Joint psychoanalytic treatment may benefit both mother and child

Even when a baby has been longed for, some mothers might have trouble bonding with their baby, who in turn may develop disturbed behaviour, such as crying, poor sleeping patterns and breast refusal. A new thesis to be published at the Swedish medical university Karolinska Institutet shows that in such cases, the joint psychoanalytic treatment of mother and infant may be effective, particularly if the mother feels that she is unconsciously contributing to the problems.

"If the situation is seen as a problem for a limited time, the good support provided by Swedish Child Health Centre (CHC) is often sufficient," says Björn Salomonsson, doctoral student at the Department of Women's and Children's Health. "But sometimes more help is needed and the mother and her child may benefit from seeing a therapist to find each other in a calm, safe environment."

In his thesis, Dr Salomonsson presents a randomized treatment study of 80 mothers with infants below the age of 18 months who reported problems during visits at CHCs, nursing centres in Stockholm and parenting internet sites. The mothers and babies were divided into two groups of 40, the one receiving Mother-Infant Psychoanalytic treatment (MIP), and the other regular CHC contact only. All babies underwent health screening by a paediatrician and continued their visits to the CHC. In addition, the MIP group received psychoanalytical treatment at the Mother-Infant Psychoanalytic Project of Stockholm over a period of about two months, with two to three sessions a week. Follow-ups were made after six months.

"The idea of MIP treatment is that the analyst helps both the mother and the baby to express how they feel," says Björn Salomonsson. "The analyst uses professional knowledge and intuition to understand the baby's signals. The study shows that babies soon respond to the analyst's attempts at contact, and become calm when words are put to their emotional world."

"This also helps the mother to understand the reason for her baby's disturbed behaviour...and gives her an opportunity to talk, in a secure environment, about how she feels criticized by the screaming baby, something she is often ashamed to talk about. Feeling a failure as a parent is taboo, especially for women."

The study showed that the MIP mothers improved on the EPDS depression questionnaire, and that they developed better relationships with the babies and a greater sensitivity to their signals, in comparison with the CHC mothers. Not every baby is that affected by a depressed mother who perhaps cries when she meets his gaze. Others, however, react by rejecting the mother's attempts to make contact and start whining. It was especially in this latter case that MIP was shown to be able to create a virtuous circle between mother and baby.

"This conclusion could be drawn as the study design enabled the identification of two sub-groups that derived particular benefit from MIP: the babies with pre-treatment symptoms such as anxiety, sleep and nursing problems and a tendency to turn away from the mother; and the mothers who intuited that they were contributing to the problems," says Dr Salomonsson.

To assess the interaction between mother and infant and their mental wellbeing, Dr Salomonsson's interviews were filmed and examined by external expert raters. He stresses that more studies are needed before the results may be considered reliable. For example we need to know more about how MIP works on other samples and when the father is involved in the treatment.

Björn Salomonsson works as a physician and a psychoanalyst in Stockholm.

Doctoral thesis: Baby worries; A randomized controlled trial of mother-infant psychoanalytic treatment.