Treatment – Mother–infant relationship psychotherapy

In this chapter, we briefly describe several modes of parent–infant-psychotherapy, an efficient way of treating parent–infant relationship disorders. We then focus on treatment for postnatally depressed mothers. Perinatal depression defines an episode of major or minor depression occurring during pregnancy or the first 12 months after birth. Attachment-based parent–infant interventions are particularly helpful in the context of maternal perinatal depression, as postpartum depression has a special link with unresolved trauma and losses in the mother's childhood. The goal of treatment is to improve the mother's mood but also to prevent or reduce the effects of postpartum depression on the child. Infants of perinatally depressed mothers are at risk for a large array of negative outcomes, including attachment insecurity (particularly disorganised attachment), social-skills deficits, cognitive difficulties, behaviour problems, and later psychopathology. The ‘ghosts in the nursery' concept refers to the painful or disturbed early childhood experiences coming from the mother's past, which haunt the present mother–infant relationship. By addressing the mother's unresolved attachment conflicts (in her relationship to her own parents), it is believed that the development of a more adaptive parenting and a more secure and less disorganised attachment between the mother and her infant is facilitated. Changes in parent– infant interaction are not dependent on the port of entry (e.g. child's behaviour, parent's representation or parent–infant relationship). The perspective of attachment is key to install a therapeutic alliance with parents.