma students on the psychological transition to parenthood and neonatal and maternal mental health. She is supervised in her practice by a trained psychotherapist when carrying out that work. Ms Kesteven has presented nationally and internationally about her work.