From Past to Present The History of Interventions

From Past to Present: The History of Interventions in Infant Mental Health Professor Tuula Tamminen President of ESCAP, Past-President of WAIMH University of Tampere, Finland Regional WAIMH Conference Acre, Israel, 8 -9 -10/9/2009

Contents of the presentation • • I II IV Introduction Origins of the present Parent-infant psychotherapies 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 psychotherapies A 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 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 therapeutical change