Attachment representations among substance-abusing women in transition to motherhood: implications for prenatal emotions and mother-infant interaction.

We studied how attachment representations contribute to central components of transition to motherhood, prenatal emotion processing (EP) and emotional availability (EA) of mother-infant interaction, and whether there are group specific differences. Participants were 51 treatment-enrolled substance-abusing (SA) mothers and their infants and 50 non-using comparison dyads with obstetric risk. Mother's attachment representations (AAI) and EP were assessed prenatally and EA when infants were four months. Results showed that autonomous attachment only had a buffering effect on prenatal EP among comparisons. All SA mothers showed more dysfunctional EP than comparisons and, contrary to comparisons, autonomous SA mothers reported more negative cognitive appraisals and less meta-evaluation of emotions than dismissing SA mothers. Preoccupied SA mothers showed high negative cognitive appraisals, suggesting under-regulation of emotions. Attachment representations were not associated with EA in either group; rather, SA status contributed to global risk in the relationship. Surprisingly, autonomous SA mothers showed a tendency towards intrusiveness. We propose that obstetric risk among comparisons and adverse relational experiences among almost all SA mothers might override the protective role of mother's autonomous representations for dyadic interaction. We conclude that prenatal emotional turbulence and high interaction risk of all SA mothers calls for holistic treatment for the dyad.

Maternal representations and emotional availability among drug-abusing and nonusing mothers and their infants.

Both negative and idealized maternal prenatal representations may constitute a risk for mother-infant interaction. This study analyzed the role of maternal prenatal representations and pre- to postnatal representational change in predicting mother-infant emotional availability (EA) among 51 drug-abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self-as-mother, and self-as-woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008) at 4 and 12 months. The results showed that drug-abusing mothers had more negative prenatal representations of the self-as-woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self-as-mother predicted mother-infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother-infant EA whereas for drug-abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug-abusing mothers should aim at supporting the development of a realistically positive view of motherhood.

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug-abusing mothers.

The purpose of this controlled study was to examine the outcome of psychodynamic mother-infant group psychotherapy (PGT) outpatient intervention for drug-abusing perinatal mother-infant dyads. PGT comprised 20 to 24 weekly 3-hr sessions with 3 to 5 months of follow-up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother-infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother-infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug-abusing dyads in PGT, 25 in PSS, and 50 dyads in a non-drug-abusing comparison group. Assessments were pre-intervention and at 4 and 12 months' follow-up, including maternal depressive symptoms and mother-child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother-infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high-risk dyads.