PROFESSIONAL DOCTORATE IN PSYCHOANALYTIC PARENT-INFANT PSYCHOTHERAPY
Parent Infant Psychotherapy: A qualitative study of what leads to change in
personal relationships in families with children displaying pre-autistic behaviour
By: Yvonne Osafo
University of Essex
Despite the claim of parent infant psychotherapy to improve the parent infant relationship, little has been researched with regard to autism and how it relates to the primary caregiver. Regulatory conditions such as autism can be best understood in a relational context since disturbances in the parent child relationship are known to be risk factors for infant social and emotional disorders. As early research confirms that the primary carer plays a significant role in regulating the infant, this study will draw on concepts of intergenerational transmission and investigate a possible link between the nature of the parents’ internal representations and the symptoms of their autistic child.
This study will look at a subset of cases where children’s autistic symptoms have improved after a six month treatment of parent infant psychotherapy and concurrently explore the changes in their parents’ internal representations. Based on a qualitative narrative analysis of three sets of data; from parents’ interviews, process recorded notes of clinical sessions and from parent infant video material it could be concluded that the capacity to change in internal representations correlates with the capacity to change in parent infant relationships which in turn leads to a relief in the symptoms of the autistic child. Implications for change in the treatment of autism through the practice of parent infant psychotherapy are considered.
Significant progress has been achieved in response to the question of ‘what leads to change in personal relationships in families with children displaying preautistic behaviours’. Not only is change possible through parent infant psychotherapy via many ports of entry (Stern-Bruschweiler & Stern, 1989; Dugmore, 2013) but it takes place at an extraordinary speed (Barrows, 2003). Eight common elements have been identified for successful treatment of autistic symptoms (Acquarone, 2007); six by Phillips and Schuler’s (2005) review of 60 cases to see what works and a further two common elements were identified by Massie’s review of 31 cases (Edelson & Rimland, 2003). Of these elements the focus on early intervention, the importance of a clear theory that guides the intervention and the family during and after treatment, and the role of the parents are key to this study.
With regard to the parents it seems to me that progressive research in the treatment of autism has been hindered partly due to Kanner’s ‘refrigerator mother’ idea (Kanner, 1943; Bettelheim, 1967) where defects in the maternal relationship was thought to be the cause of autism. Linking the parents with the symptoms of the child gave rise to guilt in the parents and suspicion of psychoanalytic techniques. However, recent research into the field of parent infant psychotherapy has positively impacted clinical practice and provided more helpful and constructive ways of articulating and addressing the problem of treating social and emotional disorders such as autism. For example, the Cochrane Review, commissioned by Parent Infant Partnership UK (PIP UK), (Barlow et al, 2015) concluded that parent infant psychotherapy is effective in improving parental and infant mental health and the parent-infant relationship by ‘targeting the mother’s view of her infant, which may be affected by her own experiences, and linking them to her current relationship to her child’.
One could argue that this view is similar to Kanner’s but somehow it avoids the pain of blame because both mother and child are at the mercy of unconscious forces beyond their control. However, in making the connection between present and past to correct the mother’s view of her child it is necessary to engage painful emotions when severing harmful ties to past relationships and forging new and healthy bonds between parent and child as guided by the therapist. The process can feel threatening and painful as parents and child learn new ways of relating together.
The aim of parent-infant psychotherapy is ‘to understand and facilitate normal communication and the development of emotions and relationships’ (Acquarone, 2004: pg.20). To achieve this with regard to autism the signs must be detected within the first two years of life. Neurodevelopment and psychoanalytic studies support the view that intervention at this early stage, while the brain is still plastic and malleable, can arrest a pathological process such as autism and the autistic child can be reclaimed into the world of human feeling and communication (Alvarez, 1999 pg. 50-59).
The practice of parent infant psychotherapy is growing rapidly and politicians from across the political spectrum have come together to promote early intervention in the first two years of life through the 1001 Critical Days all party manifesto. The national organization, Parent Infant Partnership UK (PIP UK), is instrumental in the delivery of the government agenda. They achieve this by setting up parent infant partnerships across the UK with the aim of making psychotherapeutic support available to all families who are struggling to form a secure relationship with their baby. This research will be carried out within the context of a parent infant partnership service in South London, under the umbrella of PIP UK.
This research will seek to explore beyond the testimonies of change, to enquire into the process of how change happens through parent infant psychotherapy by addressing the question:
For the children that show change in this type of treatment, is there a correlation to change in their parents’ internal representations?
Over the course of a six month treatment of psychoanalytic parent infant psychotherapy I will explore whether there is a correlation between the relief in the symptoms of the autistic child and the modification in the parents’ internal representations.
The literature review will address the aetiology of autism, how it relates to the primary caregiver and how it derails normal development in the first year of life. I will seek to illustrate how the practice of psychoanalytic parent infant psychotherapy works to get development back on track. Various theories will be presented of how change is achieved through parent infant psychotherapy and especially with regard to autism. The central themes of internal representations and intergenerational transmission will conclude this section of the paper.
Aetiology of Autism
The aetiology and nature of Autistic Spectrum Disorders (ASD) remain unclear, however research reveals neurological, cognitive and behavioural components. Psychotherapy has been useful in understanding the emotional and interpersonal aspects (Sploladore, 2013) in that it assesses what is unique in the child’s personality, including the emotional aspects, by bringing the parent child relationship under scrutiny to gain a multifactorial understanding of the aetiology (Sploladore, 2013).
Tustin (2008) distinguishes ‘organic’ (damage to the brain) from ‘psychogenic’ (damage to the psyche) autism. Psychogenic autism results from blockages and distortions in the beginnings of perception and their associated emotions. One therefore needs to understand the nature of the psychic damage in order to be of help to autistic children, rather than blame the parent (Sploladore, 2013).
Reid (1999) identified a sub group of children that developed autism after a trauma in the first two years of life; autistic post traumatic developmental disorder (APTDD). Their repetitive behaviour resembles the repetitive re-experiencing of trauma seen in Post-Traumatic Stress Disorder (PTSD).
Hobson (1993) and Trevarthen et al (1996) view autism as a disorder of intersubjectivity; a lack of a sense of other persons. Alvarez (1992), Piontelli (1987) and Liley (1972) warn ‘against simplistic, linear etiological theories of autism’; stating that neither the ‘organicist’, in the cognitivist camp who advocate biochemical and neurological causation requiring drug and behavioural treatments, nor the ‘psychodynamicist’, who blames the environment and recommends therapeutic psychotherapy have the full picture. Nowadays both groups recognize multiple causation of autism and a need to bring together expertise in a concerted approach to the problem (Bailey et al, 1996).
The past 50 years has seen a rapid, and thus far, unexplained expansion in the application of the label of autism to childhood developmental conditions. Timimi, Gardner and McCabe (2011) dismiss the diagnostic category of autism as a myth and advocate a removal of what they term an invalid and stigmatizing label that does violence to children; discrediting the DSM definitions and NICE guidelines as influenced by the pharmaceutical companies that fund and control them, and whom, they believe, are the ones benefiting from the diagnosis.
Autism is described as ‘a lifelong neurodevelopmental condition’ and an impairment in the capacity to relate to others (APA, 1994; WHO, 1987; NICE 2011). Wing and Gould (1979) identified three features of behaviours considered to be typical of autism, i.e.; severe social impairment, severe communication difficulties, both verbal and non-verbal and the absence of imagination, including pretend play, with the substitution of repetitive behaviour.
Normal development of family relationships in the first year of life
One cannot separate the treatment of the child from the parents when treating autism in the first two years of life because normal development start with a merged parent infant dyad. According to Winnicott (1987) ‘A baby cannot exist alone, but is essentially part of a relationship’. Another paediatrician, Brazelton (1991), said that he could only help infants to optimal development if parents were involved. However, apart from what the parents bring, he recognised in his study of the new-born, the powerful interaction between the ‘motor, affective, automatic and cognitive systems and how they fuelled each other as the infant strove to achieve each developmental task.’ Infants are interactive organisms from the start; not only extremely sensitive to their environment but they shape that environment.
The infant’s connection with primary caregiver
The powerful, innately motivated capacities of the child (Trevarthen, Aitken, Papoudi & Robarts, 1988) are evident even before birth as the foetus responds to the mother’s internal and external environment with all of his senses (Murray & Andrews, 2000). From birth, the child’s personality is shaped in the context of relationships with caregivers and with the environment (Johnson, Dziurawiec, Ellis and Morton, 1991). It is crucial that the new-born baby forms an attachment (Bowlby, 1969) and attunes (Stern, 1985) with caregivers because failure to bond means failure to thrive and this could even end in death (Spitz, 1952). The baby connects, communicates and expresses personality through gazing, pre speech, movement, etc. and caregivers must read and respond to his signs by enlarging his communication in order to facilitate his development (Sander, 1983, 2000; Greenspan & Weider, 2006). So powerful is the connection with the caregiver that the infant becomes distressed when contact is broken (Murray and Trevarthen, 1985; Tronick, Als, Adamson, Wise and Brazelton, 1978). In this closely attuned interaction early dyadic competencies develop (Stern, 1985; Brazelton, 2000; Sander, 1983, 2000; Stern 2000); which forms the foundation for more complex triadic ways of relating that requires joint attention where the child follows the gaze of another towards a third object (Trevarthen & Hubley, 1978; Winnicott, 1958). In an empirical study Striano and Rochat (1999) demonstrated that early dyadic competencies are carried over to strengthen later triadic competencies; forming a foundation for even the more complex proto-imperative (e.g., pointing or reaching) and proto-declarative behaviours where gestures are used to share the experience of an object with another (Bakeman & Adamson, 1982; Bates, Benigni, Bretherton, Camaioni & Voltera, 1979; Scaife & Bruner, 1975; cited in Alvarez & Lee, 2004) in an intentional way (Bretherton, 1991). Thus, the way is prepared for the development of language and enculturation (Carpenter, Nagell & Tomasello, 1998; Hobson, 1993, 2002 cited in Alvarez & Lee 2004), providing a context in which the child develops his personality. The quality of relationship and attunement with primary caregivers has a strong influence on the nature of the baby’s developing personality.
According to Brazelton, (1991) it is important to enlist the strong positive forces that are inherent on each side of the parent-infant relationship for optimal development. The parents bring their expectations and the child brings ‘reflexes, sensory capacities and states of consciousness. If the infant bonds well in the first year of life he can explore further afield, continue to enjoy relationships and develop his personality through life.
The Impact of autism on family relationships
Even as there is a response from both sides of the relationship in normal development, the onset of signs of autism involves a response from both side of the parent infant relationship. This leads me to believe that change in autistic symptoms must also demand a response from both parent and child.
Massie’s retrospective study in the 1970’s of 20 home videos revealed that the onset of signs are perceivable; that from three to six months, the babies that later developed autism lost their smiles for their mothers, avoided eye contact, did not mould to their mothers but struggled away from her. The videos revealed that they showed no excitement when reunited with her and lacked playfulness. Their passivity seemed to turn to depression by six months and by one year the child became impassive as symptoms set in (Massie, 2007). Massie’s videos also revealed that the families became increasingly desperate and disorganized in their helplessness as the baby slipped away, despite efforts to compensate for his failure to engage.
Repeated lack of response from their preautistic child can cause parents to unconsciously inhibit the cycles of communication by rushing the engagement due to the pain of rejection from the child, to adjust their behaviour according to the child’s deficits and eventually to cease to expect a response (Beebe, 1982; in Acquarone, 2007). Play becomes more frantic and intrusive in the desperation to engage the child and thus loses the sense of timeliness, rhythm (Stern, 1977) and enjoyment.
Autism is said to reduce the personhood of the child; whose suffering is often underestimated, as is the stress and tragic limitations on normal family life (Alvarez and Reid 1999: pg.xii). The autistic child is said to lack the ability to judge the mental states of others (Hobson, 1993). His inner world is said to lack the rich three dimensional space where experiences and phantasies are stored for the purpose of interacting with others (Alvarez and Reid 1999).
The autistic parent-child relationship is described as a painful state of fusion, which blocks the normal processes of psychological development, rendering the child too psychologically weak to cope with the awareness of bodily separateness Tustin (1992). This mutual state of fusion suggests to me that autism is not just a problem for the child but is a family problem. In many cases that I have treated the child is kept in a place of dependency and treated as a young baby. His baby needs around food, toilet training, sleep, etc. controls the family and parents feel too guilty not to succumb to his demands. Parents can be helped with the painful process of separating from the child and gain sufficient distance to observe him in a new light within the therapeutic relationship, which can free the child to grow independently.
What leads to change in parent infant psychotherapy?
This research enquires into what leads to change in families with children displaying autistic behaviour. According to Dugmore (2013) no published research contradicts the claims of parents, clinicians and researchers that parent infant psychotherapy leads to change but what is not clear is what contributes to change; and whether it is prevention (Fonagy, 1998; Pozzi, 2003) or early intervention (Barrows, 1997; England, 1997). In the case of autism I believe that both prevention and early intervention come into play in that preautistic symptoms are easily modified in the first year of life but after they become entrenched at the age of two and a half or so, it is difficult to change them. If signs are caught early, parents can then be helped to respond to their infant’s social deficits; the baby’s development can be stabilized and symptoms prevented from crystallizing in the second and third years of life (Acquarone, 2007).
The neuroplasticity of the brain in the early years is also a key consideration in the treatment of autism through parent infant psychotherapy (Acquaone, 2004; Baradon et al., 2005; Pozzi, 2003). On this is based the conviction that any child can learn and get back on track in their development. The work with the autistic child is driven by this idea that the brain is malleable and can change itself in response to stimulation (Diodge, 2007); rewiring itself to make good its deficits. Writers such as Gehrhardt (2004) and Stroh (2008) have made these concepts equally accessible to parents and clinicians.
Theories of change
For change to occur it is not enough to work with the child’s symptoms alone. Paul Barrows (2003) describes three main areas that can be addressed in seeking to bring about change in parent-infant work; the parents' mental state, the infant's mental state and the relationship between parent and infant. Research has shown that it is not enough to focus on just one area. If the focus is on changing the parents, the baby cannot wait (Fonagy, 1993; Thomson-Salo et al., 1999) and there’s no guarantee there would be an impact on the baby (Juffer, 1997). Direct work with the child (Thomson-Salo et al., 1999; Norman, 2001) does not guarantee change in the parent’s mental state. Barrows quotes Hopkins (1992) who recommends that the symptoms in the infant can be best treated by treating the infant-parent relationship; which is the aim of parent infant psychotherapy.
The theme of this research is closer to the representational model of parent infant psychotherapy practiced in Europe (Cramer & Palacio Espasa, 1993 & 2004; Cramer & Stern, 1988, in Pozzi & Tydeman, 2005); which focuses on the mother’s internal representations and how these impact on the mother-infant relationship. This approach is similar to the work of Selma Fraiburg; particularly her method of working long term with very disturbed children and her insight into the impact of intergenerational transmission. Key to this study is her seminal paper, ‘Ghosts in the Nursery’ (Fraiburg, 1975) which states that parents bring to the task of parenting, their own experience of having been parented; their resolved and unresolved conflicts, which become activated when they parent their own children (Manzano et al., 1999). Like Ghosts in the Nursery’ and unconscious ‘wild things’ (Fraiberg, 1975; Raphael-Leff, 1989), these conflicts invade the parent infant relationship and negatively impact feeding, toilet training, discipline, etc., by influencing the way parents interpret their child’s behaviour. When parents gain insight in the context of the therapeutic relationship they are able to free the child from their unconscious projections.
Lebovici reasons in a similar vein that due to childhood trauma, the parents may relate to a Fantasmatic child (Lebovici, 1988), which is the unconscious construction built up in the parents’ minds, as a result of the parents’ conflicts with their own parents. The parents may also relate to an imaginary child, covered with the parents’ expectations, which the child might not live up to. In such ways values that have been stated or hidden can be transmitted from generation to generation. It is this close connection between parents and child that lies at the heart of intergenerational adjustment and provides a key to understanding how the symptoms of the child can be modified by the parents’ growing awareness and understanding of their inner parents and the intergenerational dynamics that exists in the family (Acquarone, 2004).
Paula Heimann (1942) speaks of symptoms as ‘foreign bodies’ which are the parents’ narcissistic projections (ghosts); unassimilated parts of the ego; projections for which the newborn baby is a prime target. To end the transgenerational cycle of transmission the object must be assimilated before it becomes established in the infant’s psyche. Projections that have been withdrawn can emerge in the parent’s relationship which is why parent infant work usually unveils difficulties in the relationship. For this reason it is important to work with the family unit even though this is a more complex way of working and change is slow; however it is long term.
The foreign body can also be projected onto the therapist, which is the process of containment and by making links with childhood the therapist can effect a disconnection between past and present (Hopkins, 1992; Britton, 1989). Britton explains how the therapist takes a third position from which to observe object relations and this example also cultivates a capacity for reflective self-functioning in the parents. Fonagy (1993) sees the capacity in the parent of ‘reflective self-function’ to be a key ingredient that contributes to change in the child (Barrows, 2003).
Manzano (1999) explains this process further in his paper on narcissism in parenthood where he states that the first object of the child’s libidinal drives is the mother (Freud, 1909). The child is said to be the mother’s love object, and a representation of herself. Parents see and love themselves in their child (Freud, 1914); putting their own ego ideal on the child. The child identifies with this, making it his own ideal, which he will in turn project onto his own children. This is the root of intergenerational transmission. Whatever is projected onto the child includes a self-representation; hence narcissistic. The shadow of the parents has fallen onto the child resulting in a relationship between self and self. Unconscious imaginary roles determine how parents relate to their children and manifest in symptoms such as sleep disorders, which might be a projection of a dead person from the past, manifested in the parent waking the baby frequently to check if he’s alive.
Main (1988) explains that parents are less likely to repeat the mistakes of the previous generation if they can acknowledge those mistakes in their own parents. Cramer and Stern (1988) feel that change can come through containment because the family knows that they are listened to and the therapist is experienced as benign parent rather than a wicked fairy godmother.
All the above theories articulate the ways the parents’ internal representations develop and how they view the child through the eyes of their internal parents. This research aims to gain insight into this process and to observe the change in internal representations and how it affects change in the symptoms of the autistic child.
The above concepts influence the work with the autistic child in that parents are taught in the session how to do a wide range of activities with the child such as sorting, stacking, placing objects, matching and engaging in new activities that will activate all areas of the brain. When the parents see the true capacities of their child as he responds to the therapist they feel emboldened to do the same with the child at home. In this way the child and the parents change in the way they relate together.
I will also mention Norman (2001), Thomson-Salo (2002) and Salomonsson (2007), due to the primacy that they give to the infant; directly addressing the baby in the session, with the aim of activating and containing his anxieties in the here-and-now of the infant-mother relationship. Though Norman was strongly criticized for using verbal interpretations to a non-verbal infant (Flink, 2001) I can identify with his approach as it is my experience that speaking directly on behalf of the infant in the presence of the parents can activate deep feelings within them that lead to positive change as they are enabled to see him differently. However, this must be done in a very sensitive and inclusive way so as not to overwhelm the parent with primitive feelings of envy and exclusion. I find that the use of motherese on such occasions embraces and contains the child and the mother together.
Intergenerational Adjustment of Family Relationships
An underlying assumption of the research question is that there is a link between the nature of the parents’ internal representations and the symptoms of the autistic child and that parents project into their child the representations of their own internal parents along with their idealised or denigrated expectations (Pozzi, 2003).
The pregnant woman is said to give birth to three generations; the infant, herself as mother and her own mother as grandmother’ (Merbaum, 1999). Engaging with the new mother’s psychic world means engaging with all three generations, positive and negative (Abraham, 1913; Ferenzi, 1913; Jones, 1913, Rappaport, 1958; La Barre et al, 1960). Stern (1995) elaborates on the grandmother’s psychic role in the mother’s internal world. He states that when a woman becomes a mother she undergoes a developmental shift characterized by a new intrapsychic organization (the motherhood constellation) of infant, mother and maternal grandmother (Merbaum, 1999).
This research takes advantage of this intrapsychic organization when the parents are open to change; having undergone the process of making room for a new baby. They are also in touch with the raw and primitive emotions of infancy as their own baby needs are activated and are inclined to respond to the needs of their infant in the same way that they were parented. Unresolved aspects of their own childhood are played out in the relationship with the new baby.
Internal representations are difficult to conceptualise and to measure. Stern (1977) attempted to meet the conceptual need by describing them as experiential units of interpersonal experience…dynamic interpersonal moments that tumble out of memory when thinking about another person.
Such interpersonal moments begin at the very start of the earliest attachment relationship and become well established by the age of two-and-a-half or so. Representations are easily modified during this time which is why change in the child is so rapid if interventions are made within this window. The children in my sample will be age two years and below at the start of treatment to accommodate this factor.
Change in the parents’ representations takes time, however, because of the stability of the adult attachment status (Juffer, et. al.1997). While there’s a change of maternal sensitivity in response to short term treatment, actual change in internal representations take much longer. For this reason the treatment will take place over a period of six months with a further six months follow-up to enable new internal representations to become established.
This research theorises that autism is reinforced, or in some cases caused, by an inter-generational transferential load from the parents and while all parents are prone to treat their children transferentially, in the case of a pre-autistic child, this intergenerational transferential load exacerbates the autistic trajectory.
Research question and anticipated hypothesis
My research question can be articulated as follows:
For the children that show change as a result of a treatment of parent infant psychotherapy,
is there a correlation to change in their parents’ internal representations?
Change is hypothesized to occur in the parent and child, ‘through the transformational power of the therapeutic relationship, insight-oriented interpretation, and the acquisition of new interactive and caregiving behavioural patterns modelled by the therapist (Lieberman, Weston, & Pawl, 1991). As insight is gained through the process of therapy parents are able to recognize their child for who he is and free him from their projections to be a person in his own right.
Following the above hypothesis it is predicted that as a result of the course of parent infant psychotherapy treatment:
The parents’ view of their internal parents will become less persecutory due to having ‘offloaded’ their distorted perceptions through psychoanalytic parent infant psychotherapy.
The parents’ internal representations will change to become more positive and the new mental representations will stabilize over time as functional internal representations, becoming more benign as the new state of the mind continues to develop as a result of parent-infant psychotherapy involving the child and parents together (Acquarone, 2015).
There will also be a change in the way they view the child’ i.e., in his own right, freed from their own projections. Furthermore, there will be a decrease in their anxiety and an increase in their sense of confidence, playfulness and satisfaction in the relationship with the child.
With regard to the child it is my prediction that:
The decrease in autistic like behaviours will correlate with positive changes in the parents’ representations as they are ‘disconnected from the infant (in the present) and reconnected to their original source’ and alternative connections made with more benign internal objects such as the therapist (Hopkins, 1992; Stern, 1995).
The child’s tolerance of interaction with another will increase and manifest itself in a better capacity to maintain eye contact, listen, understand and carry through an instruction given by the therapist and relate socially through imitation and joint play. Thus, the aimless, autistic activity of the child will become more meaningful and be played out in the relationship with the therapist and the self-soothing activities will reduce; enabling the development of a real relationship.
My method will combine qualitative and quantitative measures to study three families with a child whose autistic symptoms have improved during a normal six month course of ‘treatment as usual’ of parent infant psychotherapy. The families selected at the end of the six month treatment will fit my pre-determined criteria and will have given written consent to participate in the study (Appendix 4).
The family will be selected from among the families that come to the PIP centre between October 2015 and April 2016.
The criteria for inclusion in the study is that;
The screening tools revealed signs of alarm of autism such as lack of eye contact, repetitive play, lack of social interaction (speech and play) and other signs of autism.
The child will be under two years of age at the start of treatment.
The family have maintained regular attendance for treatment.
The identifiable phases of the treatment are as follows;
Referral and completion of background demographic form and Ages & Stages Questionnaire Social Emotional (ASQ-SE) to screen for autistic behaviour.
Telephone Triage Assessment to fill gaps in background information and inform about research.
Face to Face Assessment to explore family dynamics and themes, identify intergenerational conditions and issues and observe symptoms of child.
Treatment (20 sessions of parent infant psychotherapy)
Individual Sessions for parents at start and end of treatment to administer the Adult Attachment Interview.
Follow-up for six months to monitor outcomes.
Generation of Data
Data will be generated from
Process recorded notes of clinical sessions
Parent infant video material
Background information form
Tape recorded, transcribed notes from the Adult Attachment Interviews;
Ages and Stages Questionnaire-3 (ASQ-3) and Ages and Stages Questionnaire - Social and Emotional (ASQ:SE)
Parent Infant Relationship-Global Assessment Scale (PIR-GAS), Assessing the Parent-Infant Relationship: Observable Strengths form.
The quality of the family relationship will be measured using the Parent-Infant Relationship - Global Assessment Scale (PIR-GAS) along with the Assessing the Parent Infant Relationship: Observable Strengths tool to gain a more objective view of what has changed.
The Ages and Stages Questionnaires (ASQ-3) and Ages and Stages Social Emotional (ASQ-SE) will be suited to measuring the global as well as the social and emotional aspects of the autistic child’s development.
The Adult Attachment Interview (AAI) will be used to measure the parents’ internal representations; to gain understanding of their internal worlds and patterns of attachment. The tools of Narrative Psychology will be applied to the material collected through the AAI interview to identify the turning points in the parents’ narratives, while at the same time preserving the fullness and richness of their unique stories.
Data analysis software will be used to examine the quantitative findings of ASQ-3, ASQ-SE and PIR-GAS. The AAI will be coded by me after receiving the prescribed training (scheduled for October 2015).
In the analysis of qualitative data my aim is to preserve as much as possible of the richness and the uniqueness of the family’s story. I will therefore utilize the methods of narrative psychology outlined by Murray (2003) to make sense of the narratives produced by the AAI. The trajectory of change will be traced in both parent and child. In respect of the parents this change will be with regard to their relationship with internal representations and in the case of the child the change will be with regard to their use of symptoms to contain their anxieties.
The AAI sessions with the parents at the beginning and end of the treatment will be subjected to rigorous psychoanalytic analysis in which I will seek to identify the conscious and unconscious elements that gives evidence of internal objects relationships. By asking the same questions in the AAI at the beginning and end of the treatment I will hope to identify the changes in the parents’ responses and in their attachment status.
Application for ethical approval for this research is being made to the University of Essex and also through the Integrated Research Application System (IRAS).
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