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This study explored the perceptions of practitioners who deliver the Baby Mat community-based, parent--infant mental healthcare intervention offered at primary healthcare clinics in Alexandra Township, South Africa. This intervention aims to foster secure attachments between mothers/caregivers and infants, shaping a healthy foundation for future holistic well-being. Data for this study was collected using qualitative techniques including two focus group discussions and three individual interviews. The 12 Baby Mat practitioners who currently deliver the intervention formed the sample of purposively selected participants. Data were analysed using thematic analysis. The practitioners' perceptions highlighted that their demonstrated skills of reflective functioning promote caregiver-infant attachment. The supportive disposition of the Baby Mat practitioners was suggested as an essential characteristic that mirrors caregivers' experiences of "umdlezane." This Nguni term refers to the post-partum period when the caregiver-infant relationship is prioritised by the support of other women in the family or community. The culturally diverse co-facilitating practitioners were understood to support the therapeutic alliance and thus enrich the applicability of the Baby Mat intervention within the targeted community context. Given the critical need for relevant and accessible mental healthcare services in communities such as Alexandra Township, the findings from the study illustrate how this community-based intervention may be useful in other comparable contexts.

Early parent-infant home visiting interventions have been found to be effective in both developed and developing countries. However, there is a need to build an evidence base for these interventions in the South African context, to inform local early childhood development policy. The Ububele Mother-Baby Home Visiting Programme in Alexandra, Johannesburg, combines a psychoanalytic approach to thinking about parent-infant relationships and local infant care knowledge. Trained, local women offer a 14-visit intervention, which aims to support mothers, increase knowledge about the relational needs of infants, and increase maternal reflective function capacities. A mixed-methods approach was used to evaluate preliminary findings regarding mothers' responses to the programme and found significant increases in the mothers' levels of perceived support, in levels of knowledge regarding the relational needs of infants and in maternal reflective function capacities. The supportive relationship between home visitors and mothers was highlighted as key to programme success.

This paper describes a once-a-week psychotherapy with a young boy over a period of 18 months. The boy was removed from his biological parents at three years of age because of concerns about his birth parents' capacity to care for him and his younger brother. When the boy was seven years old a psychotherapy was sought to address a range of behaviours that were difficult for his adoptive parents to manage. The very early history of the boy was not known. Clinical vignettes from a beginning session, the middle and toward the end of the process are used to illustrate the importance and usefulness of careful attention to countertransference, particularly when the very early history of a child is unknown. The paper demonstrates that by being attentive to these dynamics, emotionally relevant themes may be reconstructed and reworked in the clinical setting. The unknown history is reconstituted and made conscious in the therapeutic relationship. The early emotional themes from the clinical work that rose to the surface include 'twos' -- two sets of parents, two emotional worlds, two siblings, two therapists; 'transitions' -- between his two families, between his worlds, between his adoptive mother's arms into the therapy room; and 'the dark' -- what lies beneath and between, what is unseen, what is unremembered. [ABSTRACT FROM AUTHOR]

This study explored the perceptions of practitioners who deliver the Baby Mat community-based, parent–infant mental healthcare intervention offered at primary healthcare clinics in Alexandra Township, South Africa. This intervention aims to foster secure attachments between mothers/caregivers and infants, shaping a healthy foundation for future holistic well-being. Data for this study was collected using qualitative techniques including two focus group discussions and three individual interviews. The 12 Baby Mat practitioners who currently deliver the intervention formed the sample of purposively selected participants. Data were analysed using thematic analysis. The practitioners' perceptions highlighted that their demonstrated skills of reflective functioning promote caregiver–infant attachment. The supportive disposition of the Baby Mat practitioners was suggested as an essential characteristic that mirrors caregivers' experiences of umdlezane. This Nguni term refers to the post-partum period when the caregiver–infant relationship is prioritised by the support of other women in the family or community. The culturally diverse co-facilitating practitioners were understood to support the therapeutic alliance and thus enrich the applicability of the Baby Mat intervention within the targeted community context. Given the critical need for relevant and accessible mental healthcare services in communities such as Alexandra Township, the findings from the study illustrate how this community-based intervention may be useful in other comparable contexts. [ABSTRACT FROM AUTHOR]

Early parent–infant home visiting interventions have been found to be effective in both developed and developing countries. However, there is a need to build an evidence base for these interventions in the South African context, to inform local early childhood development policy. The Ububele Mother-Baby Home Visiting Programme in Alexandra, Johannesburg, combines a psychoanalytic approach to thinking about parent–infant relationships and local infant care knowledge. Trained, local women offer a 14-visit intervention, which aims to support mothers, increase knowledge about the relational needs of infants, and increase maternal reflective function capacities. A mixed-methods approach was used to evaluate preliminary findings regarding mothers' responses to the programme and found significant increases in the mothers’ levels of perceived support, in levels of knowledge regarding the relational needs of infants and in maternal reflective function capacities. The supportive relationship between home visitors and mothers was highlighted as key to programme success. [ABSTRACT FROM AUTHOR]

This paper is based on a 12 week New Beginnings group intervention for mothers and their infants in a shelter in Johannesburg, South Africa. Contextual deprivation loomed large in the therapeutic encounter and preoccupied both participants and therapists. At times, this preoccupation hindered the participants' and therapists' capacity for reflective functioning. This paper argues that contextual deprivation functioned at times as an anti-analytic third in the therapeutic process, interfering with thoughtfulness. A close reading of the beginning of two consecutive sessions that took place toward the end of the intervention reveals how central deprivation was and how, through the therapeutic group process and the therapists' working through of challenging countertransferential material, the rigidity of deprivation in the minds of the therapists and group members was shifted. Although the contextual deprivation remained unchanged, there appeared to be more capacity for flexibility in thinking about it. [ABSTRACT FROM AUTHOR]

Group parent-infant psychotherapy aims to increase parents' sensitivity to the communications of their infants and encourages normal attachment behaviours in infants. While it is significant that this kind of therapy has been found to be effective in randomised controlled trials, an understanding of the mechanisms through which it achieves these goals is essential. This paper explores the role of disruptions and their repair in the development of new implicit relational knowledge structures within the minds of both mothers and infants attending a group psychotherapy programme. The paper tracks the individual and group processes that facilitate increased affect tolerance and mentalisation abilities in the mothers and the disinhibition of the infants' capacities to seek comfort from their mothers and explore their worlds. Bion's notion of containment is discussed as an essential aspect of the normative process of relational disruption and repair. [ABSTRACT FROM AUTHOR]

This paper describes the countertransference challenges facing two psychotherapists working in a group mother-infant attachment programme, focusing specifically on the moments of collapsed thinking experienced in the face of powerful maternal projections. Most of the mothers in the group had attachment histories which included unrelenting loss, trauma and deprivation, and were considerably impaired in their capacity to reflect on their infants' emotional states of mind. At times, the therapists experienced intensely negative countertransference responses such that their empathic attunement and capacity to think were compromised in relation to disturbing mothering practices evident during the programme. Traditional use of the countertransference as a communication to be interpreted in the group was not feasible in this time-limited programme. The therapists were therefore challenged to experience and hold a range of projected primitive feelings, thoughts and behaviours for the mothers and the babies during the group process. The relationship between the powerful countertransference responses consequent to this and the reflective capacity of the therapists is explored. One mother was particularly impaired in her capacity to hold her baby in mind. Case material relating to this specific mother-infant dyad is used to illustrate therapeutic challenges faced by the therapists and the impact of this on their capacity to be containers in this particular group context. [ABSTRACT FROM AUTHOR]