Long-term effects of mother-infant psychoanalysis

Sammanfattning: This thesis is a long-term follow-up study of mothers and infants with “baby worries” or mother-infant relational disturbances, who took part in a Randomized Controlled Trial when the children were, on average, five months of age. In that study, mother-infant psychoanalysis (MIP) yielded, compared with routine care (CHCC; Child health centre care), effects on maternal depression, mother-infant relationships, maternal sensitivity, and, on a marginally significant level, maternal stress. Out of the 80 randomized dyads, 66 were now followed up when the children were 4.5 years. The thesis had two main aims: (A) To compare the long-term efficacy of MIP and CHCC on child functioning on cognitive, social and emotional domains, attachment representations, and psychological well-being (paper I), and maternal distress, representations of the child and mother-child interactions (paper II), (B) To investigate the mothers’ (paper III) and the analysts’ (paper IV) experiences of MIP. Material/Methods: (A) Mothers returned questionnaires on well-being and the child’s social and emotional functioning at a child age of 3.5. When the child was 4.5, I interviewed the child and the RCT researcher the mother. The child was assessed by the mother, the preschool teacher, external raters and myself. The mother’s well-being was rated via questionnaires and the inner representation of her child was rated from a semistructured interview. Mother-child interactions were assessed via video-recordings. (B) This aim was approached by Thematic analysis of transcribed interviews with 10 randomized MIP mothers and their analysts after six months of treatment. Instruments: The Ages and Stages Questionnaire: Social Emotional (ASQ:SE), the Children’s Global Assessment Scale (CGAS), the Emotional Availability Scales (EAS), the Edinburgh Postnatal Depression Scale (EPDS), qualitative assessments of the children (Ideal types), Machover Draw-a-person test, Story Stem Assessment Profile (SSAP), Strengths and Difficulties Questionnaire (SDQ), Symptom Check List-90 (SCL-90), Swedish Parental Stress Questionnaire (SPSQ), Wechsler preschool and primary scale of intelligence (WPPSI-III), Working Model of the Child Interview (WMCI) and information on background factors collected during interviews. Results: (1) Effects in favour of MIP-children were found on the CGAS and the Ideal types. The mothers’ psychological well-being were at normal levels in both groups, but the MIP-mothers had lower depression scores at all follow-up time points, and their sensitivity normalized faster. (2) The qualitative analyses of MIP-mother interviews yielded two themes; (i) transition to motherhood (how she developed a maternal identity in which she also perceived her child as an individual) and (ii) relationships with the infant and family (how relationships with the infant, the father and persons in her past developed). Most mothers were positive to the analyst’s focus on the child but some lacked a clearer focus on their own problems. The analyst interviews yielded two themes; (i) mother and infant together in MIP (the analyst’s effort at establishing a balance between mother and infant) and (ii) cooperation in MIP (the analyst’s striving to establish contact with (“containing”) the mother and develop a therapeutic alliance). Conclusions: MIP mothers had lower depression scores during the children’s first years and their sensitivity improved faster. This may explain why their children had better outcomes on two measures at 4.5 years; general functioning and psychological well-being. Both mothers and analysts reported positive experiences of MIP in general. The therapeutic alliance was reported to be essential. In some cases the method would need to be modified to focus more on the mother’s needs. The father took part in MIP in one or a few sessions. A future possibility could be to develop MIP to include the father.