Treating parent–infant relationship problems: Strategies for intervention

This volume is the result of a joint collaboration between clinicians and researchers representing a wide array of expertise in medicine, psychology, social work, occupational therapy, psychiatry, neurology and mental health. At the core of the book stands a transactional approach mirroring the current state-of-theart knowledge. Environmental and genetic factors are seen as reciprocally influencing each other in early development, including the impact of the environment on the anatomy and physiology of the plastic infant brain. The parent–child relationship then acquires a paramount importance. Three possible targets of intervention (the three Rs) are described by Sameroff: remediation of the child’s behaviour, redefinition of the child in the parent’s thinking, and re-education of the parent to effect a change in behaviour. Given the three Rs, the “port of entry” to intervention can be the infant, the parent or the parent–child interaction. This sets a flexible yet coherent frame of reference for interventions. Stern takes the position that different ports of entry may result in similar effects on behaviour, interaction and representations (attitudes, beliefs and internal models). Thereby, the choice of a specific intervention becomes less fateful and dramatic. The parent–infant interaction is focused on in McDonough’s chapter about “Interaction guidance”. Fivaz-Depeursinge, Corboz-Warnery and Keren present a fascinating method of assessment of family relationships—the Lausanne trilogue play (LTP) paradigm—based on observations of mother, father and child interacting in different constellations. The issue of changing parent representations in vulnerable families is treated by Lieberman, acknowledging the child’s role in the relationship. Dunn gives a detailed account of ways to enhance children’s bodily comfort by adapting sensory stimulation to the child’s individual sensory processing patterns. For instance, children with a tendency to avoid too much sensory stimulation may need to be firmly contained under heavy blankets. A developmental intervention focusing on the child’s behaviour, teaching parents to see the child’s competencies, is described by BruschweilerStern. A treatment modality for possibly maltreating parents is presented by Egeland and Farrell Erickson (the STEEP programme—Steps Toward Effective, Enjoyable Parenting). The Infant Team described by Larrieu and Zeanah aims at arriving at a reasonably quick decision regarding the placement of maltreated children (with birth parents, relatives or foster parents) according to legal requirements of permanency. The need for a diagnostic manual assessing infant mental health disturbances is addressed by Rosenblum, with particular emphasis on diagnosing relationship disorders on a separate axis, an option not included in most diagnostic systems. In a final chapter, Emde, Everhart and Wise discuss the principle of leverage, i.e. the idea of concentrating efforts to where one can find the best opportunities for successful intervention. Given this principle, different ports of entry may not be interchangeable, as implied earlier by Stern: instead, one may be preferable to another. The book describes a richness of concepts and gives thorough expositions of theoretically well-founded interventions that have all been implemented in practice. The reader is presented both with ways of thinking and with ways of working. This elegant, knowledgeable volume can be recommended as compulsory reading for a number of professionalsto-be: educationalists, doctors, nurses, psychologists and social workers.