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The Hexagon: An Exploration Tool
The Hexagon can be used as a planning tool to guide selection and evaluate potential programs and practice for use.
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Core Components
Parent Infant Psychotherapy is an intensive psychotherapeutic intervention for infants under the age of one and their primary carer, most frequently the mother. The intervention is targeted at parent-infant dyads where the mental state of the parent leads to inappropriate behaviour towards the infant. This is often a consequence of parental trauma, and PIP is particularly indicated for intergenerational trauma. The practitioner provides direct input to the infant, direct work with the parent, and works with relationship between parent and infant. Sessions typically occur in a clinic room on a weekly basis for an average of 8 months, but up to one year.
Fidelity
Fidelity is primarily managed through robust intensive training, and ongoing intensive supervision including video review. There is no formal fidelity measure.
Modifiable Components
Parent Infant Psychotherapy is a tailored intervention, responding to the needs and issues of the parent-infant dyad, within the framework of the intervention. It has been delivered in a range of different contexts in the UK and abroad. Parent Infant Psychotherapy can be delivered in a long-term group format with two therapists, where infants and parents join, and then leave an ongoing group. Both individual PIP and group PIP require significant commitment from the participants.
Parent Infant Psychotherapy (PIP) has been manualised by the Parent Infant Project team in the Anna Freud National Centre for Children and Families (AFNCCF), in London. In addition to providing training, the Parent-Infant Project offers clinical services to the local area of London, and links in with Parent Infant Partnership UK.
Support for Organisation / Practice
Implementation Support
Organisations can seek support in implementing PIP on request via AFNCCF Parent Infant Project team. Organisational Support is not formalised.
Licence Requirements
Training is only available to registered psychotherapists, or clinical or counselling psychologists. The PIP specialist training at the AFNCCF is accredited by the British Psychoanalytic Council (BPC). A further separate licence is not required.
Start-up Costs
The primary costs are in establishing a qualified workforce, and provision of supervision. Training costs are £5500 per person. Additional costs include a suitable, baby friendly therapeutic space.
Building Staff Competency
Qualifications Required
Training in Parent Infant Psychotherapy is open to psychotherapists and clinical or counselling psychologists, who are registered with professional body, and have at least 4 years’ experience working therapeutically. In additional, they need to have completed a one-year course in psychoanalytic parent-infant observation and had personal psychoanalytic psychotherapy.
Training Requirements
The PIP training is an 18 months programme and includes 688 hours of learning, including face to face teaching, self-directed study and clinical practice. The training costs £5500. Training is held at AFNCCF, London, UK with an intake every two years. Practitioners undertaking the training will require access to training cases. Training is accessed through a selection process, including interview.
There will be additional time and costs for those practitioners without a psychoanalytic background including the requirement of personal psychanalytic psychotherapy. The psychoanalytic parent-infant observation component may be completed alongside the PIP training.
Supervision Requirements
Once qualified, ongoing supervision is required provided by a psychodynamically oriented and experienced supervisor. Specialist PIP supervision is available on a time-limited group basis at the AFNCCF.
Theory of Change
Parent infant psychotherapy (PIP) is a psychoanalytically based intervention, that works with both the parent and infant together. The theoretical model posits that unprocessed parental trauma is triggered by the infant, or other stimuli and this changes the parents state of mind. In this state of mind, the parent responds to the infant with unhelpful (anomalous) behaviours such as hostility towards or withdrawal from the infant. Faced with parental emotions and behaviours that the infant cannot understand, the infant tries to the adapt to the situation, which over time can develop into insecure/disorganised attachment. By intervening in the parent-infant relationship, as well as working directly with the infant and parent, PIP targets the parent’s own internal representation of the infant. Linking past experiences to the current parent-infant relationship, provides the parent with opportunity for change in representation and behaviour, thus improving the relationship, promoting secure attachment and optimal development.
Infants and Toddlers: 0-36 months - Rating: 3+
Research Design & Number of Studies
One RCT has been completed on the manualised version of Parent Infant Psychotherapy described here (Fonagy et al, 2016).
Outcomes Achieved
For mothers experiencing social exclusion and mental health problems, in comparison with controls at 12 month follow-up PIP intervention was associated with
Child Outcomes
• No significant improvement in infant development
Parent Outcomes
• Improved mood
Key References
Fonagy, P., Sleed, M., & Baradon, T. (2016) Randomized Controlled Trial of Parent-Infant Psychotherapy for Parents with Mental Health Problems and Young Infants. Infant Mental Health Journal. 37(2):97-114.
Need
Comparable Population
Parent Infant Psychotherapy has been used with mother’s experiencing social exclusion and mental health difficulties (excluding psychotic illness) where the mental health difficulties are interfering in the mother-infant relationship. It is particularly indicated for intergenerational trauma. Prospective participants need a willingness to explore their relationship with their infant, and an ability to commit to a potentially long-term weekly intervention.
Is this an identified population of particular concern to your organisation? Desired Outcome
Parent-Infant Psychotherapy aims to mitigate the negative impact of maternal mental health on their infant through intensive early intervention. Is this a current priority for your organisation?
Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?
Need Score
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Fit
Values
Parent Infant Psychotherapy views babies as potential patients; who can be impacted both positively and negatively by their early experiences, especially the relationship with their primary caregiver. Collaboratively with parents, PIP practitioners explore whether the intervention is a good fit for the parent’s current situation and needs.
Is this in keeping with the values and beliefs of your organisation? Priorities
Parent Infant Psychotherapy is for parents and infants under one where there is concern that mental state of the parent is negatively impacting on the relationship between the relationship between parent and infant. This is often a consequence of parental trauma, and PIP is particularly indicated for intergenerational trauma.
Are the mental health needs of very young children a current priority for your service? Existing Initiatives
Services implementing Parent Infant Psychotherapy need to be connected to multi-agency services that support parents and very young children, including specialist adult mental health services, perinatal mental health services and child and adolescent mental health services; and primary care services such as GPs, midwives and health visitors. These services provide referrals for intervention, and onward, or concurrent input for parent and infants.
Does your service have links with this wide range of services? Are there already working relationships between adult and child services?
Fit Score
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Capacity
Workforce
Parent Infant Psychotherapy can either be delivered as a stand-alone service or as an intervention within an existing service, such as perinatal mental health services or Child and Adolescent Mental Health Services. PIP practitioners require time for direct face to face contact, extensive liaison work in relation to the family, and supervision time. PIP practitioners may work with a family on a weekly basis for up to a year.
Does your service know the demand for the service, and have sufficient workforce to manage the intensity and duration of the intervention? Do you have professionals with prerequisite knowledge and skills, and time in their job plans to train as PIP practitioners? Technology Support
Parent Infant Psychotherapy uses videos of parents and infant for supervision.
Does your service have facilities to video sessions and store them appropriately? Administrative Support
Parent Infant Psychotherapy requires consistent access to an appropriately furnished clinic space, for parent and infant.
Does your service have appropriate facilities? Financial Support
Parent Infant Psychotherapy training takes 18 months and costs at least £5500, plus staff costs. Interventions average 8 months but can be up to a yearlong. Additional costs will include supervision and may include appropriate clinic space.
Does your service have sufficient and stable funding to support training and intervention?
Capacity Score
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