The genesis of perinatal clinical psychology and its contemporary issues.

The main aim of French clinical psychology is to explain the psychic processes of transformation, to which the subject is central. In this context, transformations in the perinatal period open an innovating field in perinatal clinical psychology focused on the conscious/subconscious, subjective/inter-subjective psychic reality of a subject who is in the process of becoming (or becoming once again) a parent and being born a human.

Prenatal attachment, anxiety and grief during subsequent pregnancy after medical termination of pregnancy. Attachment to which child?

PURPOSE: To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS: Observational study, in a French Tertiary Maternity. POPULATION: 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS: Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p = 0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION: This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.

[How can the process of paternity in neonatology be boosted?] / Comment dynamiser le processus de paternalité en néonatologie ?

Premature birth is a test for fatherhood's process: it may hinder the ability to feel like a father or like a good father, and the ability to make the baby be part of the family line. A clinical research did explore how care givers in neonatal services may deploy psychic functions which support and revitalize a process of fatherhood which is potentially disturbed.

International Health Practices: A Multidisciplinary Approach to Therapeutic Mediations With an Artistic Medium Based on the Model of Play.

This article, corresponding to a part of the restitution of a financed international research project between France, Brazil, Canada, Italy and Belgium, aims to offer a modelisation and qualitative evaluation of mediation care settings based on an original methodological tool that involves identifying the typical games at the foundations of creativity, following a multidisciplinary perspective. Therapeutic mediations are settings or devices organized around a "pliable medium," often artistic, like painting, modeling, writing and theater, which are very widespread in institutional practices, both in France and abroad. The scientific objectives of this research consist in a multi-disciplinary exploration (anthropology, criminology, neuroscience, clinical psychology) of the process of creative symbolization understood as a process of transformation involving play. According to this orientation, play can be defined as a psychic process whereby a subjective experience can be explored with pleasure, and consequently symbolized and appropriated. Our fundamental and original hypothesis is that play is at the source of the creative process, conceived as a work of metabolization by the psyche of playful experiences during the different stages of life. The review of the understanding of play in psychoanalysis, anthropology, criminology and neuroscience emphasizes the richness of this model and the importance of reflecting on the typical games in the field of psychic care. A clinical example of treatment in a pictorial therapeutic mediation setting of a child with psychotic disorders makes it possible to identify a number of typical games as well as the modalities of interpretation of the therapists through play. These multidisciplinary studies lead to the presentation of a general table of typical games, and these first results highlight the richness of identifying typical games in clinical settings. Ultimately, the multidisciplinary approach shows the interest of the model of play in the evaluation of therapeutic mediation settings, with a convergence of the different disciplines emphasizing the pertinence of this model. The scientific impact of this research overlaps with its societal impact, through the development of innovative tools for evaluating therapeutic mediations, in order to take account of the evolution of the different forms of social expression of psychic suffering.

[The drawing of ultrasound scan, an indicator of the quality of maternal representations]. / Le dessin d'échographie, un indicateur de la qualité des représentations maternelles.

Between 2012 and 2014, a study was carried out of women pregnant for the first time to find out more about their experience of the ultrasound scan. The drawing of the image of the ultrasound scan was the main methodological tool used in the study. It enables the quality of the perception of the ultrasound scan to be linked to the quality of maternal representations. Based on the context of the ultrasound scan, elements of prenatal prevention around parenthood are addressed.

Gênese e questões epistemológicasda psicologia clínica perinatal / Genesis and epistemological issues in perinatal clinical psychology

A recente exploração das origens e das questões epistemológicas da psicologia clínica perinatal requer a retomada da fonte matricial da psicologia clínica, que se define por seu objeto de dupla face: a exploração do cotidiano da realidade psíquica consciente/inconsciente, subjetiva/intersubjetiva do sujeito em questão sob as formas individual/grupal, normais”/“patológicas”; a implementação prática de dispositivos de encontros intersubjetivos propícios à observação da processualidade associativa verbal/não verbal, focal/livre e a significação subjetivante de suafenomenologia e de seus obstáculos conflitivos inibidores ou dissociativos. A metodologia clínicadesta realidade psíquica é inseparável da sua implementação no contexto cruzado de todos osatores envolvidos. Da mesma forma, a primeira face do objeto da psicologia clínica perinatal será a exploração do cotidiano da realidade psíquica consciente/inconsciente, subjetiva/intersubjetivado sujeito em situação de tornar-se (novamente) pai, nascer humano e ser cuidador sob as formas “normais”/“patológicas”, individual, conjugal e grupal. A atenção direcionada àpossibilidade de os pais e cuidadores se beneficiarem de ambientes íntimos, privados e institucionaispropícios à metabolização desta amplificação da processualidade associativa verbal enão-verbal (somática, em particular) inerente às transformações biopsíquicas da parentalização, bem como ao seu acompanhamento profissional, constitui a segunda face do objeto da psicologiaclínica perinatal. A promessa heurística da psicologia clínica perinatal é discutida.

Social signal processing for studying parent-infant interaction.

Studying early interactions is a core issue of infant development and psychopathology. Automatic social signal processing theoretically offers the possibility to extract and analyze communication by taking an integrative perspective, considering the multimodal nature and dynamics of behaviors (including synchrony). This paper proposes an explorative method to acquire and extract relevant social signals from a naturalistic early parent-infant interaction. An experimental setup is proposed based on both clinical and technical requirements. We extracted various cues from body postures and speech productions of partners using the IMI2S (Interaction, Multimodal Integration, and Social Signal) Framework. Preliminary clinical and computational results are reported for two dyads (one pathological in a situation of severe emotional neglect and one normal control) as an illustration of our cross-disciplinary protocol. The results from both clinical and computational analyzes highlight similar differences: the pathological dyad shows dyssynchronic interaction led by the infant whereas the control dyad shows synchronic interaction and a smooth interactive dialog. The results suggest that the current method might be promising for future studies.

Why synchrony matters during mother-child interactions: a systematic review.

BACKGROUND: Assessment of mother-child interactions is a core issue of early child development and psychopathology. This paper focuses on the concept of "synchrony" and examines (1) how synchrony in mother-child interaction is defined and operationalized; (2) the contribution that the concept of synchrony has brought to understanding the nature of mother-child interactions. METHOD: Between 1977 and 2013, we searched several databases using the following key-words: "synchrony" "interaction" and "mother-child". We focused on studies examining parent-child interactions among children aged 2 months to 5 years. From the 63 relevant studies, we extracted study description variables (authors, year, design, number of subjects, age); assessment conditions and modalities; and main findings. RESULTS: The most common terms referring to synchrony were mutuality, reciprocity, rhythmicity, harmonious interaction, turn-taking and shared affect; all terms were used to characterize the mother-child dyad. As a consequence, we propose defining synchrony as a dynamic and reciprocal adaptation of the temporal structure of behaviors and shared affect between interactive partners. Three main types of assessment methods for studying synchrony emerged: (1) global interaction scales with dyadic items; (2) specific synchrony scales; and (3) micro-coded time-series analyses. It appears that synchrony should be regarded as a social signal per se as it has been shown to be valid in both normal and pathological populations. Better mother-child synchrony is associated with familiarity (vs. unknown partner), a healthy mother (vs. pathological mother), typical development (vs. psychopathological development), and a more positive child outcomes. DISCUSSION: Synchrony is a key feature of mother-infant interactions. Adopting an objective approach in studying synchrony is not a simple task given available assessment tools and due to its temporality and multimodal expression. We propose an integrative approach combining clinical observation and engineering techniques to improve the quality of synchrony analysis.

Génesis y aspectos epistemológicos de la psicología clínica perinatal / Genesis and epistemological aspects of perinatal clinical psychology

El primer aspecto a tener presente de la psicología clínica perinatal será explorar la cotidianeidad de la realidad psíquica consciente-inconsciente, subjetiva-intersubjetiva del sujeto en situación de (re)convertirse en padre, en cuidador o nacer humano. Atender para que padres y cuidadores puedan beneficiarse de instituciones propicias que permitan la metabolización de los procesos asociativos verbales y no verbales (sobre todo somáticos) inherentes a las transformaciones biopsicológicas de la paternidad y el acompañamiento profesional, constituyen el segundo aspecto. Se discute el compromiso heurístico de la psicología clínica perinatal (AU)

The principal objective of perinatal clinical psychology is to explore daily psychic conscious-unconscious reality and the subjective-intersubjective situation of the subject to become a parent, carer or newborn. The attention given to opportunities for parents and caregivers to benefit from intimate, private and institutional environments for the metabolization and amplification of verbal and nonverbal associative processes (specially somatic) inherent to biopsychic transformations is essential. The heuristic compromise of perinatal clinical psychology is discussed in the article (AU)