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Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions. publishedVersion

This prospective longitudinal study examined how maternal prenatal substance use disorder (SUD) and early mother–infant interaction quality are associated with child social cognition (emotion recognition and mentalization) at school age. A sample of 52 poly-substance-using mothers receiving early interventions and 50 non-users, along with their children, was followed from pregnancy to school age. First-year mother–infant interaction quality was measured with EA scales. At school age, child facial emotion recognition was measured with DANVA and mentalization with LEAS-C. SUD group children did not differ from comparison children in social cognition, but higher severity of maternal prenatal addiction predicted emotion recognition problems. High early mother–infant interaction quality predicted better emotion recognition and mentalization, and mother–infant interaction quality mediated the effect of prenatal SUD on emotion recognition. The results highlight the need for early treatments targeting both parenting and addiction, as well as long-term developmental support for these children. Highlights: We examined how mother's prenatal substance use disorder (SUD) and early mother–infant interaction predict child social cognition at school age. Questionnaires, observational and computer tasks were used. Maternal prenatal addiction severity and early parenting problems predicted problematic child social cognition. Early interventions should simultaneously target addiction and parenting. Attention should also be paid to the long-term developmental support of children. publishedVersion

The purpose of this controlled study was to examine the outcome of psychodynamic mother-infant group psychotherapy (PGT) outpatient intervention for drug-abusing perinatal mother-infant dyads. PGT comprised 20 to 24 weekly 3-hr sessions with 3 to 5 months of follow-up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother-infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother-infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug-abusing dyads in PGT, 25 in PSS, and 50 dyads in a non-drug-abusing comparison group. Assessments were pre-intervention and at 4 and 12 months' follow-up, including maternal depressive symptoms and mother-child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother-infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high-risk dyads.

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre- to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug-abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self-as-mother, and self-as-woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008) at 4 and 12 months. The results showed that drug-abusing mothers had more negative prenatal representations of the self-as-woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self-as-mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug-abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug-abusing mothers should aim at supporting the development of a realistically positive view of motherhood. Tanto las negativas como las idealizadas representaciones maternales prenatales pudieran constituir un riesgo para la interaccion entre madre e infante. Este estudio analizo el papel de las representaciones maternales prenatales y del cambio representacional pre y postnatal en la prediccion de la disponibilidad emocional entre madre e infante (EA) entre 51 madres que habian abusado de drogas y sus infantes, todos los cuales participaron en una terapia de grupo sicodinamica, PGT, o recibieron apoyo sicosocial, PSS, y entre 50 diadas de madres-infantes donde no se habia dado el uso de drogas, como grupo de comparacion. Las representaciones maternales de su nino, del padre del nino, de la propia madre, ella como madre y ella como mujer, fueron medidas durante el embarazo y a los 4 y 12 meses con posterioridad al parto usando IRMAG. La disponibilidad emocional (EA) fue medida por medio de las Escalas de la Disponibilidad Emocional (4a edicion) a los 4 y 12 meses. Los resultados muestran que las madres que habian abusado de drogas tenian mas representaciones negativas prenatales de ellas como mujeres y del padre del nino. Postnatalmente, las madres PSS tendian a idealizar primero al nino, pero mas tarde a experimentar desilusion en cuanto a la idealizacion. Tanto las representaciones prenatales negativas como las idealizadas de ellas como madres predijeron los problemas de disponibilidad emocional (EA) entre madre e infante, lo cual no ocurrio entre las madres PGT. Para todas las madres, el cambio representacional negativo fue perjudicial para la disponibilidad emocional (EA) de madres e infantes, mientras que para las madres que habian abusado de drogas, tambien el aumento de la idealizacion del periodo prenatal al postnatal fue danino. Los clinicos que trabajan con madres que han abusado de drogas deben tener como meta el apoyo del desarrollo de una imagen de la maternidad realisticamente positiva. Les representations prenatales maternelles a la fois negatives et idealisees peuvent constituer un risque pour l'interaction mere-nourrisson. Cette etude a analyse le role des representations maternelles prenatales et le changement representationnel pre- a postnatal en predisant la disponibilite emotionnelle chez 51 meres toxicomanes et leurs nourrissons qui ont participe soit a un groupe psycho-dynamique de therapie, abrege ici PGT en suivant l'anglais, ou ont recu un soutien psychosocial, abrege PSS en anglais, et chez 50 dyades non toxicomanes de comparaison. Les representations maternelles de l'enfant, du pere de l'enfant, de sa propre mere, de soi-meme en tant que mere et de soi-meme en tant que femme ont ete mesurees durant la grossesse et a 4 et 12 mois postpartum avec l'Interview pour les Representations Maternelles pendant la Grossesse (IRMAG). La disponibilite emotionnelle a ete mesuree avec les Echelles de Disponibilite Emotionnelle (4eme edition) a 4 et 12 mois. Les resultats ont montre que les meres toxicomanes avaient plus de representations prenatales negatives d'elles-memes en tant que femme et du pere de l'enfant. Post-natalement, les meres ayant recu un soutien psychosocial avaient tendance a d'abord idealiser leur enfant, puis plus tard a faire l'experience de desillusion de l'idealisation. Les representations prenatales a la fois negatives et idealisees de soi-meme en tant que mere etait un facteur de prediction de problemes de disponibilite emotionnelle, mais uniquement chez les meres PGT. Pour toutes les meres, le changement representationnel negatif s'est avere nuisible a la disponibilite emotionnelle mere-nourrisson, alors que pour les meres toxicomanes, l'augmentation de l'idealisation de la periode prenatale a la periode postnatale etait aussi nuisible. Les cliniciens travaillant avec des meres toxicomanes devraient se donner pour but de soutenir le developpement d'une perception positive et realiste de la maternite. Sowohl negative als auch idealisierte mutterliche pranatale Reprasentationen konnen ein Risiko fur die Mutter-Kind Interaktion darstellen. Diese Studie analysierte die Rolle der mutterlichen pranatalen Reprasentationen und pra- zu postnataler Veranderung der Reprasentationen als Pradiktoren fur die Mutter-Sauglings Emotional Availability (EA) unter 51 drogenmissbrauchenden Muttern und ihren Sauglingen, die an einer Psychodynamischen Gruppentherapie, PGT, teilnahmen, oder psychosozieale Unterstutzung erhielten, PSS, sowie unter 50 nicht-missbrauchenden Vergleichsdyaden. Die mutterliche Reprasentation ihres Kindes, des, des Kindesvaters, der eigenen Mutter, und des Selbst-als-Mutter und Selbst-als-Frau wurden wahrend der Schangerschaft und 4 und 12 Monate nach der Geburt anhand des IRMAG gemessen. EA wurde mittels der Emotional Availability Scales (4th edition) zu 4 und 12 Monaten erfasst. Die Ergebnisse zeigten, dass negative pranatale Reprasentationen des Selbst-als-Frau und des Kindesvaters in drogenmissbrauchenden Mutter starker ausgepragt waren. Postnatal neigten PSS Mutter dazu zunachst ihr Kind zu idealisieren, erfuhren jedoch spater eine Desillusionierung der Idealisierung. Sowohl negative und idealisierte pranatale Reprasentationen des Selbst-als-Mutter sagten Probleme in der Mutter-Kind EA vorher, allerdings nur unter PGT Muttern. Fur alle Mutter war eine negative Veranderung der Reprasentationen schadlich fur die Mutter-Kind EA, wohingegen fur drogenmissbrauchende Muttern, auch eine Zunahme der Idealisierung von der pra- zur postnatalen Phase sich negativ auswirkte. Kliniker, die mit drogenmissbrauchenden Muttern zusammenarbeiten sollten die Forderung einer realistisch positiven Sicht des Mutterdaseins anstreben.

Objectives: First, to compare multilevel emotion processing (EP) of pregnancy between substance-abusing and non-using women, and, second, to analyse whether different types of interventions can increase positive and functional EP and decrease negative and dysfunctional EP among substance-abusing mothers. EP was conceptualised according to the multifocal theory of emotions proposed by Frijda in 1986, comprising feeling states, behavioural urges to act, cognitive appraisals, and meta-emotions. Method: Participants were 101 women, 51 with substance abuse disorder and 50 comparisons. The substance-abusing women were provided with either intensive psychodynamic mother–infant group therapy (PGT; n = 25) or individually tailored psychosocial support (PSS; n = 26). All women reported their EP once during pregnancy (T1; N = 94), and twice postpartum, when the child was four (T2; N = 84) and twelve (T3; N = 76) months. Results: As hypothesised, the results indicated that the pregnancy-related EP of substance-abusin...

We studied how attachment representations contribute to central components of transition to motherhood, prenatal emotion processing (EP) and emotional availability (EA) of mother-infant interaction, and whether there are group specific differences. Participants were 51 treatment-enrolled substance-abusing (SA) mothers and their infants and 50 non-using comparison dyads with obstetric risk. Mother's attachment representations (AAI) and EP were assessed prenatally and EA when infants were four months. Results showed that autonomous attachment only had a buffering effect on prenatal EP among comparisons. All SA mothers showed more dysfunctional EP than comparisons and, contrary to comparisons, autonomous SA mothers reported more negative cognitive appraisals and less meta-evaluation of emotions than dismissing SA mothers. Preoccupied SA mothers showed high negative cognitive appraisals, suggesting under-regulation of emotions. Attachment representations were not associated with EA in either group; rather, SA status contributed to global risk in the relationship. Surprisingly, autonomous SA mothers showed a tendency towards intrusiveness. We propose that obstetric risk among comparisons and adverse relational experiences among almost all SA mothers might override the protective role of mother's autonomous representations for dyadic interaction. We conclude that prenatal emotional turbulence and high interaction risk of all SA mothers calls for holistic treatment for the dyad.

Some mothers who have recently lost a significant attachment figure may become mentally incoherent and sporadically even enter a trancelike, dissociative state. Such states of mind have been shown to predict infant attachment disorganization. Infants born close to the time of a parental loss are at a greater risk for intergenerational trauma. A background of maternal substance abuse is also known to increase such risk. We illustrate by way of a case study how a mother–infant group psychotherapy programme aimed at substance-abusing mothers may help to prevent the transmission of mother’s unresolved trauma to the infant. Another goal was to discuss how attachment-derived methods (namely, Adult Attachment Interview, Strange Situation Procedure and the Emotional Availability Scales) may aid in understanding the effects of the intervention.

In this article we present a novel method of outpatient care: brief, dynamic mother – infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother – infant relationship in this high-risk group. The clinical material is taken from 16 mother – infant dyads from six psychotherapy groups, which met weekly over six months from pregnancy to post-partum. The therapy process consists of 20 – 24 three-hour sessions. The basis of the therapy is to offer mothers experience of care, which they, in turn, can give to their infants. In this paper we analyse the core therapeutic elements that may contribute to better mothering and child development. They involve: the group providing a symbolic maternal lap, and the meeting of the mothers' and the infants' needs. It is hoped that this may offer the mothers a new experience within which to reappraise thei...