SIGNIFICANCE OF THE MOTHER-CHILD RELATIONSHIP PERSPECTIVE IN THE INTEGRATIVE PRACTICE OF INFANT MENTAL HEALTH

Abstract

Several decades of research has proved the considerable power of the mother-infant relationship on infant development. In keeping with those findings, the mother-infant relationship is emerging as the main target of intervention and prevention efforts in infant mental health.

In recent years, findings from translational research on the parental brain has revealed that mothers undergo neurobiological changes in the perinatal period that support development of mother-infant relationships regardless of great individual differences. In addition to demonstration of neural plasticity of the mother's brain through pregnancy, childbirth, and child-rearing based on functional magnetic resonance imaging (fMRI) studies, abnormal changes in the maternal brain associated with psychopathology (e.g., postpartum depression, posttraumatic stress disorder, substance abuse) are being clarified, as are the potentials of brain remodeling through the course of mother-child interventions.

In clinical assessment and formulation of infant mental health care, most clinical disturbances in the first 3 years of life, are more usefully conceptualized as relationship disturbances when manifested as problems in child behavior. Updated infant diagnostic criteria (Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood-Revised: DC: 0-3R) now include relationship disorders (Relationship Problems Checklist: RPCL) and an assessment scale of dyadic functional impairment (Parent-Infant Relationship Global Assessment Scale: PIR-GAS) as axes in the multi-axial diagnostic system.

To address problems in the parent-infant relationship—impaired bonding in mothers with psychopathologies such as perinatal depression or PTSD, and infants with high risk for neurodevelopmental disorders, and problems such as excessive crying or sleeping/ eating difficulties—numerous forms of psychotherapeutic interventions focusing on both mother-infant interaction and attachment representation have been developed. Nonetheless, parent-child psychotherapy for this age group is still in need of validation by efficacy and longitudinal studies, towards which findings are being accumulated through the various modes of child-rearing support in practice today.