Parent-infant psychotherapy PIP or psychoanalytic parent-infant psychotherapy PPIP or infant-parent psychotherapy IPP is a modality of psychoanalytic psychotherapy which specialises in infant mental health and aims to support and enhance infant-parent relationships.

It challenges the myth, held even today, that the infant is not necessarily thought about as a subject in their own right until he or she becomes verbal and can begin to express their needs, wishes and desires through words. Parent-infant psychotherapy starts from the premise that the infant is active and can show us, through his communication, his internal states of being. Normally developing babies are driven by both the need and desire for interactions with their caregivers and to be social beings.

The parent-infant relationship

Parents of a new baby need to understand their baby's cues. Even when parents already have children, they soon realise the differences between their children's temperaments and what works to soothe one, for example, doesn't necessarily work for another. The ways in which parents are able to tune into their babies and their capacity for attuned interactions forms the basis of their developing relationship. Simultaneously, neural pathways are being formed in the baby's developing brain; it is an evolving and dynamic process. The parent's attentiveness to their baby as well as their tone of voice, facial expressions, body language, positioning and the ways in which they handle their baby will have a powerful impact on the baby's feelings toward their parent.

Babies elicit powerful feelings within their parents too. Hopefully parental curiosity is aroused and parents allow themselves time and space with their baby to wallow in thoughts such as 'who is this little one?', 'what are they trying to tell me?', 'why does she make me feel like this?' and consider them.

These feelings can be strong and overwhelming be they pleasant, joyous, numbing or scary. As many parents will acknowledge sometimes a full range of emotions are experienced in any given hour of the day! It is normal for pregnant woman and new parents to feel a degree of ambivalence towards their baby.

Processing the emotions experienced after birth as well as managing the huge demands of caring for a new baby, often managing with less sleep, can be exhausting and destabilising. Being pregnant and having a baby can trigger unexpected or unwelcome feelings which can be difficult to process. Sometimes, through no fault of their own, circumstances either in their external or internal worlds which have remained hidden to them , can create barriers for parents in bonding with their baby.   Sometimes babies and parents need extra help at this time.

Parent-infant psychotherapists are trained in infant observation to learn about 'normal' infant development and family relationships within the baby's home. Visiting the baby's home weekly from birth for his first two years gives a valuable insight in to the physical, emotional and psychological development of the baby in relation to his caregivers and within their family and cultural context. Babies are born with their own unique character and developmental path and in these early months and years parent and baby are getting to know each other and shaping the relationship they have with each other in conscious as well as unconscious ways.

How does a parent-infant psychotherapist work?

The therapist is presented with a problem perceived to be either in the baby or in one or other of the parents.

She has to attend sensitively to the therapeutic space, ensuring it is comfortable, with suitable seating, floor space and play materials. Babies need plenty of space, facilities and can be messy. Parents value discretion as well as feeling welcomed, the therapist shows care, flexibility, is non-judgemental and open in her approach. She will listen attentively to the parent/s and to the baby and will be dividing her attention between them. Sometimes it is agreed to have sessions without baby or with one or both parents. Taking a flexible approach is key to establishing trust and in understanding the presenting difficulties.

The therapist may give a voice to the baby by expressing in words what she feels the baby might be feeling or expressing, she treats the baby as an equal in the 'conversation' and opens a space for thinking about the baby's internal world with his parent/s. She will invite the parents to consider the meaning of the baby's communications and their feelings towards their baby and about being a parent.  She will notice and build a picture of the parents' ideas about who their baby is and how they respond to her. It is not uncommon for each adult to see things differently at times in a session and this can be thought about together. The therapist may use assessments with parental consent, including video to support the work. Wider family members or other key figures in the baby's life, such as siblings, grandparents, adoptive parents or key carers can be invited to attend.

The therapist employs a multimodal approach in that she draws on a range of approaches and interventions depending on the family dynamics and situation as well as the presenting concern. Therapists draw on their knowledge and understanding of infant development, neuroscience, attachment theory, developmental trauma, physical and mental health, parental adverse early experiences, intergenerational trauma, psychoanalytic concepts, psycho education as well as with protective factors within the individuals, their wider family and community.  They are trained in safeguarding and are alert to risk factors.

The sessions aim to contain anxiety, provide a space for thinking, for conversations and play. This invariably leads to greater parental self-awareness and understanding and connectedness to their baby.

Who can benefit from parent-infant psychotherapy?

'In psychodynamic infant-parent psychotherapy the 'patient' is the relationship between infant and caregiver' Balbernie, 2020 . Symptoms of a difficulty of some sort in the infant-parent relationship may present in either the baby or the parent/s or in both.

Babies:

• who are overly sensitive and are difficult to soothe
• who cry a lot
• who have difficulty sleeping
• who have difficulty feeding
• who have experienced birth trauma, are premature or have a disability
• who were unplanned