Toddler-parent psychotherapy increases secure attachment between toddlers and mothers who have experienced major depressive disorder.

摘要

There is now strong evidence that maternal depression is a significant risk factor for the development of insecure attachment, which in turn is associated with arrange of adverse outcomes for children. However, it is striking mat few studies have attempted" to evaluate a treatment that will potentially influence the lives of many children raised in families with a depressed mother. The current study makes a significant contribution to the field by me evaluation of a structured, attachment-theory informed Intervention aimed at improving the relational context between a mother and her child.The study was -methodologically rigorous, adhering to CONSORT guidelines. Of particular note was the use of observational measures of attachment using Ainsworth's"Strange Situation assessment. Notably, the study minimised the confounds associated with maternal depression such as poor economic status or domestic violence by selecting from a sample who were predominantly middle class, educated and financially secure. Although this limits the generalisability of the results, it does provide for a particularly strong test of the intervention.The results were very encouraging. As predicted, mere were significant differences in attachment classification in the depressed groups compared to normal controls. This changed.markedly for those receiving the intervention, with a significant reduction in both avoidant and disorganised attachment classification. There was also a marked shift from insecure to secure attachment in the intervention group compared to the control group. The intervention took place in the home and took the better part of a year to provide, and although the intervention was manualised, translation into real world clinical settings .will be a significant challenge. The treatment requires considerable skill in observing the nuances,of mother-child interactions and using information to help a mother restructure her own sense of herself and how she relates to her child. Althoucjh this will be difficult, one of the key messages for clinicians is what *the authors refer to as the "malleability" of the attachment relationship in a child's early years. This study provides evidence that even a disorganised attachment style can be modified In many mother-child dyads.