Infant–Parent Psychotherapy (IPP) is a dyadic, relationship-based treatment for parents and infants that is designed to improve the parent–child relationship in the wake of incidences of domestic violence and trauma, including maltreatment and neglect of the child. To prevent compromised development that can lead to later maladaptation and psychopathology, IPP seeks to intervene in the early life course of maltreated infants. It does this by examining the insecurities that have developed in maltreating parents from negative experiences during their own childhoods.
IPP is an adaptation of Child-Parent Psychotherapy (CPP), which is a treatment for parents and young children that helps restore normal developmental functioning in the wake of domestic violence and trauma. Designed to use with mothers of maltreated infants, IPP is based on attachment theory but combines and integrates principles from multiple theories (developmental, trauma, social-learning, psychodynamic, and cognitive–behavioral theories) to improve the relationship and attachment between the mother and her infant. The IPP model is guided by the idea that problems in the parent–infant relationship are not just the result of deficits in parenting knowledge and skills. Rather, the problems stem from insecurities that developed from the mother’s own experiences in childhood. The infant may remind the mother of negative childhood relationship experiences; in the process, a mother’s unresolved feelings can be projected onto her infant, resulting in insensitive care and maltreatment.
In IPP treatment, the emphasis is on the relationship between the mother and her baby. A therapist meets weekly with mothers and their 12-month-old infants. Sessions are conducted in the home, usually over the course of a year. The therapy sessions are designed to be supportive, nondirective, and include developmental guidance on the basis of concerns from the mothers.
During the sessions, the therapist and mother observe the baby together. Throughout the observation period of mother–infant interaction, the therapist allows the mother’s distorted emotional reactions and perceptions of the infant to be associated with memories from the mother’s childhood experiences. The therapist shows the mother respect, empathetic concerns, and positive regard. The therapeutic relationship that is established between the therapist and the mother provides the mother with a corrective emotional experience, which allows her to differentiate current from past relationships and to form positive representations of herself and of herself in relationship to others, especially her baby. As a result of this process, mothers are able to expand their responsiveness and sensitivity to the baby. This in turn fosters security in the mother–infant relationship and promotes emerging autonomy in the child.
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The baseline assessments performed in the study by Cicchetti, Rogosch, and Toth (2006) showed there were significant differences between the mothers in the normative control (NC) group and mothers in the maltreatment group, including mothers who received the Infant–Parent Psychotherapy (IPP), Psychoeducational Parenting Intervention (PPI), and community standard (CS) condition. Mothers in the maltreatment group reported greater abuse and neglect in their own childhood, more insecure relationships with their own mothers, more maladaptive parenting attitudes, more parenting stress, and lower family support and also evidenced lower maternal sensitivity during observational sessions. In addition, infants in the maltreatment group had significantly higher rates of disorganized attachments in comparison with infants in the NC group.
Measures of Attachment
There were significant group differences on measures of attachment classification using the Strange Situations scale. Overall, the IPP group significantly improved on measurements of attachment when compared with the CS group. However, there were few significant differences between the IPP group and the PPI and NC groups.
Compared with the CS group, the IPP group had significantly higher rates of secure attachment at the follow-up period. The rates of secure attachment increased from 3.1 percent to 60.7 percent for the IPP group, and there was virtually no change in secure attachment in the CS group (the rate increased from 0 to 1.9 percent). The IPP group also had significantly lower rates of disorganized attachment compared with the CS group. At the follow-up, disorganized attachment was prominent in the CS group (77.8 percent), while IPP group displayed much lower rates (32.1 percent).
In addition, all study participants were classified into one of four attachment groups: stable insecure, insecure to secure, secure to insecure, and stable secure. The rate of becoming secure differed significantly among the IPP, CS, and NC groups. The rate of change from insecure to secure was 57.1 percent in the IPP group, compared with 1.9 percent in the CS group and 18.2 percent in the NC group. The rates of stable insecure were also significantly different for the IPP and CS group. In the absence of a theoretically informed intervention, nearly all (98.1 percent) of the CS group was stable insecure, while the rates were significantly lower in the IPP group (39.3 percent). Finally, the rates of stable disorganized attachment were also significantly lower in the IPP compared with the CS group. In the CS group, 74.1 percent of the children were classified as disorganized at both time periods, while rates of stable disorganized attachment were significantly lower for the IPP group (28.6 percent).
Intent-to-treat analyses were performed because of the sizable number of mothers and infants who were randomized into the intervention groups but who did not participate or complete the intervention. At follow-up, the IPP decliners, the PPI decliners, and the CS randomized groups did not differ on the four-group attachment classifications. Disorganized attachment was the most frequent classification among the subgroups. Thus, the three subgroups of study participants who did not receive an intervention were comparable and characterized by stable insecure and disorganized attachment from baseline to the follow-up assessment.
The intent-to-treat analyses also confirmed the treatment effects of the interventions, despite the inclusion of the nonparticipating cases in the outcome results. Those study participants randomized to the IPP, PPI, and NC group had significantly higher rates of secure attachment than the participants randomized to the CS group. The randomized IPP group also had significantly higher rates of becoming secure than the CS group. Stable disorganized attachment was also more frequent in the group randomized to CS than the group randomized to IPP. Thus, the analyses showed that, even with the inclusion of cases that declined, treatment effects were nonetheless still found following the IPP intervention.
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