Psychodynamic Therapy with Infants and Parents (abbr. PTIP) aims to relieve emotional disturbances within the parent(s), the baby, and/or their interaction, for example, postnatal depression and anxiety, infant distress with breastfeeding and sleep, and attachment disorders. It rests on attachment theory and psychoanalysis. Sigmund Freud suggested that a modification of his method could be applied to children, and child analysis was introduced in the 1920s by [Anna Freud].., [Melanie Klein], and Hermine Hug von Hellmuth. Klein speculated on infantile experiences to understand her patients' disorders but she did not practice PTIP. Donald Winnicott, a pediatrician and analyst, focused on the mother-baby interplay in his theorizing and his brief parent-child consultations, but he did not work with PTIP.
Definitions
PTIP was introduced by Selma Fraiberg and Françoise Dolto after World War II. Fraiberg was trained in the ego-psychological tradition, while Dolto was a pupil of Jacques Lacan. Another section Attachment-based therapy (children) complements the present one. A related method was developed by Esther Bick at the Tavistock Clinic in London, psychoanalytic infant observation, aiming to enhance therapy students' skills and to train clinicians who work with babies. This article focuses on "the phase prior to word presentation and the use of word symbols", that is, up to 18 months of age.
A psychodynamic perspective sees humans as struggling with unconscious urges that impact on their character, relationships, interests, passions, conscious attitudes, and cognitive capacities. PTIP focuses both on patients' behaviors and feelings as well as their unconscious motives for developing and maintaining them. Supportive elements are limited, though the therapist's "holding" or "containing" the patient's distress does have such ingredients. Other methods are more supportive and encourage the mother to change her behavior with the baby; developmental guidance, infant massage, interaction guidance, and Marte Meo. They are not covered here.
Parents strive consciously to bond with the child and provide a fertile ground for attachment. Simultaneously, their unconscious impulses may run in opposite directions. Psychoanalytic theory often regards the mother as the baby's primary object, especially, her body parts or functions that stimulate the infant's fantasy life. Her bodily closeness with the foetus and the child will add unique qualities to their relationship. Yet, modern fathers are involved with their babies and some therapists argue that they should be invited more often in PTIP.
A late development
Sigmund Freud viewed the baby as involved in passionate relationships with his parents. He also uncovered infant-like remnants in every adult's personality. This affects the countertransference, the therapist's emotional reactions to the patient, even more so if the patient is a baby. The PTIP therapist is prone to a "massive identification with the child… it is not always easy to control one's reactions to [the baby's] positive or negative provocations". This may explain why PTIP took a long time to develop. Also, the notion of psychoanalysis as a "talking cure" led to the idea that the primary therapy data are words, rather than all the "representations or signifiers of process". This, too, may have prevented analysts from treating babies. Those from the tradition of ego psychology advise against attributing mental capacities beyond the baby's developmental time-table. This may make them reluctant to view the baby as an active participant in therapy. A final reason for the late development of PTIP might be that the high prevalence of postnatal depression and infant emotional disturbances, was demonstrated only recently. Many "baby worries" emerge at Child Health Centers without the mother feeling that she needs psychotherapy herself. It is the baby who functions, through various symptoms, as the alarm-clock.