Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions.

A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.

Observing and interpreting clinical process: Methods and findings from 'Layered analysis' of parent-infant psychotherapy.

This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi-faceted microanalytic research approaches. Findings from the application of Layered Analysis to video-recorded micro-events of rupture and repair in four psychoanalytic parent-infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co-constructed micro-events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self-organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re-establishing self-regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes.

Este ensayo describe un método para investigar un proceso clínico, Análisis en Capas, el cual combina los reportes de contratransferencia del terapeuta y los acercamientos investigativos micro analíticos multifacéticos. Se presentan los resultados de aplicar Análisis en Capas a micro eventos, grabados en video, de ruptura y reparación en cuatro sesiones de sicoterapia sicoanalítica de progenitor e infante. Los Análisis en capas mostraron que la contratransferencia y la observación son perspectivas complementarias que, en combinación, permiten el estudio concomitante de eventos interactivos, experiencias internas conscientes, así como elementos no conscientes de la interacción terapéutica. Adicionalmente, los resultados mostraron que la ruptura y la reparación constituyen micro eventos co-construidos que ocurren muy fugazmente y a menudo implícitamente, y que difieren en la estructura, coherencia, flujo de interacciones y en la relación entre la comunicación verbal y no verbal. Es más, rupturas interaccionales pueden 'meterse en' el terapeuta y transitoriamente interrumpir su autoorganización, de manera que el terapeuta se convierte en un punto de interrupción para el paciente y la ruptura pasa a ser parte del sistema terapéutico. La reparación interactiva está sostenida por, y depende de, la metabolización del terapeuta de los aspectos incorporados y verbales de la ruptura. Estudiar tales procesos puede mejorar nuestra comprensión del proceso clínico y ser usado en entrenamiento y supervisión de terapeutas.

Cet article décrit une méthode d'investigation du processus clinique d'Analyse Multidimensionnelle en Couches, qui combine des rapports de contre-transfert du thérapeute et des approches de recherche micro-analytique à facettes multiples. Les résultats de l'application de l'analyse multidimensionnelle en couches à des micro-événements enregistrés à la vidéo de rupture et de réparation dans quatre séances de psychothérapie psychanalytiques parent bébé sont présentés. L'analyse multidimensionnelle en couches a montré que le contre-transfert et l'observation sont des perspectives complémentaires qui, combinés l'un avec l'autre, permettent une étude concomitante d'événements interactifs, d'expériences internes conscientes et d'éléments non-conscients de l'interaction thérapeutique. De plus, les résultats ont montré que la rupture et la réparation constituent des micro-événements co-construits, qui se passent très fugacement et souvent implicitement et diffèrent en structure, cohérence et flux des interactions et dans la relation entre la communication verbale et non verbale. Enfin les ruptures interactionnelles peuvent 'entrer' dans le thérapeute et perturber de façon transitoire leur auto-organisation, de telle manière que le thérapeute devient le locus de la perturbation pour le/la/les patient(e/s) et la rupture s'encastre dans le système thérapeutique. La réparation interactive est étayée par, et elle en dépend également, la métabolisation d'aspects verbaux et incarnés de la rupture du thérapeute. L'étude de tels processus peut améliorer notre compréhension du processus clinique et être utilisée dans la formation et la supervision des thérapeutes.

Trust me! Parental embodied mentalizing predicts infant cognitive and language development in longitudinal follow-up.

Children's cognitive and language development is a central aspect of human development and has wide and long-standing impact. The parent-infant relationship is the chief arena for the infant to learn about the world. Studies reveal associations between quality of parental care and children's cognitive and language development when the former is measured as maternal sensitivity. Nonetheless, the extent to which parental mentalizing - a parent's understanding of the thoughts, feelings, and attitudes of a child, and presumed to underlie sensitivity - contributes to children's cognitive development and functioning, has yet to be thoroughly investigated. According to the epistemic trust theory, high mentalizing parents often use ostensive cues, which signal to the infant that they are perceived and treated as unique subjective beings. By doing so, parents foster epistemic trust in their infants, allowing the infant to use the parents a reliable source of knowledge to learn from. Until recently, parental mentalizing has been limited to verbal approaches and measurement. This is a substantial limitation of the construct as we know that understanding of intentionality is both non-verbal and verbal. In this investigation we employed both verbal and non-verbal, body-based, approaches to parental mentalizing, to examine whether parental mentalizing in a clinical sample predicts children's cognitive and language development 12 months later. Findings from a longitudinal intervention study of 39 mothers and their infants revealed that parental embodied mentalizing in infancy significantly predicted language development 12 months later and marginally predicted child cognitive development. Importantly, PEM explained unique variance in the child's cognitive and linguistic capacities over and above maternal emotional availability, child interactive behavior, parental reflective functioning, depression, ethnicity, education, marital status, and number of other children. The theoretical, empirical, and clinical implications of these findings are discussed.

The assessment of representational risk (ARR): Development and psychometric properties of a new coding system for assessing risk in the parent-infant relationship.

There are few clinically valid tools that can be used to assess potential parent-infant relational risk. This study describes the development and initial validation of the assessment of representational risk (ARR) coding system to be applied to the parent development interview (Slade, A., Aber, J. L., Bresgi, I., Berger, B., & Kaplan, M. (2004). The Parent Development Interview - Revised. Unpublished protocol. New York, NY: The City University of New York.) for assessing potential risk in caregivers' representations of their infant, themselves as parents, and their relationship. The ARR was developed and validated in three samples in England. A review of the literature informed the selection of 10 items. It had a three-factor structure that was used to inform subscales: hostile, helpless, and narcissistic caregiving representations. The subscales and total risk scores showed good criterion validity for discriminating between high and low risk samples and good concurrent validity with measures of parental psychopathology and parent-infant interaction. The ARR is a potentially valuable coding system for identifying risk in early attachment relationships.

Hay pocas herramientas clínicamente válidas que pueden usarse para evaluar los posibles riesgos en la relación progenitor-infante. Este estudio describe el desarrollo y la convalidación inicial de la Evaluación del Riesgo Representacional (ARR), un sistema de codificación para aplicarse a la Entrevista del Desarrollo del Progenitor (PDI; Slade et al., 2004) para evaluar el posible riesgo en las representaciones que los cuidadores tienen de sus infantes, de ellos mismos como padres y de sus relaciones. La ARR se desarrolló y se convalidó en tres grupos muestras en Inglaterra. Una revisión de la información disponible sirvió de base para la selección de 10 puntos. La misma tenía una estructura de tres factores que se usó como base en las subescalas: representaciones para prestar cuidado de tipo Hostil, Desesperanzado y Narcisista. Los puntajes de las subescalas y los totales mostraron buen criterio de validez para diferenciar entre los grupos muestras de alto y bajo riesgo, así como una buena validez concurrente con las medidas de sicopatología de progenitores y la interacción progenitor-infante. La ARR es un sistema de codificación de valor potencial para identificar el riesgo en las tempranas relaciones de afectividad.

Il existe peu d'outils cliniquement valables qui peuvent être utilisés pour évaluer le risque relationnel potentiel parent-nourrisson. Cette étude décrit le développement et la validation initiale du système de codage Evaluation du Risque Représentationnel (abrégé ici ERR en français) destiné à être appliqué à l'Entretien du Développement du Parent (PDI; Slade et al., 2004) pour évaluer le risque potentiel dans les représentations que les parents se font de leur nourrisson, d'elles-mêmes ou d'eux-mêmes en tant que parents, et de leur relation. L'ERR a été développé et validé dans trois échantillons en Angleterre. Une revue des recherches a éclairé la sélection de 10 éléments. Celle-ci a suivi une structure de 3 facteurs qui ont été utilisés pour éclairer les sous-échelles: représentations des parents de l'enfant Hostiles, Impuissantes, Narcissiques. Les Sous-échelles et les scores de risque total ont fait preuve d'une bonne validité du critère pour séparer les échantillons à risque élevé et à faible risque, et d'une bonne validité concurrente avec des mesures de psychopathologie parentale et d'interaction parent-nourrisson. L'ERR s'avère pouvoir être un système de codage utile pour l'identification du risque dans les relations d'attachement précoce.

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta-analysis.

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent-infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta-analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta-analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta-analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta-analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: -0.46; 95% confidence interval [CI] [-0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent-infant interaction (SMD: -0.10; 95% CI [-0.46, 0.26]), parental depression (SMD: -1.55; 95% CI [-3.74, 0.64]) or parental global distress (SMD: -0.19, 95% CI [-3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation-based treatment with non-mentalization-based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.

El funcionamiento de reflexión del progenitor (PRF) es un factor importante de predicción de la afectividad del infante, y las intervenciones que se enfocan en díadas progenitor/infante/niño pequeñito que experimentan problemas significativos tienen la posibilidad de mejorar el PRF. La meta de esta revisión fue evaluar la eficacia de las intervenciones diádicas que se enfocan en los progenitores de infantes y niños pequeñitos, para mejorar el PRF y un número de resultados secundarios. Se llevó a cabo una revisión sistemática y un meta-análisis en los que se investigaron bancos de información electrónica claves hasta octubre de 2018. Se identificaron estudios elegibles y se sacó de ellos la información. Se sintetizó esa información usando meta-análisis y la misma fue presentada tanto en términos de dimensión de efectos como la proporción de riesgo. Se identificaron seis estudios que aportaron un total de 521 participantes. Los resultados de seis meta-análisis mostraron un moderado, poco significativo y limítrofe mejoramiento en cuanto al PRF en el grupo de intervención (SMD: -0.46; 95% CI -0.97, 0.04), una reducción significativa en la afectividad desorganizada (RR: 0.50; 95% CI: 0.27, 0.90), pero no así en la afectividad segura (OR: 0.71; 95% CI: 0.19, 2.64), y ninguna evidencia de beneficio para la interacción progenitor-infante (SMD: -0.09; 95% CI: -0.51, 0.32). Se dio un mejoramiento grande no significativo en la depresión del progenitor (SMD: -1.55; 95% CI -3.74, 0.64), pero no hubo evidencia de beneficio en cuanto a la angustia total (SMD: -0.19; 95% CI: -3.04, 22.65). Se discuten las implicaciones para la futura investigación.

Le fonctionnement parental réfléchi (en anglais Parental Reflective Functioning, soit PRF) est un facteur de prédiction important de l'attachement du bébé, et les interventions qui ciblent les dyades parent-bébé/petit enfant qui font l'expérience de problèmes importants ont le potentiel d'améliorer le fonctionnement PRF. Le but de cette article était d'évaluer l'efficacité d'interventions dyadiques ciblant les parents de bébés et de petits enfants, en améliorant le fonctionnement PRF et un bon nombre de résultats secondaires. Une revue et une méta-analyse ont été faites, les bases de données électroniques clés ayant été passées au crible en octobre 2018. Les études pouvant être utilisées ont été identifiées et les données ont été extraites. Les données ont été synthétisées en utilisant une méta-analyse et exprimées sous forme d'ampleur de l'effet et de risque relatif. Six études ont été identifiées, pour un total de 521 participants. Les résultats de six méta-analyses ont montré une amélioration limite non importante modérée dans le PRF dans le groupe d'intervention (SMD: -0,46; 95% CI -0,97, 0,04), une réduction importante dans l'attachement désorganisé de l'enfant (RR: 0,50; 95% CI: 0,27, 0,90) mais non dans l'attachement sécure (OR: 0,71; 95% CI: 0,19, 2,64), ainsi qu'aucune preuve de bénéfice pour l'interaction parent-bébé (SMD: -0,09; 95% CI -0,51, 0,32). Il y avait une grande amélioration non-importante dans la dépression parentale (SMD: -1,55; 95% CI -3,74, 0,64) mais aucune preuve de bénéfice dans la détresse globale (SMD: -0,19; 95% CI: -3,04, 22,65. Les implications pour les recherches futures sont discutées.

Studying the process of psychoanalytic parent-infant psychotherapy: Embodied and discursive aspects.

This paper presents findings from an intensive, mixed methods case study of one session of psychoanalytic parent-infant psychotherapy (PPIP) addressing early relational trauma, and aims to shed light on the multimodal interactive processes that take place in the moment-to-moment exchanges comprising the therapeutic encounter. Different research methods were used on video material from PPIP sessions, including microanalysis of adult-infant interactions, discourse analysis of talk, and coding systems developed to study parent-infant interaction. These different perspectives were brought together with the clinical narrative to illuminate the complex, dynamic processes of parent-infant-therapist interaction. More specifically, the detailed analysis of one interactive episode revealed brief behavioral manifestations of fearful and disoriented states of mind, reflecting dysregulated interaction between mother and infant, which also powerfully affected the therapist. The processes through which the therapist gradually resolves this rupture are also described in detail. Through this pilot study, we were able to show that it is possible to systematically study the process of PPIP. The study contributes to the growing psychotherapy research literature that takes into account both the verbal domain and implicit, interactional processes in therapeutic practice, and underscores the therapist's comprehensive engagement in the therapeutic process.

Este ensayo presenta resultados de un intensivo estudio de caso, con métodos mixtos, de una sesión de sicoterapia sicoanalítica de progenitor e infante (PPIP) dirigida al temprano trauma en la relación, y se propone arrojar luz sobre los procesos interactivos multimodales que se llevan a cabo en los intercambios de momento a momento que componen el encuentro terapéutico. Se usaron diferentes métodos de investigación en el material de video de las sesiones de PPIP, incluyendo el micro-análisis de las interacciones adulto-infante, análisis discursivos del habla y sistemas de codificación desarrollados para estudiar la interacción progenitor-infante. Estas diferentes perspectivas se pusieron juntas con la narrativa clínica para dar luz a los complejos, dinámicos procesos de interacción progenitor-infante-terapeuta. Más específicamente, los análisis detallados de un episodio interactivo revelaron breves manifestaciones de conducta de estados mentales de miedo y desorientación, lo cual refleja la interacción desregulada entre la madre y el bebé, lo que también afecta poderosamente al terapeuta. También se describen en detalle los procesos a través de los cuales el terapeuta gradualmente resuelve esta ruptura. Por medio de este estudio piloto, pudimos mostrar que es posible estudiar sistemáticamente el proceso de sicoterapia sicoanalítica de progenitor e infante. El estudio contribuye al creciente cuerpo investigativo sobre sicoterapia que toma en cuenta tanto el dominio verbal como los implícitos procesos interactivos en la práctica terapéutica y subraya la participación comprensiva del terapeuta en el proceso terapéutico. Palabras claves: sicoterapia progenitor-infante, comunicación multimodal, dominio implícito, investigación de procesos, trauma en la relación.

Studying the process of psychoanalytic parent-infant psychotherapy: Embodied and discursive aspects Cet article présente les résultats d'une étude de cas intensive par méthodes mixtes d'une session de psychothérapie psychanalytique parent-bébé adressant un trauma relationnel précoce. Il se donne pour but de mettre en lumière les processus interactifs multimodaux qui prennent place dans les échanges de moment-à-moment que comprend la rencontre thérapeutique. Différentes méthodes de recherches ont utilisé du matériel vidéo de séances PPIP, y compris des micro-analyses des interactions adulte-bébé, une analyse textuelle du dialogue et des systèmes de codage développés afin d'étudier l'interaction parent-bébé. Ces différentes perspectives ont été rassemblées avec la narration clinique afin d'illuminer les processus complexes et dynamiques de l'interaction parent-bébé-thérapeute. Plus particulièrement l'analyse détaillée d'un épisode interactif a révélé de brèves manifestations comportementales d'états d'esprit craintifs et désorientés, reflétant une interaction dys-régulée entre la mère et le bébé, qui ont aussi profondément affecté le thérapeute. Les processus au travers desquels le thérapeute a graduellement résolu cette rupture sont également décrits en détail. A travers cette étude pilote nous avons pu montrer qu'il est possible d'étudier systématiquement le processus de psychothérapie psychanalytique parent-bébé. L'étude contribue aux recherches en psychothérapie qui tiennent en compte à la fois le domaine verbal et implicite et les processus interactionnels dans la pratique thérapeutique, et souligne l'engagement total du thérapeute dans le processus thérapeutique. Mots clés: Psychothérapie parent-bébé, communication multimodale, domaine implicite, recherches processus, trauma relationn.

Caregiving representations in war conditions: Associations with maternal trauma, mental health, and mother-infant interaction.

Risk features in mothers' caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers' caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers' pre- and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1-year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers' prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother-infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed.

Reflective Functioning on the Parent Development Interview: validity and reliability in relation to socio-demographic factors.

The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers' capacity for mentalization. However, little is known about its psychometric properties.The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors.Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded.The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified.

"What support would you find helpful?" The relationship between treatment expectations, therapeutic engagement, and clinical outcomes in parent-infant psychotherapy.

The aim of this study was to investigate the impact of pretreatment expectations on clinical outcomes and engagement in Parent-Infant Psychotherapy (PIP). Sixty-one mothers who were experiencing mental health difficulties and who were receiving PIP with their young infants participated in the study. A mixed-methodology was used to examine participants' expectations through transformation content analysis of pretreatment interviews; recurring themes were classified and quantified. Further statistical analyses explored relationships between the quantified themes of parental expectations and clinical outcomes and engagement in treatment. No significant correlation was found between expectations and engagement. One of the six clinical outcomes significantly correlated with parental expectations. Improved reflective functioning (RF) was predicted by participants describing expectations of wanting to improve their parent-infant relationship through the treatment, and expressing concerns about discussing their past experiences. These two expectations predicted improvements in RF independently and when combined. These results indicate that PIP may be more effective for some mothers than others and that assessing future clients' expectations before beginning PIP may be beneficial.

El propósito de este estudio fue investigar el impacto de las expectativas anteriores al tratamiento acerca de los resultados clínicos y la participación en la Sicoterapia Progenitor-Infante (PIP). Sesenta y una madres que experimentaban dificultades de salud mental y que estaban recibiendo PIP con sus pequeños infantes participaron en el estudio. Se utilizó una metodología mixta para examinar las expectativas de las participantes a través de análisis de contenido de transformación de las entrevistas anteriores al tratamiento; los temas recurrentes fueron clasificados y cuantificados. Análisis estadísticos adicionales exploraron las relaciones entre los temas cuantificados de expectativas de las madres y los resultados clínicos y participación en el tratamiento. No se encontró una correlación significativa entre las expectativas y la participación. Uno de los seis resultados clínicos se correlacionó significativamente con las expectativas de las madres. Las participantes predijeron el funcionamiento reflexivo mejorado (RF) al describir sus expectativas de querer mejorar su relación progenitor-infante por medio del tratamiento, así como al expresar preocupación sobre discutir sus experiencias pasadas. Estas dos expectativas predijeron las mejoras en RF independientemente y cuando estaban combinadas. Estos resultados indican que PIP pudiera ser más eficaz para ciertas madres que para otras y que evaluar las expectativas de futuros clientes antes de comenzar PIP pudiera ser beneficioso.

Le but de cette étude était de se pencher sur l'impact des attentes pré-traitement sur les résultats cliniques et l'engagement clinique dans une Psychothérapie Parent-Nourrisson (abrégée ici PPN)/ Soixante et une mères qui faisaient l'expérience de difficultés de santé mentale et qui recevaient une PPN avec leur jeune bébé ont participé à cette étude. Une méthodologie mixte a été utilisée afin d'examiner les attentes des participantes à travers une analyse de contenu de transformation des entretiens pré-traitement. Les thèmes qui revenaient ont été ont été classifiés et quantifiés. Des analyses statistiques supplémentaires ont exploré les relations entre les thèmes quantifiés des attentes des parents et les résultats cliniques ainsi que l'engagement clinique dans le traitement. Aucune corrélation n'a été trouvée avec les attentes parentales. Un fonctionnement réfléchi (abrégé RF en français) amélioré a été prédit par les participantes, décrivant des attentes, attentes selon lesquelles elles voulaient améliorer leur relation parent-nourrisson à travers le traitement, et exprimant leurs soucis concernant la discussion de leurs expériences passées. Ces deux attentes ont prédit des améliorations dans le RF indépendamment et lors combinées. Ces résultats indiquent que la PPN peut être plus efficaces pour certaines mères que d'autre et que le fait d'évaluer les attentes des clients avant de commencer la PPN peut s'avérer être une bénéfice.

Lighthouse Parenting Programme: Description and pilot evaluation of mentalization-based treatment to address child maltreatment.

This article introduces an innovative mentalization-based treatment (MBT) parenting intervention for families where children are at risk of maltreatment. The Lighthouse MBT Parenting Programme aims to prevent child maltreatment by promoting sensitive caregiving in parents. The programme is designed to enhance parents' capacity for curiosity about their child's inner world, to help parents 'see' (understand) their children clearly, to make sense of misunderstandings in their relationship with their child and to help parents inhibit harmful responses in those moments of misunderstanding and to repair the relationship when harmed. The programme is an adaptation of MBT for borderline and antisocial personality disorders, with a particular focus on attachment and child development. Its strength is in engaging hard to reach parents, who typically do not benefit from parenting programmes. The findings of the pilot evaluation suggest that the programme may be effective in improving parenting confidence and sensitivity and that parents valued the programme and the changes it had helped them to bring about.

RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS.

There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship.

New Beginnings for mothers and babies in prison: a cluster randomized controlled trial.

Mothers in prison represent a high-risk parenting population. New Beginnings is an attachment-based group intervention designed specifically for mothers and babies in prison. This cluster randomized trial examined the outcomes for 88 mothers and babies participating in the New Beginnings program and 75 dyads residing in prisons where the intervention did not take place. Outcomes were measured in terms of parental reflective functioning, the quality of parent-infant interaction, maternal depression, and maternal representations. Mothers in the control group deteriorated in their level of reflective functioning and behavioral interaction with their babies over time, whereas the mothers in the intervention group did not. There were no significant group effects on levels of maternal depression or mothers' self-reported representations of their babies over time. An attachment-based intervention may mitigate some of the risks to the quality of the parent-infant relationship for these dyads.

A psychotherapeutic baby clinic in a hostel for homeless families: practice and evaluation.

OBJECTIVES: A pilot baby clinic in a hostel for homeless families has been established to address the specific attachment and developmental needs of infants living in temporary accommodation. The aim of this study was to assess whether this clinic model was associated with more positive outcomes than mainstream community services in terms of infant development and parent-infant interactions. DESIGN: Parent-infant psychotherapy and health visiting services collaborated to develop a new model of baby clinic, which reconfigured the traditional clinic to give priority to infants' affective experiences in a therapeutic group setting. Outcomes for parent-infant dyads in a homeless hostel where this service model was applied were compared with outcomes for parents and infants in hostels, which did not have such a service. METHODS: Fifty-nine mother-baby dyads participated in evaluation, 30 in the intervention hostel group and 29 living in comparison hostels. Infant mental and motor development was assessed using the Bayley Scales of Infant Development. Interactions between the parents and infants were video-recorded and coded on the Coding Interactive Behaviour Scales. RESULTS: The indices of mental and motor development of infants in the intervention hostel were significantly improved over time in relation to infants in the comparison hostels. No significant differences were found in the quality of parent-infant interaction between the two groups over time. CONCLUSIONS: The findings indicate that the service model may have positive benefits for infant development. The findings, study limitations, and clinical implications are discussed. PRACTITIONER POINTS: Parents and infants living in temporary accommodation represent a high-risk and hard-to-reach population. A new model of intervention, which combines universal infant health services with a therapeutic parent-infant group may be an effective means of supporting the emotional needs of hard-to-reach parents and infants.

The Ages & Stages Questionnaire: Social-Emotional: A validation study of a mother-report questionnaire on a clinical mother-infant sample.

Mother-report questionnaires of infant socioemotional functioning are increasingly used to screen for clinical referral to infant mental health services. The validity of the Ages & Stages Questionnaire: Social Emotional (ASQ:SE; J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002) was investigated in a sample of help-seeking mothers with young infants. It was compared with independent observer-rated dyadic interactions, and the quality of dyadic relationships was rated by expert clinicians. The ASQ:SE ratings also were compared with questionnaires on maternal psychological stress and distress. The ASQ:SE did not correlate significantly with either external ratings of dyadic interaction or clinically assessed relationship qualities, though the latter two were strongly associated with each other. In contrast, ASQ:SE scores were associated with questionnaires relating to maternal psychological distress. This was especially true for mothers classified as depressed. Furthermore, reports on the ASQ:SE were strongly predicted by maternal stress. The study points to some problems with the concurrent validity of the ASQ:SE in clinical samples. It also demonstrates a close link between mothers' psychological distress and their ratings of infant social and emotional functioning. Further research should investigate the extent to which the ASQ:SE specifically measures infant functioning or maternal distress, and how it functions in clinical versus nonclinical samples.

Development and preliminary psychometric evaluation of the parent report version of the Bath Adolescent Pain Questionnaire (BAPQ-P): A multidimensional parent report instrument to assess the impact of chronic pain on adolescents.

Assessing the experience and impact of pain in adolescents with chronic pain is necessary to guide both individual treatment and to inform treatment development. Ideally, to obtain a comprehensive understanding of the impact of pain, assessment should be multidimensional, should be sensitive to contextual variables, and should allow for multiple informants (in particular, parents). The purpose of this study was to develop a standardized parent-report measure of chronic pain in adolescents, the Bath Adolescent Pain Questionnaire - Parent report (BAPQ-P). Participants included 222 adolescents with chronic pain and their parents recruited from two specialty clinics in the UK. The adolescents completed a battery of self-report inventories related to their pain and daily functioning whilst parents completed the BAPQ-P and additional measures of adolescent functioning. Scales of the BAPQ-P emerged to be internally consistent and temporally stable over a 17-day period. Validity was examined in relation to existing validated child report measures of anxiety, depression, catastrophizing, disability, family, and social functioning and parent report measures of disability and family functioning. Psychometric evaluation suggests that the BAPQ-P is a reliable and valid parental report tool for assessing the multidimensional impact of adolescent chronic pain. It can be used in conjunction with the previously established adolescent self-report measure, the BAPQ, alone where adolescent self report is not possible, in studies where parent report is the focus, or in studies where concordance between parent and adolescent reports is of interest.

Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: randomised controlled trial.

BACKGROUND: Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent. AIMS: To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively. METHOD: In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria. RESULTS: Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group. CONCLUSIONS: Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the shortterm and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

The costs and effectiveness of two psychosocial treatment programmes for personality disorder: a controlled study.

This paper examines the costs and cost-effectiveness of psychosocial treatment for personality disorder in a controlled study. Using well-validated cost and outcome measures three groups are compared: the One-Stage group (n=32) received 12 months of inpatient treatment; the Step-Down group (n=29) received 6 months of inpatient treatment followed by 12 months of outpatient therapy; and the control group of 47 people used routinely available services. Both specialist programmes were more effective than routine psychiatric services but more costly. Using an extended dominance approach the incremental cost-effectiveness ratio showed that achieving one extra person with clinically relevant outcomes required an investment in the Step-Down programme of around 3400 pound sterling over 18 months. Small sample sizes and non-random allocation to programmes are limitations of this study but the costs and effectiveness findings consistently point to advantages for the shorter residential programme followed by community-based psychotherapeutic support.

The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study.

Chronic pain in adulthood is one of the most costly conditions in modern western society. However, very little is known about the costs of chronic pain in adolescence. This preliminary study explored methods for collecting economic-related data for this population and estimated the cost-of-illness of adolescent chronic pain in the United Kingdom. The client service receipt inventory was specifically adapted for use with parents of adolescent chronic pain patients to collect economic-related data (CSRI-Pain). This method was compared and discussed in relation to other widely used methods. The CSRI-Pain was sent to 52 families of adolescents with chronic pain to complete as a self-report retrospective questionnaire. These data were linked with unit costs to estimate the total care cost package for each family. The economic impact of adolescent chronic pain was found to be high. The mean cost per adolescent experiencing chronic pain was approximately 8,000 pounds per year, including direct and indirect costs. The adolescents attending a specialised pain management unit, who had predominantly non-inflammatory pain, accrued significantly higher costs, than those attending rheumatology outpatient clinics, who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated UK prevalence data of adolescent chronic pain demonstrates a cost-of-illness to UK society of approximately 3,840 million pounds in one year. The implications of the study are discussed.

The Bath Adolescent Pain Questionnaire (BAPQ): development and preliminary psychometric evaluation of an instrument to assess the impact of chronic pain on adolescents.

Chronic pain causes significant problems in the lives of many adolescents, considerably affecting their physical, psychological and social functioning. The assessment of the multidimensional impact of chronic pain is an essential clinical task. This study reports on the development and psychometric evaluation of the Bath Adolescent Pain Questionnaire (BAPQ); an assessment tool designed specifically for use with adolescents who experience chronic pain. A sample of 222 adolescents (11-18 years) experiencing chronic pain completed the 109-item draft inventory. Participants were recruited from two different UK clinics. All participants responded to items using a 5-point frequency scale. Psychometric evaluation of the data resulted in a reduced inventory length of 61 items. Internal consistency of all seven questionnaire subscales was established using Cronbach's alpha. Comparative validity was undertaken by comparison of all individual subscales with existing validated measures (SCAS, CDI-S, FDI, Brief FAM. PCS and CASAFS). The temporal reliability of each inventory subscale was established using a sub-sample of 30 adolescent participants over a 17-day period. Psychometric evaluation of the data suggests the inventory yields both a reliable and valid assessment of the impact of chronic pain on the lives of adolescents. The BAPQ may offer a comprehensive way to assess the widespread deleterious impact of adolescent chronic pain in both a research and clinical setting. Further investigation is needed on the predictive validity of the subscales. Additional data from samples of patients with diagnoses that are not musculoskeletal in origin would be of great assistance.