Parent-infant Relationship Research Articles

Evaluation of a Model of Transitional Care After Preterm Birth on Parents' Mental Health and Self-Efficacy: A Randomized Controlled Pilot Trial.

Parents of premature infants experience depression, anxiety, post-traumatic stress disorder, and increased stress, which can negatively impact parent-infant relationships and infant development. To reduce negative consequences and optimally support families, we developed the Transition to Home model (TtH). In this randomized controlled pilot trial (RCT), the feasibility of performing an experimental study to analyse the effects of TtH on parental mental health over time was evaluated. The following domains were assessed: recruitment, follow-up and study burden, outcome measures used and parental mental health outcomes. We included n = 22 parent couples with their preterm infants in the control group and n = 23 in the intervention group. Depression, anxiety and post-traumatic stress disorders, parenting stress, and parental self-efficacy were assessed at five timepoints. The study burden was evaluated once at the end of the study. The control and intervention groups had similar socio-demographic characteristics. The groups showed no differences in the mental health outcomes except for depression in mothers at T2 (p = 0.042) and T5 (p = 0.027) and state anxiety in fathers at T2 (p = 0.016). This pilot RCT established a framework for the evaluation of the TtH model of care and demonstrated the viability of the evaluation scheme. The results confirm the suitability of the RCT's structure and the feasibility of the methods and instruments used. Minor adjustments are recommended to include a more diverse sample in future studies.

Challenges of preterm families: parenthood and participation in the Neonatal Intensive Care Unit in Northern Italy

ABSTRACT Prematurity can disrupt the psychological transition to parenthood, with the unfamiliar environment of the Neonatal Intensive Care Unit (NICU) often exacerbating parental concerns about their baby’s health and survival. This study explores factors influencing parental coping mechanisms during their NICU stay, focusing on gender differences and parental perceptions of staff support. Sixteen Italian parents of preterm infants (born before 37 weeks of gestation and hospitalized for at least 10 days) participated in remote narrative interviews. Thematic analysis revealed key differences in the emotional experiences and care participation between mothers and fathers, shaped by traditional Italian gender norms and further impacted by COVID-19 restrictions limiting fathers’ access to the NICU. Additionally, parents who were more involved in their infant’s recovery through interactions with doctors reported higher levels of personal well-being. These findings highlight the importance of fostering parent-staff communication and support, particularly during times of crisis, to promote positive outcomes in the parent-infant relationship and enhance parental well-being. Recommendations include tailored interventions to ensure mothers and fathers are actively engaged in their infant’s care.

Optimal presence: enhancing parent integration to maximize neurodevelopmental outcomes in preterm infants.

Preterm birth disrupts the natural progression of events in the parent-infant relationship and bestows many of the typical parent responsibilities to the clinical care team. In turn, the neonatal intensive care environment (NICU) introduces obstacles to parents that would not otherwise be encountered and forces parents to adapt to this artificial environment as they seek to bond with and care for their newborn. Facilitating parent presence at the bedside and incorporating them into the care of their preterm infant is critical for lessening the immediate burden to both the parent and offspring while also ensuring the best possible outcome for preterm infants. In this review, we explore the impact that parents exert on the neurodevelopmental outcome of preterm infants and identify several barriers and facilitators to parent presence.

Early psychosocial parent-infant interventions and parent-infant relationships after preterm birth-a scoping review.

Early psychosocial interventions for preterm infants and their parents are diverse. This study aimed to structure the knowledge on psychosocial parent-infant interventions and to identify gaps in the intervention studies. We included studies on early (during first year of life) psychosocial parent-infant interventions with parent-infant relationship outcomes after preterm birth (< 37 weeks). We excluded studies that did not focus on preterm infants, failed to indicate the studied intervention and outcomes, were not written in English, were not controlled or peer-reviewed studies, or did not provide essential information for eligibility. The search included studies published between January 2000 and March 2024 in PubMed and PsycINFO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in reporting. Psychosocial parent-infant intervention studies were classified adapting the International Classification of Health Interventions (ICHI) and the Template for Intervention Description and Replication (TIDieR). The included 22 studies reported data from 18 different interventions with preterm infants (< 37 weeks). Studies excluded preterm infants with health risks (19/22, 86%), with very low gestational age and/or birth weight (7/22, 32%), and/or mothers with psychosocial risks (14/22, 64%). Of the 18 interventions, 12 (67%) were classified as counseling, 3 (17%) as emotional support, 2 (11%) as psychotherapeutic, and 1 (6%) as educational. The parent-child relationship was assessed using 30 different methods and varying time points up to 18 months of age. Most studies (17/22, 77%) reported positive changes in the parent-child relationship favoring the intervention group. We identified four types of interventions to influence parenting behavior; the most used was counseling. All four intervention types showed positive effects on parent-infant relationships, although the preterm populations studied were selective, the effects were evaluated using different methods, and the follow-up periods were short. These findings indicate a need for studies with standardized methods, longer follow-up, and less-restricted preterm populations to develop guidelines for all families with preterm infants.

Effects of Parental Predictors on Postpartum Depression.

Postpartum depression (PPD) is highly prevalent and plagues a significant proportion of parents. Postpartum depression also exerts various negative consequences on infant development and parent-infant relationships. Social support is identified as an important factor influencing many parental predictors, and may affect the development of PPD. This study aimed to investigate how perceived social support can indirectly influence PPD symptoms in parents at 6 months postpartum by influencing postpartum anxiety, parental satisfaction, and parental self-efficacy (PSE). A secondary analysis of data from a randomized controlled trial was used with a cross-sectional exploratory design. A total of 400 Singaporean parents (200 couples) were included, and structural equation modeling was used to analyze the relationships between PPD and potential predictors. Findings revealed a less adequate fit between the hypothesized model and the data collected. Social support was found to be a significant predictor of postpartum anxiety, PSE, and parental satisfaction. Postpartum anxiety was a significant predictor of PPD, but PSE and parental satisfaction were not. This study provides an overview of how different parental predictors may be associated with PPD among Asian parents. Postpartum anxiety significantly predicted PPD, but social support had negative effects on postpartum anxiety, parenting satisfaction, and PSE. The findings provide further insight into how parents at risk of PPD can be identified and demonstrated how social support might negatively impact parental outcomes. More qualitative research with Asian parents is needed to further explain these findings and inform the development of future interventions.

Does broad autism phenotype traits effect mother-child interaction?: a cross-sectional study from Turkey

Objectives Broad Autism Phenotype (BAP) is defined as personality, social, and language features that parallel the defining behavioral characteristics of autism spectrum disorder, including social deficits, communication abnormalities, and stereotyped repetitive behavior. The objective of this study was to assess the impact of maternal BAP characteristics on the dynamic interaction between mothers and their children. Methods Children aged 12–60 months who were referred to the Infant Mental Health Unit of our outpatient clinic were analyzed. Forty-one children who were diagnosed with autism and 35 children who were diagnosed with global developmental delay (GDD) and their mothers were included in the study. The Parent–Infant Relationship Global Assessment Scale (PIR-GAS), Autism-Spectrum Quotient (ASQ), Parental Acceptance–Rejection Questionnaire, and Recognition of Emotional Maltreatment Scale (REMS) were used. Results The PIR-GAS score was significantly lower in the autism group than in the GDD group, and mothers of children with autistic children exhibited higher BAP scores. Conclusions Our study suggests a link between maternal BAP scores and the quality of mother-child relationships. Further studies are needed to examine and improve our ability to evaluate the effects of parental BAP in terms of parental intervention effectiveness.

Maternal stress and breastfeeding outcomes in the NICU couplet care experience: a prospective cohort study.

Couplet care is an innovative approach to provide postpartum care in the neonatal intensive care unit (NICU) with little known about its impact on infant feeding outcomes and maternal stress. We compared breastfeeding outcomes and maternal NICU-related stress among mother-infant dyads based on exposure to couplet care in a prospective cohort study. Among 19 couplet-care exposed (CCE) dyads and 19 traditional postpartum care dyads, CCE mothers had lower self-reported stress related to parent-infant relationship as compared to traditional care (P < 0.001). CCE infants received relatively more feeds at the breast (P < 0.001), more breastmilk feeds (P = 0.002), and fewer feeds by staff (P < 0.001). Adjusted for gestational age, marital status, and infant length of stay, couplet care was associated with being in a higher tertile of percent breastmilk feeds (aOR 7.29, 95% CI 1.45-36.65). NICU couplet care was associated with improved parental stress and breastfeeding outcomes during hospitalization.

Parent-child relationship measures and pre-post treatment changes for a clinical preschool sample using DC:0-3R

BackgroundTo reduce psychopathologies in children, various treatment approaches focus on the parent-child relationship. Disruptions in the parent-child relationship are outlined in the most recently revised versions of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R/DC:0–5). The measures used to assess the parent-child relationship include the Parent-Infant Relationship Global Assessment Scale (PIRGAS) and the Relationship Problems Checklist (RPCL), which cover, e.g., essential concepts like over- or underinvolvement of the caregiver. However, not much is known about the cross-sectional and predictive value of PIRGAS and RPCL scores at admission to discharge, namely whether changes in these scores are correlated with child and maternal psychopathologies and changes through treatment.MethodsBased on clinical records of 174 preschool-aged children of the Family Day Hospital, we report related basic descriptive data and changes from admission to discharge for the parent-child relationship, child behaviour, and maternal psychopathology. We used a Pearson correlation or a point-biserial correlation to describe the associations and performed a paired t-test to examine differences before and after measurement.ResultsOur results show overall improvements in our parent-child relationship measures and in child and maternal psychopathology. However, we observed little or no correlation between the parent-child relationship measures and child or maternal psychopathology.ConclusionsWe highlight potential drawbacks and limitations of the two relationship measures used that may explain the results of this study on the associations between the variables assessed. The discussion emphasizes the assessment of DC:0-3R/DC:0–5, which are popular in clinical practice for economic reasons.

Joint observation in NICU (JOIN): A randomized controlled trial testing an early, one-session intervention during preterm care to improve perceived maternal self-efficacy and other mental health outcomes.

Parents of preterm infants in the Neonatal Intensive Care Unit (NICU) environment may experience psychological distress, decreased perceived self-efficacy, and/or difficulties in establishing an adaptive parent-infant relationship. Early developmental care interventions to support the parental role and infant development are essential and their impact can be assessed by an improvement of parental self-efficacy perception. The aims were to assess the effects of an early intervention provided in the NICU (the Joint Observation) on maternal perceived self-efficacy compared to controls (primary outcome) and to compare maternal mental health measures (perceived stress, anxiety, and depression), perception of the parent-infant relationship, and maternal responsiveness (secondary outcomes). This study was a monocentric randomized controlled trial registered in clinicatrials.gov (NCT02736136), which aimed at testing a behavioural intervention compared with treatment-as-usual. Mothers of preterm neonates born 28 to 32 6/7 weeks gestation were randomly allocated to either the intervention or the control groups. Outcome measures consisted of self-report questionnaires completed by the mothers at 1 and 6 months after enrollment and assessing perceived self-efficacy, mental health, perception of the parent-infant relationship and responsiveness, as well as satisfaction with the intervention. No statistically significant group effects were observed for perceived maternal self-efficacy or the secondary outcomes. Over time, perceived maternal self-efficacy increased for mothers in both groups, while anxiety and depression symptoms decreased. High satisfaction with the intervention was reported. The joint observation was not associated with improved perceived maternal self-efficacy or other mental health outcomes, but may constitute an additional supportive measure offered to parents in a vulnerable situation during the NICU stay.

Examining the implications of contextual stress and maternal sensitivity for infants’ cortisol responses to the still face paradigm

Infants’ hypothalamic-pituitary-adrenocortical (HPA) axis responses to acute stressors are theorized to be shaped by parents’ sensitive responsiveness to infants’ cues. The strength and direction of the association between maternal sensitivity and infants’ HPA responses may depend on the context in which maternal sensitivity is observed and on broader environmental sources of stress and support. In this preregistered study, we used data from 105 mothers and their 7-month-old infants to examine whether two empirically identified forms of contextual stress—poor maternal psychosocial wellbeing and family socioeconomic hardship—moderate the association between maternal sensitivity and infants’ cortisol responses to the Still-Face Paradigm (SFP). Results indicated that maternal sensitivity during the free play and family socioeconomic hardship interacted to predict infants’ cortisol responses to the SFP. Specifically, maternal sensitivity during this non-distressing interaction was negatively associated with cortisol responses only among infants whose mothers were experiencing relatively high socioeconomic hardship. Exploratory analyses revealed that poor maternal psychosocial wellbeing was positively associated with overall infant cortisol production during the SFP. Altogether, these findings suggest that experiences within early parent-infant attachment relationships and sources of contextual stress work together to shape infant HPA axis activity.

Study protocol for a systems evaluation of an infant mental health service: Integration of 'Little Minds Matter' into the early years system.

Infant Mental Health relates to how well a child develops socially and emotionally from birth to age three. There is a well-established link between parent-infant relationship quality, Infant Mental Health, and longer-term social and emotional development there is a lack of evidence-based interventions that support the parent-infant relationship and/or protect against poor Infant Mental Health. Little Minds Matter is a specialist Infant Mental Health service developed in Bradford (UK) to support parent-infant relationships by providing training and consultation for professionals and direct clinical work to families. The successful implementation of this intervention depends upon how well it becomes embedded within, or integrated into, the early years system. For the purposes of this study, the early years system includes health, social and education services that support child health and development from conception to primary school entry at age five. This study protocol aims to apply a systems approach to evaluate this service and provide a perspective on the process of embedding a complex service within a healthcare system. Multiple methods will be used to investigate embeddedness within the wider early years system. Routinely collected quantitative data about the service will be used to develop a system map showing interaction with related services. Qualitative data will be collected at two time points through interviews with individuals involved in the design and provision of the service, and professionals working within the early years system. Framework analysis will be used to analyse the data inductively and deductively within a systems approach. The findings from this study will provide evidence to inform the ongoing implementation of the service for providers and commissioning bodies. Exploring the application of a systems approach in this clinical context will have application more broadly for researchers evaluating complex interventions and services within a wider system.

Video feedback for young babies and maternal perinatal mental illness: intervention adaptation, feasibility and acceptability.

We aimed to adapt, pilot and explore experiences of receiving and delivering the video feedback intervention for positive parenting (VIPP) for 2 to 6 month old babies, mothers experiencing moderate to severe perinatal mental health difficulties and perinatal mental health clinicians. The VIPP intervention was adapted to include developmentally appropriate activities and developmental psychoeducation for 2 to 6 month olds, alongside psychoeducation on emotion regulation, and then piloted in 14 mothers experiencing moderate to severe perinatal mental health difficulties (registration ISRCTN64237883). Observational and self-reported pre-post outcome data on parenting and parent-infant mental health was collected, and post-intervention qualitative interviews were conducted with participating mothers and clinicians. Consent (67%), intervention completion (79%) and follow-up rates (93%) were high. Effect sizes on pre-post outcome measures indicated large improvements in parenting confidence and perceptions of the parent-infant relationship, and a medium-size improvement in maternal sensitivity. In qualitative interviews, clinicians and mothers described how mothers' initial anxieties about being filmed were allayed through receiving positive and strengths-focussed feedback, boosting their self-confidence, and that the video feedback facilitated identification of young babies' subtle behavioural cues and moments of mother-infant connection. Streamlining the information provided on maternal emotion regulation, and allowing increased use of clinical judgement to tailor intervention delivery, were suggested to optimise intervention feasibility and acceptability. It is feasible and acceptable to implement VIPP with very young babies and their mothers experiencing perinatal mental health difficulties. A fully powered randomised controlled trial is required to establish intervention efficacy.

Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants.

Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants.

Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying.

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N=389) of infant carrying (six times a week or daily) and parents reporting low levels (N=128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

Mother–infant bonding in the first nine months postpartum: the role of mother’s attachment style and psychological flexibility

ABSTRACT Introduction Mother’s bond to the infant in the postpartum period plays an important role in the subsequent mother–infant relationship and the infant’s socio-emotional functioning. Several maternal characteristics, such as attachment style and psychological flexibility, may contribute to the quality of mother–infant bonding, though literature examining these variables is still scarce. The present study aimed to examine the impact of mother’s attachment on mother–infant bonding in the first month postpartum and the mediating role of psychological flexibility on that association. Methods Participants were 226 mothers of an infant up to 9 months old, who reported on their own attachment style (in terms of anxiety, comfort with proximity, trust in others), psychological flexibility (in terms of openness to experience, behavioural awareness, valued action) and mother–infant bonding. Results Results showed that mother’s attachment anxiety predicted a bond with the infant directly and indirectly via mother’s psychological flexibility, specifically through behavioural awareness and valued action. Trust in others had an impact on mother–infant bonding through behavioural awareness, whereas comfort with proximity influenced mother–infant bond indirectly, via valued action. Finally, mothers’ civil status, schooling and number of children were relevant to better understand the variance of our mediating and dependent variables. Discussion Our findings highlight the importance of mother’s attachment and psychological flexibility in promoting the quality of mother–infant bonding, which can inform future intervention programmes targeting modifiable factors, such as psychological flexibility, to promote early positive parent–infant relationships, particularly for single, first-time mothers, with higher levels of education.

Predictive role of NICU-related stress, postpartum depression trajectory and family coping on growth trajectory of moderate-to-late preterm infants: A longitudinal study.

To describe the changes in moderate-to-late preterm infants' (MLPIs) growth during 12 months of corrected age (CA) and to examine the predictive role of NICU-related stress, postpartum depression trajectory and family coping ability on the physical developmental trajectory of MLPIs. A prospective longitudinal study. There were 237 mother-infant dyads with at least two follow-up data records included. General characteristics and NICU-related stress were recorded from medical records at baseline. Infants' physical growth was measured at 40 weeks, 1, 3, 6, 9 and 12 months CA during outpatient follow-up. Maternal postpartum depressive symptoms and family coping ability were assessed by questionnaires at 1, 3, 6, 9 and 12 months CA and 1 month CA respectively. We investigated the modifiable factors inside and outside of NICU on the trajectories of physical growth in the first year in MLPIs, mainly by using latent growth curve models with time-varying covariates. The curved trajectories of weight, length and head circumference in the first year in MLPIs demonstrated gradually slowed growth rates and these infants were above the WHO growth standards for the same age and sex. The latent growth curve models indicated that more NICU-related stress was negatively associated with the weight and length at 40 weeks CA, and family coping ability (parent-child relationship) at 1 month CA was associated with the growth rate of weight. Besides, more NICU-related stress predicted faster length growth rate. The infants of mothers who were in the group of high-level postpartum depression trajectory had a slower growth rate of head circumference. Our study identified the modifiable factors along the care continuum influencing the trajectory of MLPIs' physical growth. Nurses should receive more training about infant stress measurement and family-centred care to work in partnership with parents so that MLPIs can reach their full developmental potential. Also, multidisciplinary interventions including stress reduction strategies, close psychological monitoring and education improving parent-infant relationships should be further developed to achieve optimizing growth in the first year of MLPIs. It is recommended that nurses pay attention to the long-term physical growth status of MLPIs, and closely support their families. Quantifying NICU-related stress and developing reduction strategies should be the priority for clinical staff during hospitalization. After discharge, persistent screening of depressive symptoms, psychological intervention and education about the parent-child relationship need to be included in the follow-up visits. No patient or public contribution. The study only included patients who were research participants.

Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic.

Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (β=.805, p=.029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.

The Stress Levels of Premature Infants' Parents and Related Factors in NICU.

Parental stress related to their infants' hospitalization is a significant concern that affects both parents and their infants. Fathers' experiences tend to be understudied compared to mothers. Further research on fathers' stress levels is necessary. While parental stress has been correlated with infant health severity, the specific causes and risk factors contributing to heightened stress levels in parents of neonatal intensive care unit (NICU) infants are not yet fully understood and require further investigation. This study aimed to examine the stress levels experienced by parents of premature infants in the NICU and to explore the factors associated with parental stress in this specific context. A cross-sectional observational design was used to accomplish this study, which was carried out on 743 parents from nine different NICUs located in governmental hospitals across various locations in Egypt. We used characteristics of parents and premature infants, and Parent Stress Scale was used for data collection. A majority of parents reported experiencing high stress in the following domains: sight and sound (80.3%), infants' appearance (69%), and the parent-infant relationship (81.4%). Additionally, about three-quarters (73.6%) of parents experienced high stress overall, with a mean score of 167.56 (21.3). About three-quarters of the parents experienced high overall stress levels. Also, factors that were found to affect parents' stress levels included premature infants connected to mechanical ventilators, previous neonatal death, parents living far from hospitals, infants delivered through cesarean section, insufficient income, and prolonged hospitalization beyond 5 days.

Parental stress and associated factors among parents of preterm neonates admitted at neonatal intensive care unit among selected governmental hospitals Addis Ababa, Ethiopia, 2022. An institution-based cross-sectional study.

The birth of a preterm infant and their subsequent admission to the Neonatal Intensive Care Unit (NICU) is a distressing and challenging experience for parents. The stress experienced by parents can have a significant impact on their mental health, parenting behaviors, and the parent-infant relationship. Recognizing and addressing the stressors faced by parents in the NICU is essential for promoting their well-being and facilitating positive parent-infant interactions. A cross-sectional study was conducted at healthcare facilities. The participants for the study were selected using a systematic sampling method, where the sampling interval (K) was calculated for each hospital. Data collection involved the use of a pretested structured questionnaire administered by interviewers. The collected data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 25.0. Simple and multivariable linear regression analyses were performed. Statistical significance was determined using a p-value of less than 0.05. The accompanying mother (β = 3.094, 95% CI: 3.615, 6.550), length of NICU stay greater than 10 days (β = 5.823, 95% CI: 1.759-9.887), the gestational week between 34 -37 weeks (β = -3.509, 95% CI: -6.358, -.659), parents with college degrees and above (β = -8.667, 95% CI: (-14.111,3.223), mothers who delivered via cesarean section (β = 2.468, 95% CI: -1.822, 4.759), parents without a history of neonatal NICU admission (β = -6.16, 95% CI: -11.69, -.63), and parents whose infant without ventilation (β = -2.755, 95% CI:. -5.492, -.0189) were significantly associated with parental stress. Parent in this setting revealed high levels of stress during their premature infants' NICU admission. The gestational week, educational status of the parents, mode of admission, and mode of delivery were found to have significant associations with parental stress. It is important for healthcare providers to recognize and understand the stress experienced by parents when caring for families with preterm infants in the NICU. They should provide support and assistance to parents as they navigate the challenges and stress that come with this situation.

The Lausanne Trilogue Play: bringing together developmental and systemic perspectives in clinical settings

AbstractDevelopmentalists have demonstrated that the quality of relationships established by infants with their proximal social environment is crucial for lifecourse development. However, studies of parent–infant relationships have mostly centred on the mother–child dyad. Stemming from family systems theory that considers interactions within the whole family as critical for an individual's personal development, a group of family therapists and researchers in Lausanne (Switzerland) tried to bridge the gap between systemic and developmental thinking by stressing the need to establish the mother–father–infant triad as a collective unit of study. In response, they created the Lausanne Trilogue Play (LTP), a method to systematically assess the quality of mother–father–infant interactions. The LTP is an observational situation during which parents are asked to play with their infant in four parts: (i) one parent plays with the infant, while the other parent is ‘simply present’; (ii) the parents switch roles; (iii) all three play together; (iv) the parents discuss in front of the infant. The theoretical model underpinning the LTP is the family alliance model, which postulates that the quality of the coordination demonstrated by the triad to achieve this task can be assessed mainly through careful observation of non‐verbal behaviours as indicators of the achievement of four interactive functions (i.e., participation, organisation, focalisation, affect sharing); fulfilment of these functions determines the quality of relational functioning within the system. This article introduces the clinical, theoretical, and empirical foundations of using the LTP method with the family alliance model; its use in clinical and research contexts; and the most recent advances in the field of research on mother–father–infant interactions based on the LTP situation.