Parent-infant psychotherapy

Domain I · Psychodynamic & depth psychology · Selma Fraiberg · 1975 · Ann Arbor

What it is

It is psychotherapy of the infant-parent relationship. The parent(s) and baby (pregnancy to about age 3; CPP 0–5) are seen together, classically in the family home ("kitchen table therapy"). Psychodynamic work on the parent's past is combined with concrete help, emotional support and developmental…

Format

• Format (Fraiberg original). Joint sessions with parent(s) and baby, usually at home, weekly, at least an hour, more often in crisis. Duration is open-ended and was often a year or more in the published cases. The work was done by a multidisciplinary team (social workers, psychologists, nurses,…
• Foundational phase: assessment and engagement. Intake with the caregiver alone; dyadic observation; child and caregiver trauma histories and symptoms. Common instruments in implementations include the TESI or THS and the LSC (Life Stressor Checklist). Assess safety; discuss cultural child-rearing…

Who practises it, and how they are trained or regulated

• Core idea of change. "In every nursery there are ghosts" (Fraiberg et al. 1975). Unremembered, unfelt pain from the parent's own childhood intrudes into the present. The parent then misreads the baby, for example hearing the baby's cry as an attack, or not hearing it at all, and repeats what was done to them. The authors argue that parents who can remember and feel their childhood suffering are protected from…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• interpretations that blame either partner. Working: softer responses follow.
• information that feels like criticism. Working: fewer negative attributions to the child.
• always defaulting to the same port. Working: the chosen entry opens conversation rather than defensiveness.
• idealisation used to deny harm. Working: the parent draws on the remembered figure in their behaviour with the baby.
• taking over as the "better parent"; harsh physical restraint. Working: the caregiver steps in sooner and more calmly.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.