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.

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.

The development of family alliance from pregnancy to toddlerhood and child outcomes at 5 years.

This article presents a longitudinal study of the development of "family alliance" from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5 years. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the 5th month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play). Marital satisfaction and child temperament were assessed through self-reported questionnaires. Several outcomes of the child at age 5 years were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: "high stable" (n = 19), "high to low" (n = 10), and "low stable" (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5 years, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family-level and individual-level variables for understanding individual differences in the social and cognitive development of children.

A systems perspective on the integrative child psychiatry approach. Discussion of paper: "Working here and now with the individual and family system: A case of a traumatized child".

In this discussion, after a few general comments, I will propose a systems reading of the intervention so elegantly described by Kaija Puura. I will draw parallels between the therapeutic and the family groups as framing-developing systems and formalize the steps taken by the family toward healing under the influence of the therapist's team.

Coparenting and toddler's interactive styles in family coalitions.

The current study examined the coparenting and toddler's interactive styles in family coalitions. According to structural family theory, boundaries between generations are clear in alliances, but disturbed in coalitions: the parents look to the child to regulate their conflictual relationship and the child attempts to meet this need. In a normative sample studied longitudinally during the Lausanne Trilogue Play situation (LTP, N=38), 15 coalition cases were detected. Styles of coparenting and of child's interactions were determined and compared in coalition and alliance cases at 18 months. Findings confirm the structural family model by showing the specific ways in which the coparenting and the toddler's interactive styles are associated in 3 different patterns of coalitions: binding, detouring, and triangulation. They illustrate how the child's triangular capacity, or her ability to simultaneously communicate with both parents, is used to regulate the parents' relationship. They suggest that the LTP observational paradigm is a promising assessment method of early family interactions. They point to the importance of assessing early the child's contribution to family coalitions.

Young infants' triangular communication with their parents in the context of maternal postpartum psychosis: Four case studies.

With increasing data on the dynamics of normative couples as they transition to parenthood and become a triad, the need for greater understanding of the impact of parental psychopathology on this transition has become clear. The goal of the current article is to begin exploring this area that has received little attention to date, by describing case examples from a study of clinical families as they transitioned to parenthood. Four representative cases were selected from a pool of 13 mother-father-baby triads, for whom the mother had been hospitalized conjointly with her infant due to a psychotic episode during the postpartum period. The families were observed as part of a clinical consultation that included a semistructured play paradigm known as the Lausanne Trilogue Play (LTP; E. Fivaz-Depeursinge, & A. Corboz-Warnery, 1999). Interactions were scored using standardized measures as well as clinical impressions. All families from the clinical sample were noted to struggle and frequently failed to achieve the goals of play. The impact on the infants in terms of their developing sense of self as well as their defensive strategies in this context are discussed, with clinical implications explored.

New evidence for the social embeddedness of infants' early triangular capacities.

Infants appear to be active participants in complex interactional sequences with their parents far earlier than previously theorized. In this report, we document the capacity of 3-month-old infants to share attention with two partners (mothers and fathers) simultaneously, and trace links between this capacity and early family group-level dynamics. During comprehensive evaluations of the family's emergent coparenting alliance completed in 113 homes, we charted infants' eye gaze patterns during two different mother-father-infant assessment paradigms. Triangular capacities (operationalized as the frequency of rapid multishift gaze transitions between parents during interactions) were stable across interaction context. Infants exhibiting more advanced triangular capacities belonged to families showing evidence of better coparental adjustment. Theoretical and practice implications of these findings are discussed.

Infant's triangular communication in "two for one" versus "two against one" family triangles: Case illustrations.

Infants use their social competence very early to communicate not only in dyads but also in triads, in particular in the triangle they form with their mother and father. The development of this triangular communication is largely shaped by the ways the parents support or undermine each other in relation to their child. Whereas triangular communication is facilitated in "two for one" alliances, it is recruited in the service of regulating the parents' conflicts in "two against one" coalitions. These processes are manifest in toddlerhood and may be traced back to the coparenting alliance in formation during pregnancy.

Exploring triangulation in infancy: two contrasted cases.

Two contrasted father-mother-infant interactions are observed longitudinally during trilogue play. They illustrate the contribution of recent research to the exploration of triangulation in infancy: namely, the infant's capacity to handle triangular interactions and share her affects with her two parents, and the way that this capacity is recruited in functional versus problematic alliances. It is likely that an infant under stress when interacting with one parent will protest at that parent and also at the other. Such is the case when, for example, the father acts intrusively while playing with his baby. The infant is then driven to avert and turns to the mother. The regulation of this dyadic intrusion-avoidance pattern at family level depends on the family alliance. When coparenting is supportive, the mother validates the infant's bid for help without interfering with the father. Thus, the problematic pattern is contained in the dyad, and the infant's triangular capacities remain in the service of her own developmental goals. But when coparenting is hostile-competitive, the mother ignores the infant's bid or engages with her in a way that interferes with her play with her father. In this case, the infant's triangular capacities are used to relieve the tension between the parents. The importance of tracing family process back to infancy for family therapy is discussed.

Niveles de regulación afectiva en la interacción terapéutica / Levels of affective regulation in therapeutic interaction

El afecto es un idioma universal y acultural practicado entre padres e hijo/a mucho antes de la aparición del lenguaje verbal. Las coordinaciones afectivas fundan y sostienen todas las transacciones sociales, sin importar el objetivo de las mismas (cognitivo, relacional, instrumental). Por lo tanto, las coordinaciones afectivas son clave en los procesos evolutivos. La observación de la interacción terapeuta-pareja pone al descubierto varios micro-procesos de coordinación interactiva, reparación de incoordinaciones y giros disfuncionales e improductivos. Estos procesos pueden ser descriptos sistemáticamente y contribuir así, a la validación de las hipótesis clínicas sobre los procesos sistémicos. Desde esta perspectiva, el presente artículo brinda varios ejemplos de (in)coordinaciones afectivas durante la psicoterapia y se discute sus implicancias para un punto de vista evolutivo de la terapia familiar y marital.

Niveles de regulación afectiva en la interacción terapéutica / Levels of affective regulation in therapeutic interaction

El afecto es un idioma universal y acultural practicado entre padres e hijo/a mucho antes de la aparición del lenguaje verbal. Las coordinaciones afectivas fundan y sostienen todas las transacciones sociales, sin importar el objetivo de las mismas (cognitivo, relacional, instrumental). Por lo tanto, las coordinaciones afectivas son clave en los procesos evolutivos. La observación de la interacción terapeuta-pareja pone al descubierto varios micro-procesos de coordinación interactiva, reparación de incoordinaciones y giros disfuncionales e improductivos. Estos procesos pueden ser descriptos sistemáticamente y contribuir así, a la validación de las hipótesis clínicas sobre los procesos sistémicos. Desde esta perspectiva, el presente artículo brinda varios ejemplos de (in)coordinaciones afectivas durante la psicoterapia y se discute sus implicancias para un punto de vista evolutivo de la terapia familiar y marital.(AU)