From Past to Present: The History of Interventions in Infant

Mental HealthProfessor Tuula Tamminen

President of ESCAP, Past-President of WAIMHUniversity of Tampere, FinlandRegional WAIMH Conference

Acre, Israel, 8-9-10/9/2009

Contents of the presentation

• I Introduction

• II Origins of the present

• III Parent-infant psychotherapies

• IV Conclusions

I History as a field of science

• Psychohistory

• Developmental history?

• History of childhood:

- de Mause (1974): the history of childhood is

a nightmare from which we are wakening”

- Ariès (1962)

- Pollock (1983)

• History of infant interventions

Through out the history of humankind there have been

infant interventions

II Interventions based on needs

• Abandoned infants…

neglected…

monasteries, churches,

voluntary people

• Abuse and violence…

• Infants’ shaffering and their needs

II Interventions based on needs

• Infants with disabilities… focus on child, stimulus, education… focus on parents… focus on family, parent-infant

relationship• Stern (1985): emerging self as a social

creation; Zola (1993): a social construction of disability

• Infants in broader context

II Interventions based on needs

• Preventions and promotion

”Milk drop” clinics…

Well-baby clinics…

Family guidance centers…

Parent education…

• Huge possibilities to intervene

II Interventions based on needs

• Physically ill infants…

Work done by pediatricians

Brazelton and Neonatal Behavioral

Assessment Scale

Premature infants…

• Sensitizing parents to their infants

II Interventions based on needs

• Early psychopatholy, infant psychiatry…• Mothers and fathers needs… Puerperal psychosis Infanticide… Postnatal depression Parent’s bonding difficulties• Attachment and its transgenerational

continuation

II Interventions based on others’ needs

• History of modes in parenting…

• Modes in research and theory…

• Societies’ impact and meaning of policies

• Many others as:

History of toys and materialism…

III History of parent-infant psychotherapiesA multimodal method of

intervention with the goal of improving the parent-infant

relationship

III Background for P-I Psychotherapies

1. Infant research, especially from 1970 onwards

- Observational studies- Longitudinal studies

2. Attachment theory and research- Bowlby, Ainsworth and Main - Other intersubjective theories

3. Psychoanalytical theory and its new trends

Attachment relationship

• Attachment realtionship/system is the basic organizer of infants’s development

• Criticized from psychoanalytical field and from developmental research field

• Importance now well understood

• Bonding from adult research (Brockington, 1997) (bonding difficulties and adult psychopathology)

III Changes in psychoanalytical thinking

• Sigmud Freud (1905, 1931): childhood universe

• Anna Freud (1951) and Melanie Klein (1957): psychoanalytical view of child’s inner world

• Observations: - Spitz (1945, 1947) and Bowlby (1952)- Stern (1977) and Tronick (1978)

III Changes in psychoanalytical working

• Selma Fraiberg (1975): Ghosts in the nursery

• Peter Fonagy (1993): Transgenerational transmission

• Transactional issues (also based on the systems theory)

• Elizabeth Fivaz (1999): Triangles

III Changes in psychoanalytical working

• Present situations

• Brain research: - Social brain- Theory of Mind (TOM)

• Mentalization (Fonagy et Target, 1998)

• Reflective functioning

III Parent-Infant Psychotherapies

• Parent/s and infant/toddler/preschooler present

• Focus on inner and outer reality• Interpretative and supportive techniques• Working here and now (from retrospection

to observation)• Videofeedback more and more important

technique• Emotional availability of the therapist

III Parent-Infant Psychotherapeis

• The parent-infant clinical system (Stern, 1995)

• Theoretical target of parent-infant therapy• Ports of entry for therapist:

- Child’s behavior- Parent-Child interaction- Child’s representations- Parental representations- Intertwined P-C representations- Parent-Therapist relationship

IV Conclusions

What have we learnt?

• Infant interventions seem to be effective, partly exceptionally effective

• There are many ways to intervene

• Creative new psychotherapeutical methods

• We don’t yet clearly know what creates the therapeutical change