Infant-Parent Psychotherapy
Infant-Parent Psychotherapy (IPP) is a psychoanalytic intervention targeting mother-infant dyads who may be at risk of an insecure attachment.
Specifically, IPP aims to prevent insecure attachment or to shift an insecure to a secure attachment, as measured by Ainsworth’s Strange Situation. Mothers identified as being depressed, anxious, traumatised or at risk of maltreating their child attend weekly sessions with their infant (< six months) for a period of 12 months or longer.
Please note that this Guidebook page describes the evidence for a specific programme that makes use of psychotherapy. It does not describe the evidence for psychotherapy with children as a broader practice.
EIF Programme Assessment
Child outcomes
This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Supporting children's mental health and wellbeing
Improved attachment security
based on study 1
Improved attachment security (% secure)
based on study 2
- Statement: 40.9-percentage point increase in proportion of participants with secure attachment (measured using coded observation of Ainsworth's Strange Situation)
- Score: 50
- Timeframe: Immediately after the intervention
based on study 2
- Statement: 28.7-percentage point increase in proportion of participants with secure attachment (measured using coded observation of Ainsworth's Strange Situation)
- Score: 33
- Timeframe: A year later
- Long term: 1
Improved attachment security (% changing from insecure to secure)
based on study 2
- Statement: 38.6-percentage point increase in proportion of participants moving from insecure to secure attachment (measured using coded observation of Ainsworth's Strange Situation)
- Score: 50
- Timeframe: Immediately after the intervention
Improved attachment security (% stable disorganised)
based on study 2
- Statement: 34.5-percentage point reduction in proportion of participants with stable disorganised attachment (measured using coded observation of Ainsworth's Strange Situation)
- Score: 32
- Timeframe: Immediately after the intervention
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Who is it for?
The best available evidence for this programme relates to the following age-groups:
Infants
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
- Individual
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
- Home
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted indicated
Where has it been implemented?
- United States
Ireland provision
Ireland evaluation
About the programme
What happens during the delivery?
How is it delivered?
- IPP is delivered in 32 sessions of approximately 1 to 1.5 hours' duration each by one clinical practitioner.
What happens during the intervention?
- IPP is delivered by a practitioner with a Masters (or higher) qualification in psychology or social work. Mothers and their toddler attend weekly sessions for a period of 12 months or longer.
- During each session, the practitioner uses empathic, non-didactic support to help the mother reflect on her childhood experiences and differentiate them from her current relationship with her toddler.
- The practitioner also engages jointly with the mother and infant, so that they can model sensitive responding and suggest positive explanations for the child’s behaviour.
- As the therapeutic relationship develops, the mother learns to dissociate negative feelings informed by her own childhood from her interactions with her infant and appropriately interpret her infant’s behaviours.
What are the implementation requirements?
Who can deliver it?
- The practitioner who delivers this programme is a clinical practitioner with NFQ-9/10 qualifications.
What are the training requirements?
- The practitioner has 92 hours of programme training. Booster training of practitioners is recommended.
How are the practitioners supervised?
- It is recommended that practitioners are supervised by one host agency supervisor (qualified to NFQ-9/10 level) with 92 hours of programme training. There is no licensing requirement to run this programme.
What are the systems for maintaining fidelity?
Is there a licensing requirement?
There is no licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- Positive and sensitive parent/child interactions increase the likelihood of a secure parent/infant attachment relationship.
- Parents experiencing multiple hardships and/or an insecure attachment relationship in their own childhood are less likely to develop positive representations of their infant, reducing their ability to develop a secure attachment relationship.
- Parents receive therapeutic support to improve their ability to form positive representations of their infant and provide an appropriately nurturing and sensitive caregiving environment.
- In the short term, parents develop positive representations of their infant, their sensitivity increases and the infant is more likely to develop a secure attachment.
- In the longer term, children will develop positive expectations of themselves and others, demonstrate improved mental health and be at a reduced risk of child maltreatment.
Intended outcomes
Contact details
Chandra Ghosh
University of California San Francisco
chandra.ghosh@ucsf.edu
About the evidence
Infant-Parent Psychotherapy’s (IPP) most rigorous evidence comes from two RCTs which were conducted in the US.
This studies identified statistically significant positive impact on child and parent outcomes.
This programme has evidence from at least one rigorously conducted RCT along with evidence from an additional comparison group study. Consequently, the programme receives a 3+ rating overall.
Study 1
| Citation: | Lieberman et al (1991) |
| Design: | RCT |
| Country: | United States |
| Sample: | 100 Spanish-speaking mothers at risk of depression with a 12-month infant |
| Timing: | Post-test |
| Child outcomes: |
|
| Other outcomes: |
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| Study rating: | 3 |
Lieberman, A.F., Weston, D.R., & Pawl, J.H. (1991). Preventive intervention and outcome with anxiously attached dyads, Child Development, 62, 199-209.
Available at
https://www.jstor.org/stable/1130715?seq=1#page_scan_tab_contents
Study design and sample
The first study is an RCT.
This study involved random assignment of mother-child dyads to an IPP treatment group or a control condition group involving no additional therapy. Also, securely attached children served as an additional ‘secure’ group as a point of comparison.
This study was conducted in the US, with a sample of 100 low-SES Spanish-speaking mothers with a toddler (aged 12 months to two years) who had immigrated to the United States from Mexico or Central America within the past five years.
Measures
Child attachment behaviours (angry behaviour, restricted affect, avoidance, resistance) were measured using Ainsworth’s Strange Situation (expert observation of behaviour). Child attachment security was measured using the Attachment Q-sort (direct assessment). Dyadic partnership was measured using coded observation (expert observation of behaviour).
Maternal empathic responsiveness and maternal initiation were measured using the coded observation of freeplay measures (expert observation of behaviour). Maternal child-rearing attitudes were measured using the Spanish version of the Maternal Attitude Scale (parent report).
Findings
This study identified statistically significant positive impact on one child and parent outcome, respectively.
Specifically, the child outcome is: Improved attachment security.
Study 2
| Citation: | Cicchetti et al (2006); Cicchetti et al (2011); Stronach et al (2013) |
| Design: | RCT |
| Country: | United States |
| Sample: | 189 mothers, 137 of whom were at risk of maltreating their child |
| Timing: | Post-test; one-year follow-up |
| Child outcomes: |
|
| Other outcomes: |
|
| Study rating: | 3 |
Cicchetti, D., Rogosch, F.A., & Toth, S.L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623-649.
Cicchetti, D., Rogosch, F.A., Toth, S.L. & Sturge-Apple, M.L. (2011). Normalising the development of cortisol regulation in maltreated infants through preventive interventions. Development and Psychopathology, 23, 789-800.
Stronach, E.P., Toth, S.L., Rogosch, F., & Cicchetti, D. (2013). Preventive interventions and sustained attachment security in maltreated children, Developmental Psychopathology. 25, 919-930.
Available at
https://www.ncbi.nlm.nih.gov/pubmed/17152394
https://www.ncbi.nlm.nih.gov/pubmed/21756432
https://www.ncbi.nlm.nih.gov/pubmed/24229539
Study design and sample
The second study is a rigorously conducted RCT.
This study involved random assignment of mothers-child dyads to an IPP treatment group, a variation called psycho-educational parenting intervention (PPI), and a control group involving standard care.
This study was conducted in the US, involving 189 infants (average 13.31 months of age) and their mothers who were predominantly of minority race/ethnicity (74.1%).
Measures
Child attachment organisation was measured using Ainsworth’s Strange Situation (expert observation of behaviour). Child behaviour problems were measured using the Child Behavior Checklist (parent report).
Findings
This study identified statistically significant positive impact on one child outcome, specifically: Improved attachment security.