2002 International International Biennial Scientific Meeting

A REVIEW OF THE THEORY AND PRACTICE OF MOTHER-INFANT PSYCHOTHERAPY

Megan Galbally

Mother-Baby Unit, Mercy Hospital For Women, Melbourne

mgalbally@mercy.com.au

Mother-infant psychotherapy differs in a number of ways from the longer established tradition of individual psychotherapy. The significance and importance of such interventions is growing alongside studies which point to the crucial importance of the mother-infant relationship for the subsequent emotional, psychological and social development of the child. The field of infant psychiatry is a rapidly growing area, which draws on disciplines ranging across the biological, psychological and social domains. Work with mothers and infants brings new challenges to psychiatry that have tended to focus on either the mother within an adult psychiatry context, or the infant within a child psychiatry setting. In this sense both the underlying theoretical frameworks and corresponding interventions are, to some degree, in a state of flux. Therefore the aim of this research project is to examine the emerging psychotherapeutic models which attempt to combine previously disparate fields of psychiatry.

Research suggests that there are very significant and complex interactions between maternal psychiatric illness and infant symptomatology. A range of research findings show the impact on infants of maternal psychopathology. These include the infant's cognitive development which has also been shown to be significantly inhibited at 18 months in infants born to mothers with PND. Maternal Post Partum Depression (PND) has been found to be associated with a disturbance in the mother-infant attachment and consistent with this are studies which show increased rates of insecure attachment amongst infants of mothers with PND and mother-infant bonding.

On the basis of these findings, it can be reasonably asserted that maternal mental illness does have a significant impact on the infant, that the attachment relationship is impacted and that the neurology, cognitive, emotional and social development of the future child will also be impacted. This makes a strong and compelling case for early intervention with mothers and infants. It has therefore become apparent that the infant and the relationship between the mother and infant needs to be addressed as part of any treatment plan for post partum psychiatric illness. However, while we can cogently argue the case for as to why we ought to intervene, the question of how is less easily answered.

In the area of mother-infant psychotherapy there is a similar multiplication and pluralisation of models of psychotherapy as has occurred in psychotherapy in general where there is now over 400 models of psychotherapy. Out of this arises issues such as clinical practice standards and training. Thus a critical examination of models and practitioners use, knowledge and training in these models is required to begin the debate on the efficacy, effectiveness and efficiency and development of appropriate outcome measures.

A critical review of theoretical models, their implementation and any outcome studies available in Mother-Infant Psychotherapy will be presented. In addition the results of a survey of clinicians working with mothers and infants in psychiatric settings in Melbourne, Australia regarding attitudes, indications, theoretical models used and training in Mother-Infant Psychotherapy.