Framing the work: A coparenting model for guiding infant mental health engagement with families.

When working with families of infants and toddlers, intentionally looking beyond dyadic child-parent relationship functioning to conceptualize the child's socioemotional adaptation within their broader family collective can enhance the likelihood that clinical gains will be supported and sustained. However, there has been little expert guidance regarding how best to frame infant-family mental health therapeutic encounters for the adults responsible for the child's care and upbringing in a manner that elevates their mindfulness about and their resolve to strengthen the impact of their coparenting collective. This article describes a new collaborative initiative organized by family-oriented infant mental health professionals across several different countries, all of whom bring expansive expertise assessing and working with coparenting and triangular family dynamics. The Collaborative's aims are to identify a means for framing initial infant mental health encounters and intakes with families with the goal of assessing and raising family consciousness about the relevance of coparenting. Initial points of convergence and growing points identified by the Collaborative for subsequent field study are addressed.

Cuando se trabaja con familias de infantes y niños pequeñitos, el mirar intencionalmente más allá del funcionamiento de la relación diádica niño-progenitor para conceptualizar la adaptación socioemocional del niño dentro de la amplitud del colectivo familiar puede mejorar la posibilidad de que los logros clínicos sean apoyados y mantenidos. Sin embargo, ha habido poca guía de expertos acerca de cómo enmarcar mejor los encuentros terapéuticos infante-familia de salud mental para los adultos que son responsables del cuidado y crianza del niño de una manera que se eleve su estado consciente acerca de y su determinación de reforzar el impacto del colectivo en el proceso de la crianza compartida. Este artículo describe una nueva iniciativa colaborativa organizada por profesionales de la salud mental infantil orientados hacia la familia en varios diferentes países, todos los cuales aportan su conocimiento amplio evaluando y trabajando con las dinámicas familiares de crianza compartida y triangular. Las metas de este esfuerzo Colaborativo son identificar un medio para enmarcar los encuentros y la proporción de salud mental infantil con familias que se proponen evaluar y crear consciencia familiar acerca de la relevancia de la crianza compartida. Se abordan los puntos iniciales de convergencia y puntos de crecimiento identificados por el esfuerzo Colaborativo para subsecuentes estudios en el campo.

En travaillant avec des familles de nourrissons et de petits enfants, le fait de regarder délibérément au- delà du fonctionnement de la relation dyadique enfant-parent afin de conceptualisation l'adaptation socio émotionnelle de l'enfant, au sein de leur collectif familial plus large, peut accroître la probabilité que les gains cliniques seront bien soutenus et prolongés. Cependant il y a eu peu de directive experte concernant la meilleure manière d'encadrer les rencontres thérapeutiques nourrisson-famille de santé mentale pour les adultes responsables du soin de l'enfant et de son éducation d'une manière qui élève la pleine conscience et la détermination qu'il y a à renforcer l'impact de leur coparentage collectif. Cet article décrit une nouvelle initiative collaborative organisée par des professionnels de la santé mentale du nourrisson centrés sur la famille au travers de plus pays différents, tous étant de grands experts évaluant et travaillant avec des dynamiques de coparentage et de famille triangulaire. Les buts de cette collaboration sont d'identifier un moyen d'encadrer des rencontres de santé mentale initiales et les apports des familles avec le but d'évaluer et d'améliorer la conscience de la famille quant à la pertinence du coparentage. Les premiers points de convergence et de développement identifiés par la collaboration pour des études sur le terrain à venir sont discutés.

Systematic review and theoretical comparison of children's outcomes in post-separation living arrangements.

The purpose of the systematic review was to synthesize the literature on children's outcomes across different living arrangements (nuclear families, shared physical custody [SPC], lone physical custody [LPC]) by extracting and structuring relevant theoretical hypotheses (selection, instability, fewer resources, and stressful mobility) and comparing the empirical findings against these hypotheses. Following the PRISMA guidelines, the review included 39 studies conducted between January 2010-December 2022 and compared the living arrangements across five domains of children's outcomes: emotional, behavioral, relational, physical, and educational. The results showed that children's outcomes were the best in nuclear families but in 75% of the studies children in SPC arrangements had equal outcomes. Children in LPC tended to report the worst outcomes. When compared with the different theoretical hypotheses, the results were the most consistent with fewer resources hypothesis which suggests that children especially in LPC families have fewer relational and economic resources whereas children in SPC families are better able to maintain resources from both parents.

Coparenting change after couple therapy using self-reports and observational data.

Parent couples are involved in a coparenting bond and in a romantic relationship. Research on couple therapy has mainly explored the impact of couple therapy on romantic relationships; however, little is known about how couple therapy affects the coparenting relationship. Self-reports of positive and negative coparenting and observed emotional behavior in coparenting-related conversation tasks were assessed pre- and posttherapy (6 months intervals) in 64 mixed-sex parental couples. Results showed that mothers and fathers reported more positive coparenting after therapy. There were no significant changes in the reported negative coparenting and in the emotional behavior. Exploratory analyses indicated gender differences in emotional expression. The findings suggest that fathers might have been more active in the coparenting conversation after therapy.

An ultra-brief systemic intervention to address child mental health symptomatology.

Drawing on decades of research in family systems, coparenting, and developmental science, we present a clinical approach to address unmet service needs in children's mental health. Specifically, we describe Lausanne Family Play - Brief Intervention (LFP-B) - a manualized family systems approach providing a caregiver-caregiver-child therapy (and sibling/s, when applicable). The LFP-B is ultra-brief, typically delivered in as few as three sessions (two assessment sessions followed by a video feedback session), with the aim of reducing children's mental health symptomatology by enhancing the coparenting relationship. We review literature on systemic family therapies and provide a rationale for including coparents and children in child mental health care. We then provide a rationale for using behavioral observations and video feedback in treatment, drawing on research in related family-based treatments (e.g., parent-child therapies). Finally, we provide an overview of the LFP-B manual and a case illustration.

Couple therapy with parents: Results from a pragmatic randomized controlled trial testing the Integrative Brief Systemic Intervention (IBSI).

This study aimed to compare the effectiveness of the Integrative Brief Systemic Intervention (IBSI), combining therapeutic work on marital and coparenting relationships with brief systemic therapy (BST-as-usual) for parent couples. Couples were randomly assigned to the IBSI (n = 51) or BST (n = 50). Both treatments were six-session interventions and lasted about 6 months. Questionnaires on individual, marital, coparenting and family-related functioning were completed before and after therapy, and at 6-month follow-up. A significant improvement in all areas of functioning was observed after treatment and maintained at follow-up for both IBSI and BST-as-usual treatments. No significant differences in outcomes were found between the treatments. Additionally, women reported more distress overall than men, and this distress was reduced more significantly after therapy. Last, BST-as-usual couples requested more additional sessions compared to IBSI couples. This study extends the literature on couple therapy with parents.

Engaging in coparenting changes in couple therapy: Two contrasting cases.

Following the task analysis method, this study aimed to confirm the relevance of our model of resolving coparenting dissatisfaction to differentiate between two contrasting couples undergoing couple therapy. The model under study described the steps through which couples resolve coparenting issues in couple therapy for parents. Two contrasting couples were selected from a sample of parents undergoing systemic couple therapy. We analyzed videotaped discussions about the couple's coparenting relationship to select one couple whose interaction quality improved after therapy and one couple who worsened. Records of therapy sessions were rated by two independent coders to verify whether the model of coparenting change was present. Results showed that the couple that improved after therapy presented almost all the steps of the model whereas the couple that worsened after therapy presented only two steps. This study supported the relevance of the model and its various components to discriminate between two contrasting cases.

Parents in couple therapy: An intervention targeting marital and coparenting relationships.

This article describes the treatment framework and core therapeutic principles of the integrative brief systemic intervention (IBSI), a manualized six-session intervention intended for parents seeking couple therapy. IBSI aims to work on the couple's presenting problem, considering its specific impact in the marital and coparenting domains. The basic premise of IBSI is to consider that, when working with couples who have children, therapeutic work on their coparenting alliance may be used as a lever, as both parents may be particularly motivated to improve their relationship for their children's benefit. Increasing the coparenting alliance may then facilitate work on deeper conflicts within the marital relationship. The core therapeutic principles of IBSI are: (1) joining with the couple as romantic partners and a coparenting team from the start of the therapeutic process; (2) supporting the parents in increasing their awareness regarding their children's behavior and emotional experiences when facing their parents' conflicts; and (3) working on the spill- and cross-over effects between marital and coparenting relationships (i.e., exploring how conflict or positivity spills over from one relationship to the other or crosses over from one partner to the other). Therapeutic work following these main therapeutic principles is expected to improve the quality of both relationships. A clinical case is provided to illustrate the core therapeutic principles of IBSI.

Putting parental overprotection into a family systems context: Relations of overprotective parenting with perceived coparenting and adolescent anxiety.

Previous research offers evidence for how overprotective parenting is related to psychosocial maladjustment among adolescents, and documents the parent-related and child-related antecedents of overprotective parenting. Using a family systems perspective, the present study aimed at extending this knowledge by looking into contextual determinants of overprotective parenting. More specifically, the goal of this study was to examine associations between adolescents' perceptions of the coparental relationship (i.e., the way parental figures relate to each other in their role as parents) and overprotective parenting, which in turn was expected to relate to more adolescent anxiety symptoms. A sample of 174 Swiss adolescents (Mage  =16.99 years, 73% girls) completed questionnaires assessing their perceptions of the coparental relationship (in terms of cooperation, conflict, and triangulation), overprotective parenting, and symptoms of anxiety. Analyses indicated that triangulation, in particular, was uniquely related to higher levels of overprotective parenting, which in turn was associated with more anxiety symptoms among adolescents. These results provide evidence for the importance of considering the larger family systems context for understanding the dynamics involved in overprotective parenting. Theoretical and clinical implications of these findings are discussed.

Existen investigaciones previas que comprueban cómo la crianza sobreprotectora está relacionada con la inadaptación psicosocial entre los adolescentes y que documentan los antecedentes de la crianza sobreprotectora relacionados con los padres y los niños. Utilizando una perspectiva de sistemas familiares, el presente estudio tuvo como finalidad ampliar estos conocimientos estudiando los determinantes contextuales de la crianza sobreprotectora. Más específicamente, el objetivo de este estudio fue analizar las asociaciones entre las percepciones de los adolescentes de la relación de cocrianza (p. ej.: la manera en la que las figuras de los padres se relacionan mutuamente en su papel como padres) y la crianza sobreprotectora, que a su vez se esperaba que se relacionara con más síntomas de ansiedad en los adolescentes. Una muestra de 174 adolescentes suizos (edad promedio =16.99 años, el 73% niñas) contestó cuestionarios que evaluaban sus percepciones de la relación coparental (desde el punto de vista de la cooperación, el conflicto y la triangulación), la crianza sobreprotectora y los síntomas de ansiedad. Los análisis indicaron que la triangulación, en particular, estuvo relacionada exclusivamente con niveles más altos de crianza sobreprotectora, la cual, a su vez, estuvo asociada con más síntomas de ansiedad entre los adolescentes. Estos resultados comprueban la importancia de tener en cuenta el contexto mayor de los sistemas familiares para comprender la dinámica que supone la crianza sobreprotectora. Se debaten las implicancias teóricas y clínicas de estos resultados.

Affective Behavior in Parent Couples Undergoing Couple Therapy: Contrasting Case Studies.

Being in a romantic relationship is characterized by a high degree of intimacy and affective involvement. Affective behavior indicates the emotional content in couple interactions and therefore promotes an understanding of the evolution of romantic relationships. When couples are also parents, their affective behavior reflects their romantic and coparental bonds. In this paper, we present an observation of parent couples' affective behavior during a coparenting conflict discussion task to document whether and how much it improved during couple therapy. Two contrasting cases of affective behavior change are included. Observational coding of affective behavior within pre- and post-intervention coparenting conflict discussion tasks was carried out to compute means and CIs for each partner in both cases. In addition, the partners' coparental and romantic satisfaction were evaluated through validated self-report questionnaires in pre- and post-intervention assessments; this helped document whether the partners' coparental and romantic satisfaction were dissimilar between the two cases. Finally, a clinical analysis of both cases was realized with the contribution of the therapists to investigate possible differences within therapy sessions. Statistical analyses revealed negative means of affective behavior for couple A in the pre-intervention assessment and positive means in the post-intervention assessment. Partners from couple B had negative means of affective behavior in the pre- and post-intervention assessments. Results concerning coparental and romantic satisfaction differed: Couple A's coparental satisfaction slightly increased and the romantic satisfaction somewhat decreased, whereas couple B's coparental satisfaction remained stable and the romantic satisfaction slightly increased between the pre- and post-intervention assessments. The clinical analysis revealed that the interactional quality of couple A slightly improved within therapy sessions and that both partners succeeded in working together as coparents, notwithstanding their romantic distress. Couple B conveyed coparental distress and exhibited poor interactional quality throughout therapy sessions (e.g., repeated criticism and contempt). This study contributes to enriching the more traditional empirical research methods in the field of couple psychotherapy, as it takes into account microlevel affective changes within parent couples' interactions in addition to self-reported data. Furthermore, the analysis of therapy sessions supports the importance of working with affective behavior in couple therapy.

Resolving Coparenting Dissatisfaction In Couples: A Preliminary Task Analysis Study.

This study explored the change that unfolded when parents resolved their coparenting dissatisfaction during an Integrative Brief Systemic Intervention (IBSI) for parent couples. We conducted a task analysis (Greenberg, 2007) to build a model of resolving coparenting dissatisfaction. We compared a postulated model of change (rational model) based on theoretical and clinical assumptions to the observations of the actual change process that couples experienced in an IBSI (empirical analysis). The empirical analysis was conducted on six IBSI therapy cases (three exhibiting positive development and three exhibiting no development). We defined positive development in IBSI as moving from coparenting dissatisfaction to coparenting satisfaction. The final rational-empirical model included six steps that facilitated the resolution of coparenting dissatisfaction. This study contributes to deepening the knowledge of how coparenting may change during marital therapy.

Protocol of a longitudinal study on the specific needs of Syrian refugee families in Switzerland.

BACKGROUND: The ongoing Syrian civil war has led to massive population displacements, leading to the reorganization of the asylum policies of several countries. Accordingly, like other European countries, the Swiss government has recently chosen to implement a specific resettlement program. This program is characterized by the fact that the whole nuclear family is granted a work and residence permit upon arrival, and benefits from enhanced integration services. The aim of the present project is to evaluate the effects of the Swiss resettlement program, with a special focus on mental health, while adopting a family perspective. METHODS: The outcomes of 15 Syrian families taking part in this program will be compared to those of 15 Syrian families that came to Switzerland through other means (i.e., following the usual asylum procedure, which is much more stressful and time consuming). Each family member above 8 years old will be invited to participate to a 3-wave longitudinal survey concerning the resettlement process: upon arrival in the collective shelters, six and 12 months later. Questionnaires will be used for the evaluation of participants' mental health, risk behaviors, general health, romantic relationship, parent-child relationship, family functioning, parentification, social support, and social identities related to group belongingness. DISCUSSION: The findings of the present project will provide longitudinal information on Syrian refugees. A comprehensive approach will be adopted by screening potential difficulties that the sample may be faced with and potential strengths that participants may rely on. Accordingly, physical and mental health, as well as the quality of family functioning, the feeling of support and of belongingness to different groups will be evaluated. We will also compare the results of families who had the chance to immigrate through the Swiss resettlement program, to the results of families that did not. This comparison will allow the elaboration of hypotheses regarding adjusted asylum policies. Furthermore, it will enhance our knowledge regarding the impact of displacement on the family system. Indeed, although the role of the family for the well-being of adults and children has been established, surprisingly few studies have adopted this focus in the asylum field.

Partner support during the prenatal testing period after assisted conception.

BACKGROUND: Pregnancy after infertility is a challenging experience. The first-trimester screening test may add stress. Partner support reduces psychological distress in pregnant women after spontaneous conception. No data are available for women who conceive via assisted reproductive technology. AIM: To assess whether there was a difference between couples who underwent assisted reproductive technology and couples who conceived spontaneously in the support they felt they provided to their partner and whether their perception of support received from their partner reduced their distress. METHODS: This longitudinal prospective study included 52 women (spontaneous conception) and 53 women (assisted reproductive technology), as well as their partners. Participants completed the state scale of the State-Trait Anxiety Inventory, the Edinburgh Depression Scale, and two partner-support subscales of the Dyadic Coping Inventory: before prenatal testing (gestational age 12 weeks), immediately after receiving the results (gestational age of approximately 14 weeks), and once all the prenatal screenings had been completed (gestational age 22 weeks). FINDINGS: Women who underwent assisted reproductive technology felt less able to help their partner cope with stress and felt their partner was less able to help them cope with stress than women with spontaneous pregnancy. This difference was not observed in men. Higher perceived partner support lowered the anxiety and depression of couples who conceived spontaneously, but did not benefit couples who followed fertility treatment. CONCLUSION: These results add to our knowledge of the emotional state of women and their partners during pregnancy after infertility. This knowledge may allow prenatal care providers to offer specialized counselling to women and their partners in the transition from infertility to parenthood.

The impact of pre- and post-natal psycho-educational intervention on the construction of parenthood.

A pilot study was conducted to assess the merits and feasibility of a standardized postnatal psycho-educational interview on mothers' mental wellbeing, self-efficacy, and mother-child and couple relationships. A comparison of prenatal psycho-educational interview (n = 23) vs. pre- and post-natal psycho-educational interviews (n = 26) was carried out. Parental self-efficacy and the mother-child relationship were significantly improved for the group who received a post-natal interview at 2 and 3 months postpartum in addition to a prenatal interview. Pre- and post-natal interviews improve the construction of parenthood.

Prenatal Intuitive Coparenting Behaviors.

Micro-analytic research on intuitive parenting behaviors has shed light on the temporal dynamics of parent and child interactions. Observations have shown that parents possess remarkable implicit communicative abilities allowing them to adapt to the clues infants give and therefore stimulate the development of many of the infants' abilities, such as communication skills. This work focused on observing intuitive parenting behaviors that were synchronized and coordinated between the parents. We call them "prenatal intuitive coparenting behaviors" and used an observation task - the Prenatal Lausanne Trilogue Play procedure - to observe them. For this task, the parents role-play their first encounter with their future baby, represented by a doll. Two cases from a study on pregnancy after assisted reproductive technology are provided to illustrate how these behaviors manifest themselves. The observations from the first case suggest that expectant parents can offer the baby a coparental framework, whereas the observations from the second case show that opportunities for episodes of prenatal intuitive coparenting can be missed due to certain relationship dynamics. These kinds of observations deepen our knowledge of the prenatal emergence of the coparenting relationship and allow us to hone our strategies for intervening during pregnancy with couples who experience coparenting difficulties. Furthermore, these observations provide a novel and complementary perspective on prenatal intuitive parenting and coparenting behaviors.

Anxiety, depression, and attachment before and after the first-trimester screening for Down syndrome: comparing couples who undergo ART with those who conceive spontaneously.

OBJECTIVES: This study's aim was to describe the emotional status of parents to be before and after the first-trimester combined prenatal screening test. METHODS: One hundred three couples participated, of which 52 had undergone an in vitro fertilization/intracytoplasmic sperm injection treatment [assisted reproductive technology (ART)] and 51 had conceived spontaneously. Participants completed the state scale of the State-trait Anxiety Inventory, the Edinburgh Depression Scale, and the Maternal and Paternal Antenatal Attachment Questionnaire before the first-trimester combined prenatal screening test at around 12 weeks of gestational age (T1) and just after receiving the results at approximately 14 weeks of gestational age (T2). RESULTS: We observed a significant decrease in anxiety and depression symptoms and a significant increase in attachment from T1 to T2. Results showed no differences between groups at either time point, which suggests that ART parents are more similar to than different from parents conceiving spontaneously. Furthermore, given the importance of anxiety during pregnancy, a subsample of women with clinical anxiety was identified. They had significantly higher rates of clinical depression and lower attachment. CONCLUSIONS: These results indicate that, regardless of whether conception was through ART or spontaneous, clinical anxiety in women over the prenatal testing period is associated with more vulnerability during pregnancy (i.e. clinical depression and less attachment to fetus).

Couple and family treatments: study quality and level of evidence.

This paper examines the application of the guidelines for evidence-based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two-step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, "evidence-based" treatments; one was a level II, "evidence-informed treatment with promising preliminary evidence-based results"; and four were level I, "evidence-informed" treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.

Anxiety and psychological stress before prenatal screening in first-time mothers who conceived through IVF/ICSI or spontaneously.

Mothers' general anxiety, anxiety about the well-being of the child and psychological stress before prenatal testing was studied by comparing women who conceived through in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with women who conceived naturally. Before the first trimester screening test for Down's syndrome, a group of 51 women who conceived through IVF/ICSI and a group of 54 women who conceived spontaneously completed the State Scale of the State-Trait Anxiety Inventory (S-Anxiety; Spielberger, 1983), the Fear of Bearing a Physically or Mentally Handicapped Child Subscale of the Pregnancy-related Anxiety Questionnaire (PRAQ-R; Huizink et al., 2004), the Psychological Stress Measure (PSM; Lemyre & Tessier, 1988), and the Prenatal Psychosocial Profile (PPP; Curry, Campbell, & Christian, 1994). Women who conceived through IVF/ICSI had more elevated levels of general anxiety and psychological stress than the women who conceived naturally; however, no difference was observed between the two groups for anxiety specifically related to the health of the child. These results underline the need to monitor women's emotional state after conception via IVF/ICSI-when counseling usually ends-and around the time of the first trimester screening. Counseling might thus be extended.

The transition of care from fertility specialists to obstetricians: maternal adjustment and postpartum depressive symptoms.

AIM: This study examines the transition from fertility to obstetrical care of women who conceived through IVF. MATERIALS & METHODS: 33 women filled out questionnaires before IVF, during pregnancy and after birth on infertility stress, maternal adjustment and depressive symptoms. During pregnancy, they participated in an interview about their emotional experiences regarding the transition. Responses were sorted into three categories: Autonomy, Dependence and Avoidance. RESULTS: Exploratory results show that 51.5% of women had no difficulties making the transition (Autonomy), 21.2% had become dependent (Dependence) and 27.3% had distanced themselves from the specialists (Avoidance). Women who became dependent had more trouble adjusting to motherhood and more depressive symptoms. CONCLUSION: Difficulty making the transition may be linked to decreased ability to adjust to motherhood and more postpartum depressive symptoms.