Astrid Berg

Talking with infants: A bridge to cross-cultural intervention

Abstract Infant-led psychotherapies are receiving increasing attention. Talking to the infant directly has proven to be a useful way of engaging the infant as well as the mother, particularly in a cross-cultural setting. The setting of a community clinic is described with attention given to the manner in which the political and economic contexts of the local circumstances affect the clinician. The intensive psychoanalytic psychotherapy given to a 6-month-old infant is recounted in order to illustrate the ability of the baby to use the therapeutic space. This is followed by two brief cases from the clinic which illustrate similar points and which underscore the therapeutic impact that can be made when personhood is conferred on the infant.

Infant mental health needs a model of service delivery.

The concept of infant mentally health is generally not well known in communities and in those who provide care for young children. A plea is made for greater awareness of the importance of the early care-giving environment through improved training of health care workers on all levels.

Peri-partum psychosis: How does parental reflective function affect the quality of mother-infant interaction?

Introduction The purpose of this exploratory study was to examine the impact of peri-partum psychosis on parental reflective function and quality of mother-infant interaction in a South African sample at high risk of developing attachment difficulties. Besides the effects of physical separation, attachment difficulties may arise from other maternal factors, such as a lack of reflective capacity or negative symptoms affecting the warmth with which a mother interacts with her child. This study examined the quality of mother-infant interaction to determine how the presence of psychotic symptoms during pregnancy or shortly after delivery affects aspects like maternal sensitivity, child social involvement and dyadic engagement. Ultimately, the study aimed to investigate the association between psychosis, parental reflective functioning and quality of parent-infant interaction. Methods The study followed a descriptive, observational design. Mothers were recruited if they experienced psychotic symptoms during pregnancy or within the first 6 months postpartum. Demographic information and psychiatric history were collected. Parental reflective function was assessed by the Parent Development Interview (PDI), and the quality of mother-infant interaction in an unstructured play interaction was coded using the Coding Interactive Behaviour (CIB). Results Eight participants aged between 22 and 44 years, with diagnoses of bipolar disorder, schizophrenia and MDD with psychosis, were recruited. Parental reflective functioning showed significant variation with scores approaching and exceeding ordinary reflective functioning, typically found in non-clinical populations. At the time of the play interaction, infants were aged between 6 and 10 months. Play interactions were mostly parent-led, with some surprising findings, such as a lower than anticipated frequency of parental negative affect, moderate maternal sensitivity and wide variation in scores for infant withdrawal. Conclusion The results found in this small sample of mothers with peri-partum psychosis have presented unexpected results, both in terms of higher than anticipated capacity for parental reflective functioning and aspects of the quality of interaction with their infants. Possible implications for future interventions will be discussed.

REFLECTIVE PRACTICE IN INFANT MENTAL HEALTH-A SOUTH AFRICAN PERSPECTIVE.

Reflective practice forms a pivotal part of mental health intervention in a setting where language and cultural differences require working together with a community counselor for language interpretation. Reflective practice in infant mental health began with Esther Bicks () infant observations and continued with Selma Fraibergs () parent-infant psychotherapy. These two models formed the basis of the practice of infant mental health in a community in South Africa. A clinical example will highlight the importance of culturally informed observation that is then reflected upon. A qualitative study that examined the interaction among the participants in three clinical settings shows that a sustained partnership and tolerance for flexibility lie at the heart of good practice in intercultural settings. Object-relations theory offers an additional, in-depth understanding of the underlying psychic processes in reflective practice.

Early Identification of Psychopathology

This chapter deals with identification of psychopathology in the first 3 years of life. Early identification implies, by definition, the use of assessment tools. We will show how assessment must be tailored to the specific culture to which the infant and his/her parents belong: tools that fit Western cultures will probably not fit nonWestern cultures. As an instance of the Western culture, we describe the Infant Mental Health Assessment Form that was developed in Finland to help primary health care professionals identify infants and families in need of psychosocial support. The tool has two cutoffs: Exceeding the lower cut-off score indicates that the infant or the family needs further examination at the primary level of care, while the higher cut-off indicates that the infant and his/her parents needs a referral to a child psychiatric clinic. In contrast, the typical clinical situation in a nonWestern country such as South Africa is characterized by numerous challenges that do not allow for the usually known methods of assessment, such as a quiet, contained space, toys, and time. A simple, creative assessment tool, named the “biscuit game” has been developed in Capetown, as a cultural appropriate assessment tool that provided a useful adjunct to observing the infant with an eating disorder, as illustrated with a clinical vignette. Finally, early identification of psychopathology requires knowing about risk and protective factors in the infant, the parents, and their environment, as also illustrated by a clinical vignette. After reading this chapter, the reader will realize that early signs of psychopathology are already evident in infants and most of the major mental disorders like anxiety, depression, and behavioral disorders often have their origin already in this early age; the reader will also become more aware of the need to use culture appropriate assessment tools.

The importance of the first 1 000 days of life

At the World Association for Infant Mental Health’s (WAIMH) 11th International Conference in Yokohama, Daniel Stern, one of the most prominent scholars in the field, made an impassioned call for action on behalf of infants. He listed various research findings and concluded that we know enough and that more is now required. What we need to do is to change the society’s perception of what is happening. We have to shift the Zeitgeist. We have to look at what we can do differently, we have to move it through the social and the knowledge-academic base to the purely political.1 This call was made in 2008 and it so happens that five years later the UK government did just that by issuing a cross party manifesto entitled “The 1001 Critical Days” in which the pledge was made, “to work to ensure all babies have the best possible start in life”.2 One year later a multi-disciplinary working group — The Parent Infant Child Health and Wellness Working Group (PICH WG) — was established at provincial level in South Africa. This Group was mandated to drive the agenda for the Western Cape Provincial First 1000 Days Initiative, a lead project of the Provincial Strategic Plan for 2014–2019. This is the first public health call in South Africa which specifically focusses on the beginning of life in a holistic, comprehensive manner. What has taken place in the collective conscious attitude to bring about this new interest, perhaps even this shift in the Zeitgeist that Daniel Stern called for? The answer lies in part in the evidence that has been gathered from research and clinical observations of infants and their families. What are the discoveries that have been most influential in altering the Zeitgeist? These could be grouped into three broad categories: 1. Findings from neuroscience — in particular human brain development 2. The role of toxic stress 3. Infant observation and longitudinal studies

The management of traumatic stress disorder in infants

The number of very young children exposed to trauma is under-represented. Trauma interferes with the organisation and development of brain structures and thus may have lasting effects on the individuals life. Traumatic stress disorder (TSD), which is the Axis I diagnosis used in the under-three patient population, encompasses four symptom clusters. Of note is the integral part of the Relationship Disorder Classification (Axis II) during this phase of life. The capacities needed to experience and recall early trauma are largely present from the beginning of life and rapidly develop during the first six months. The treatment of traumatic stress disorder rests on establishing a sense of safety, reducing the overwhelming affects evoked, helping the child to form a coherent narrative and thereby aiding the integration and psychological mastery of the traumatic event. The support of the attachment relationship with an adequate caregiver is pivotal

ESR-Experiments on the Two-Dimensional Electron Gas of Heterostructures

The epitaxial growth of thin layers of semiconductors, where the composition of the material can be changed within one lattice constant, is used for the realization of new microelectronic devices. The simplest structure consists of an interface between the semiconductors GaAs and AlGaAs. Free electrons are present at the GaAs-side of the interface if the AlGaAs material is doped with donors. Calculations show that the electrons are confined within a narrow interface region of about 10 nm which leads to a quantization of the energy within this channel (electric subbands). In our experiments only the lowest electric subband E0 of such a two-dimensional electron gas is occupied with electrons so that the energy is the sum of the fixed energy Eq for the motion perpendicular to the interface and the free motion within the plane.