Program Profile: Infant-Parent Psychotherapy

This is a dyadic, relationship-based therapy intended for maltreating parents (who had neglectful experiences in their childhood) and their infants. This program is rated Effective. Families in the treatment group experienced a statistically significant higher rate of secure attachment and a higher likelihood of change from insecure to secure attachment from baseline to follow up, as well as a lower rate of stable disorganized attachment, compared with families in the control group.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

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.

Program Theory

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, which explains how the parent-child relationship develops and provides influence on later behaviors and relationships (e.g., Sroufe and Waters 1977; Bretherton 1992). The tenets of attachment theory were used to classify parent-child attachment into four types: Secure attachment and three types of insecure attachment – avoidant, resistant, and disorganized (Ainsworth, Blehar, Waters, and Wall 1978; Main and Solomon 1990). IPP integrates the tenets of attachment theory with principles from additional 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 (Cicchetti, Rogosch, and Toth 2006).

Services Provided

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.

Study

Cicchetti, Rogosch, and Toth (2006) examined the efficacy of specific types of behavioral versus relationship-based interventions for infants from maltreating families (including Infant–Parent Psychotherapy) through a randomized preventive intervention trial. Year-old infants from maltreating families (60 boys, 77 girls) and their mothers were randomly assigned to one of three intervention conditions: Infant–Parent Psychotherapy (IPP), Psychoeducational Parenting Intervention (PPI), and community standard (CS) controls. The IPP intervention, an adaption of Child-Parent Psychotherapy for infants which is more concentrated on maternal representation and the mother–child relationship, while the PPI intervention is oriented more toward parent skills. The CS condition included no enhanced services; rather, families received services that are typically available to maltreating families.

A Department of Human Services (DHS) recruitment liaison identified infants known to have been maltreated or living in maltreating families with their biological mothers (or both). Eligible families were contacted, and mothers who were interested in participating in the study provided informed consent and signed release forms that allowed access to DHS records regarding the family’s involvement with Child Protective Services. DHS records were retained and coded using the Maltreatment Classification System. Among the recruited sample of infants, 66.4 percent had directly experienced abuse or neglect (or both) during the first year of their lives. The remaining 33.6 percent of infants were living with families in which abuse or neglect had been experienced by siblings. Of the infants who had experienced abuse or neglect, 8.8 percent had been physically abused, 69.3 percent had been emotionally maltreated, and 84.6 percent had been neglected.

Following a baseline assessment, mothers and children were randomly assigned to one of three groups: IPP (n = 53), PPI, (n = 49), and CS (n = 35). The groups did not differ on child gender, maternal age, maternal minority race/ethnicity, current receipt of TANF, total family income, or marital status. The entire study sample was 53.4 percent infant girls. Mothers averaged 27 years old, 74.6 percent were of minority race/ethnicity, and 12.7 percent were currently married. However, not all mothers in the intervention groups (IPP and PPI) participated in treatment. Overall, about 40 percent of the mothers randomly assigned to the IPP intervention and 51 percent of the mothers randomly assigned to the PPI intervention did not participate. A comparison of the IPP group, the IPP decliners, the PPI group, the PPI decliners, and the CS group revealed no significant differences on baseline demographic variables. The CrimeSolutions review of this program focused on the intent-to-treat analyses examining the differences between the IPP treatment group (including the IPP decliners) and the CS control group.

Measures of interest consisted of the Childhood Trauma Questionnaire (CTQ), the Perceptions of Adult Attachment Scale (PAAS), the Maternal Behavior Q–Set (MBQ), the Adult–Adolescent Parenting Inventory (AAPI), the Social Support Behaviors Scale (SBS), the Parenting Stress Inventory (PSI), and the Strange Situation scale. The CTQ measures past experiences of maltreatment, of both the infants and the mothers. The PAAS measures an individual’s perceptions of the quality of her early childhood relationship with her mother, as well as her perceptions regarding current attachment and relationship with her mother. The MBQ consists of 90 items that assess maternal sensitivity in relating to the infant that are measured during a 3-hour home observation session. The AAPI is a 32-item questionnaire that measures parenting and childrearing attitudes. The SBS is a 45-item instrument that measures real and potential social supports available to individuals. The PSI is a 101-item questionnaire that assesses parenting stress in the child domain and the parent domain. The Strange Situation was conducted to measure the infant’s attachment organization. Multivariate analyses of variance (MANOVAs) were conducted to determine differences between groups. The study authors did not conduct subgroup analyses.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Preventive Child Maltreatment Programs

Preventive child maltreatment programs are designed to prevent physical child abuse or neglect by educating expectant and new parents in parenting skills, coping with stressors, and stimulating child development. This practice is rated Effective for preventing child abuse, neglect, and maltreatment.

Evidence Ratings for Outcomes

Victimization - Child abuse/neglect/maltreatment

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?