Outcome evaluation in brief mother-infant psychotherapy: A preliminary report

Abstract

The emerging field of mother-infant psychotherapy lends itself particularly well to objective measures of change. The improvements are often rapid, involving symptom relief or removal. These improvements can be related to subjective change in mothers and to modifications of various interactive variables. We examined changes due to brief therapy (maximum of 10 sessions) in cases of functional and behavioral disturbances in children less than 30 months old. Evaluations were done before treatment and at 1 week, 6 months, and 12 months after therapy. The outcome measures were changes in the infant's symptoms, the mother's representations, and the behavioral interactions between mother and infant. One group of mothers and infants was seen in a form of psychodynamic brief psychotherapy developed in our Center, and a control group was seen in a noninterpretive form of therapy called interactional guidance. This progress report includes the initial 38 mother-infant dyads who have completed the first three evaluations. Results indicate that the major changes are seen in symptom relief or removal; interactions change in the direction of becoming more “harmonious,” with mothers becoming less intrusive and infants being more cooperative. A better identification between mothers and infants is seen in the measures of the mothers' representations. No major differences between the two forms of therapy have yet appeared. To date, pretreatment predictions show little correlation with actual outcomes. Change proved to be durable, even showing some improvement in the 6-month follow-up evaluations. Results are discussed from the point of view of (1) the challenge of an objective, quantitative evaluation of subjective changes; (2) the issue of specificity of modes of treatment; (3) the difficulties of outcome predictions; (4) the remarkable opportunities for prevention of psychic disturbances in infancy; and (5) the relational nature of early disturbances.