Perinatal Clinical Psychology: Parent-Child Interaction in Primary Care

Article excerpt

Abstract: Perinatal clinical psychology deals with infant mental development, primary parent-child relationships, and problems related to nurturing and parenting activities of the woman and the couple during the prenatal and neonatal period. Its aims are promoting positive influences and preventing risk elements for the child's development and for the parents raising the child, thus providing support to primary relationships. Perinatal clinical psychology studies intra-psychic, interpersonal, and transgenerational mental processes. In this paper, we present a short synthesis of the origin and development over time of the main concepts that are used in perinatal clinical psychology interventions and research.

Keywords: primary relationships, emotional regulation, attachment theory, affect attunement, reflective function, affect regulation, Neuroscience, fetal mind, Protomental Theory.

Mother-Child Interactions In Primary Care: Convergence Of Research

Pre and perinatal psychiatric literature has produced research concerning mental illness in pregnancy and postpartum problems (depression, puerperal psychosis, psychiatric syndromes). Psychoanalytic and psychological literature specifically refer to the child's primary care, introducing the concept of "maternal care" and "maternal careless" (when care is inadequate, causing abnormal or pathological syndromes in children). This concept of "maternal care" has changed in different ways as theories have changed (Imbasciati, 2008). Over time we can find a convergence of the studies about maternal care and the influence on primary infant mental development (Imbasciati, Dabrassi, & Cena, 2007).

Psychoanalysis, in particular infant psychoanalysis, first with the research of Anna Freud (1949, 1957) by means of the children's observation method, and continuing with Melanie Klein's studies (1932) considering abnormal or pathological syndromes in children related to inadequate maternal care (maternal careless).

Ferenczi (1927, 1929, 1932) was the first psychoanalyst to focus on the emotional investment of parents in their children, shifting the attention from the psychological study of the individual to the influence of the relationship between individuals and, in particular, the therapeutic value of affective relationship.

Rene Spitz studied, through observation, abandoned and orphaned children (after WWII in particular) and emphasized that infants subjected to relationship deprivation fall into a pathological condition of psychological and physical disorder, which he called anaclytical depression (1946). Thanks to the studies of Spitz, an important series of research studies (which we will address in this paper) concerning primary mother-child interactions and maternal care deprivation began (1965).

In the United States, where many psychoanalysts from Vienna and Berlin lived (having emigrated prior to or during World War II), Ego Psychoanalytic Psychology developed (Hartman, 1939) and interest within psychology moved to ego adaptive processes related to the environment and the first phases of the child's development that characterize environment-ego interactions.

Kris (1950), through direct child observation, studied parent-child relationship problems, exploring the conflicts that the parents transmit to their child. He also identified a mechanism to explain the parents' transfer of their own infant experiences to their children. Later Fraiberg (Fraiberg, Adelsen, & Shapio, 1975) called this psychological process the parents' "ghosts" in the nursery.

Winnicott (1945) analyzed the quality of the first mother-child interactions and the emotional environment in which the child matures (1960) as the central element of the child's psychological development. Winnicott (1958) mainly set child psychoanalysis in developmental contexts. In addition, he developed his own theory about the observation of mother-child from childbirth. …