Academic journal article Journal of Prenatal & Perinatal Psychology & Health

The Mother-Baby Prenatal Group: Nurturing Reflective Functioning in a Methadone-Maintenance Clinic

Academic journal article Journal of Prenatal & Perinatal Psychology & Health

The Mother-Baby Prenatal Group: Nurturing Reflective Functioning in a Methadone-Maintenance Clinic

Article excerpt

ABSTRACT: This paper describes the rationale and curriculum for an attachment-based intervention for pregnant women who attend an outpatient methadone-maintenance clinic. Maternal drug use has been associated with negative prenatal internal representations and problems in mutual regulation after birth. Maternal attachment status during pregnancy has been correlated with subsequent security of infant attachment. Recent studies suggest maternal reflective functioning as a key mediator in attachment. The focus of the 6-week Mother-Baby Prenatal Group is to provide a safe space in which to develop and nurture reflective functioning to support secure maternalfetal and maternal-infant attachment relationships.

KEY WORDS: Maternal-infant attachment, mentalization, reflective functioning, maternal substance abuse, prenatal intervention

INTRODUCTION

The literature on substance abuse among women describes problems frequently encountered, including psychiatric disorders; a history of sexual and/or physical abuse; lack of social support; domestic violence; and inadequate housing (Hans, 1999; Horrigan, Schroeder & Schaeffer, 2000; Howell & Chasnoff, 1999). These problems are even more critical when the woman is pregnant, for they may adversely affect both mother and infant, including the relationship that is forming between the two. Maternal drug use has been associated with negative prenatal internal representations and problems in mutual regulation between mother and baby after birth (e.g., Das Eiden, 2001; Goodman, Hans & Bernstein, 2005; Pajulo, Savonlahti, Sourander, Piha & Helenius, 2001). Additionally, maternal attachment status during pregnancy has been correlated with subsequent security of infant attachment (Fonagy, Steele, Moran, Steele & Higgitt, 1993). Recent studies suggest that maternal reflective functioning is a key mediator in the intergenerational transmission of attachment (Fonagy & Target, 2005; Grienenberger, Kelly & Slade, 2005; Slade, Grienenberger, Bernback, Levy & Locker, 2005). These findings support the significance of interventions that focus on nurturing reflective functioning to promote secure maternalfetal and maternal-infant attachment relationships.

BACKGROUND OF PROJECT

The project described in this paper is an outcome of consultation to the Narcotic Treatment Program (NTP) at Acadia Hospital in Bangor, Maine. As many as 600 individuals may attend the outpatient NTP clinic daily for treatment of opioid addiction. Many clients in the program have co-existing psychiatric disorders, with depression and anxiety being prevalent. At any given time, the clinic population includes between 20 to 30 women who are pregnant and treated with methadone.

During the last year, the hospital has started a program of in-house obstetric and pediatric services for NTP clients who are pregnant or parenting preschool children. Women who abuse substances tend not to access traditional systems of care for a variety of reasons, including barriers within the health care system itself and the inability of traditional systems to provide health care and treatment for substance abuse using an inclusive approach (Milligan, et al., 2002; Sword, Niccols & Fan, 2004). Research shows that the programs most effective in meeting the multiple needs of women with drug problems provide integrated services, with prenatal care and child care as important components (Ashley, Marsden & Brady, 2003; Howell & Chasnoff, 1999; Sweeney, Schwartz, Mattis & Vohr, 2000). As Sword and colleagues note (2004), evidence-based practice confirms "the importance of comprehensive, coordinated, and individualized service provided by an interdisciplinary team of professionals who are supportive, nonjudgmental, and nurturing" (p. 2).

Goals of the Well Child Clinic at Acadia Hospital include providing supportive care to pregnant women who attend the methadone clinic during the prenatal and postpartum period, and making available maternal and infant mental health services to mothers and infants at risk for relationship problems. …

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