Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-27T06:38:56.320Z Has data issue: false hasContentIssue false
  • English
  • Français

Mothering from the Inside Out: Adapting an evidence-based intervention for high-risk mothers in the Western Cape of South Africa

Published online by Cambridge University Press:  31 January 2019

Nancy Suchman Open the ORCID record for Nancy Suchman [Opens in a new window] ,
Astrid Berg ,
Lameze Abrahams ,
Toni Abrahams ,
Amy Adams ,
Brenda Cowley ,
Cindy Decoste ,
Waseem Hawa ,
Anusha Lachman  and
Bulelwa Mpinda
...Show all authors
Nancy Suchman*
Affiliation:
Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA Yale Child Study Center, New Haven, CT, USA
Astrid Berg
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Red Cross War Memorial Children's Hospital, Cape Town, South Africa
Lameze Abrahams
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Lentegeur Psychiatric Hospital, Cape Town, South Africa
Toni Abrahams
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Lentegeur Psychiatric Hospital, Cape Town, South Africa
Amy Adams
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Stikland Psychiatric Hospital, Cape Town, South Africa
Brenda Cowley
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa
Cindy Decoste
Affiliation:
Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
Waseem Hawa
Affiliation:
Lentegeur Psychiatric Hospital, Cape Town, South Africa Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa
Anusha Lachman
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Tygerberg Hospital, Cape Town, South Africa
Bulelwa Mpinda
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Stikland Psychiatric Hospital, Cape Town, South Africa
Nasera Cader-Mokoa
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Lentegeur Psychiatric Hospital, Cape Town, South Africa
Nosisana Nama
Affiliation:
Red Cross War Memorial Children's Hospital, Cape Town, South Africa
Juané Voges
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Stikland Psychiatric Hospital, Cape Town, South Africa
*
Author for correspondence: Nancy Suchman, Moms ‘n’ Kids Program, One Long Wharf Drive, Suite 310, New Haven, CT06511. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

During South Africa's first two decades as a democracy, the Western Cape Province has undergone radical changes to its healthcare system in an effort to address the extensive socioeconomic inequities that remain in the aftermath of the apartheid era. Although progress has been made, there is a clear need for interventions that support parents and children receiving health services in the public sector who are vulnerable to multiple psychosocial risks associated with extreme poverty. In this mixed-method study, we examined the feasibility and acceptability of adapting an evidence-based parenting intervention called Mothering from the Inside Out that was developed for mothers who are vulnerable to similar risks in the United States. Using qualitative methods, we documented the collaborative process that was guided by principles of community-based participatory research and examined themes in the Western Cape collaborators’ perspectives about the feasibility and acceptability of the intervention. Using quantitative methods, we tested the preliminary efficacy of the adapted version of Mothering from the Inside Out for improving maternal reflective functioning and mother–child interactions. Although findings from both study components indicated preliminary promise, a number of obstacles and challenges at multiple levels underscore the need for (a) flexibility and contextual support for intervention research conducted in under-resourced communities, (b) clinical sensitivity to the unique experiences of parents rearing children in highly stressful, under-resourced environments, and (c) equal partnerships that allow the expertise of local providers to inform the design proposals of consulting investigators.

Keywords

parent interventionimplementation researchcommunity-based participatory researchmaternal addictionmaternal mental illness
Type
Regular Articles
Information
Development and Psychopathology , Volume 32 , Issue 1 , February 2020 , pp. 105 - 122
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ainsworth, M. D. S. (1967). Infancy in Uganda: Infant care and the growth of love. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Allen, J., Fonagy, P., & Bateman, A. (2008). Mentalizing in clinical practice. Arlington, VA: American Psychiatric Publishing.Google Scholar
BeLue, R., Schreiner, A. S., Taylor-Richardson, K., Murray-Kolb, L. E., & Beard, J. L. (2008). What matters most: An investigation of predictors of perceived stress among young mothers in Khayelitsha. Health Care for Women International, 29, 638–648. doi:10.1080/07399330802089198CrossRefGoogle ScholarPubMed
Bers, S. A. (2016). Mothering from the Inside Out: Providing a mentalization-based parenting therapy for mothers in treatment for substance misuse. International Journal of Birth and Parent Education, 3, 25–28.Google Scholar
Bray, R., Gooskens, I., Kahn, L., Moses, S., & Seekings, J. (2010). Growing up in the new South Africa: Childhood and adolescence in post-apartheid Cape Town. Cape Town, South Africa: HSRC Press.Google Scholar
Camoirano, A. (2017). Mentalizing makes parenting work: A review about parental reflective functioning and clinical interventions to improve it. Frontiers in Psychology, 8. doi:10.3389/fpsyg.2017.00014CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
Cooper, P. J., Landman, M., Tomlinson, M., Molteno, C., Swartz, L., & Murray, L. (2002). Impact of a mother-infant intervention on an indigent peri-urban South African context: Pilot study. British Journal of Psychiatry, 180, 76–81. doi:10.1192/bjp.180.1.76CrossRefGoogle ScholarPubMed
De Sousa, A. (2010). Psychological aspects of paediatric burns (A clinical review). Annals of Burns and Fire Disasters, 23, 155–159.Google Scholar
Fearon, R. M. P., Tomlinson, M., Kumsta, R., Skeen, S., Murray, L., Cooper, P. J., & Morgan, B. (2017). Poverty, early care, and stress reactivity in adolescence: Findings from a prospective, longitudinal study in South Africa. Development and Psychopathology, 29, 449–464. doi:10.1017/S0954579417000104CrossRefGoogle ScholarPubMed
Feldman, R. (1998). Coding interactive behavior manual. Ramat Gan, Tel Aviv, Isreal: Bar-Ilan University.Google Scholar
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.Google Scholar
Fonagy, P., Sleed, M., & Baradon, T. (2016). Randomized controlled trial of parent-infant psychotherapy for parent-infant psychotherapy for parents with mental health problems and young infants. Infant Mental Health Journal, 37, 97–114. doi: 10.1002/imhj.21553CrossRefGoogle ScholarPubMed
Fonagy, P., Steele, M., Steele, H., Moran, G. S., & Higgitt, A. (1991). The capacity for understanding mental states: The reflective self in parent and child and its significance for security of attachment. Infant Mental Health Journal, 12, 201–218. doi:10.1002/1097-0355(199123)12:33.0.CO;2-73.0.CO;2-7>CrossRefGoogle Scholar
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective-Functioning Manual, Version 5. Unpublished manuscript.Google Scholar
Gershy, N. (2015). Mentalization, mindfulness and emotion regulation: Do parents need to mind themselves in order to mind their children? Dissertation Abstracts International, 57.Google Scholar
Gilson, L., Pienaar, D., Brady, L., Hawkridge, A., Naledi, T., Vallabhjee, K., & Schneider, H. (2017). Development of the health system in the Western Cape: Experiences since 1994. South African Health Review 2017: 20th Edition (pp. 59–60). Durban, South Africa: Health Systems Trust.Google Scholar
Greenberg, D. M., Kolasi, J., Hegsted, C. P., Berkowitz, Y., & Jurist, E. L. (2017). Mentalized affectivity: A new model and assessment of emotion regulation. PLOS ONE, 12, e0185264. doi:10.1371/journal.pone.0185264CrossRefGoogle ScholarPubMed
Gunnar, M., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145–173. doi:10.1146/annurev.psych.58.110405.085605CrossRefGoogle Scholar
Innamorati, M., Imperatori, C., Harnic, D., Erbuto, D., Pattitucci, E., Janiri, L., … Fabbricatore, M. (2017). Emotion regulation and mentalization in people at risk for food addiction. Behavioral Medicine, 43, 221–230. doi:10.1080/08964289.2015.1036831CrossRefGoogle ScholarPubMed
Israel, B. A., Schulz, A. J., Parker, E. A., Becker, A. B., Allen, A. J., & Guzman, J. R. (2003). Critical issues in developing and following CBPR principles. In Minkler, M. & Wallerstein, N. (Eds.), Community-based participatory research for health (pp. 47–62). San Francisco, CA: Wiley.Google Scholar
Kent, L., King, H., & Cochrane, R. (2000). Maternal and psychological sequelae in paediatric burn injuries. Burns, 26, 317–322. doi:10.1016/S0305-4179(99)00172-2CrossRefGoogle ScholarPubMed
Kotchick, B. A., & Forehand, R. (2002). Putting parenting in perspective: A discussion of the contextual factors that shape parenting practices. Journal of Child and Family Studies, 11, 255–269. doi:10.1023/A:1016863921662CrossRefGoogle Scholar
Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10, 434–445. doi:10.1038/nrn2639CrossRefGoogle ScholarPubMed
Mayes, L., Carter, A., & Stubbe, D. (1993). Individual differences in exploratory behavior in the second year of life. Infant Behavior and Development, 16, 269–284. doi:10.1016/0163-6383(93)80035-7CrossRefGoogle Scholar
Mbugua, M. N., Kuria, M. W., & Ndetei, D. M. (2011). The prevalence of depression among family caregivers of children with intellectual disability in a rural setting in Kenya. International Journal of Family Medicine, 2011, 534513. doi:10.1155/2011/534513CrossRefGoogle Scholar
McGarry, S., Girdler, S., McDonald, A., Valentine, J., Wood, F., & Elliot, C. (2013). Paediatric medical trauma: The impact on parents of burn survivors. Burns, 39, 1114–1121. doi:10.1016/j.burns.2013.01.009CrossRefGoogle ScholarPubMed
Minde, K. (2000). Prematurity and serious medical conditions in infancy: Implications for development, behavior, and intervention. In Zeanah, C. H. (Ed.), Handbook of infant mental health (2nd ed., pp. 176–194). New York: Guilford Press.Google Scholar
Minkler, M., & Wallerstein, N. (2003). Introduction to CBPR: New issues and emphases. In Minkler, M. & Wallerstein, N. (Eds.), Community-based participatory research for health (pp. 5–19). San Francisco, CA: Wiley.Google Scholar
Onken, L. S., Carroll, K. M., Shoham, V., Cuthbert, B. N., & Riddle, M. (2014). Reenvisioning clinical science: Unifying the discipline to improve the public health. Clinical Psychological Science, 2, 22–24. doi:10.1177/2167702613497932CrossRefGoogle ScholarPubMed
Reissman, C. K. (1993). Narrative analysis (Qualitative Research Methods) (1st ed.). Thousand Oaks, CA: Sage.Google Scholar
Roman, N. V., Makwakwa, T., & Lacante, M. (2016). Perceptions of parenting styles in South Africa: The effects of gender and ethnicity. Cogent Psychology, 3. doi:10.1080/23311908.2016.1153231CrossRefGoogle Scholar
Rotheram-Fuller, E. J., Tomlinson, M., Scheffler, A., Weichle, T. W., REzvan, P. H., Comulada, W. S., & Rotheram-Borus, M. J. (2018). Maternal patterns of antenatal and postnatal depressed mood and the impact on child health at 3-years postpartum. Journal of Consulting and Clinical Psychology, 86, 218–230. doi:10.1037/ccp0000281CrossRefGoogle ScholarPubMed
Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & Mayes, L. C. (2013). Minding the Baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Mental Health Journal, 34, 391–405. doi:10.1002/imhj.21406CrossRefGoogle Scholar
Sealy, J., & Glovinsky, I. P. (2016). Strengthening the reflective functioning capacities of parents who have a child with a neurodevelopmental disability through a brief, relationship-focused intervention. Infant Mental Health Journal, 37, 115–124. doi:10.1002/imhj.21557CrossRefGoogle ScholarPubMed
Shai, D., & Meins, E. (2018). Parental embodied mentalizing and its relation to mind-mindedness, sensitivity, and attachment security. Infancy. Advance online publication. doi:10.1111/infa.12244CrossRefGoogle Scholar
Slade, A., Aber, J. L., Berger, B., Bresgi, I., & Kaplan, M. (2003). The Parent Development Interview–Revised. Unpublished manuscript, City University of New York.Google Scholar
Slade, A., Grienenberger, J., Bernbach, E., Lew, D., & Locker, A. (2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment and Human Development, 7, 283–298. doi:10.1080/14616730500245880CrossRefGoogle ScholarPubMed
Sleed, M., Baradon, T., & Fonagy, P. (2013). New Beginnings for mothers and babies in prison: A cluster randomized controlled trial. Attachment and Human Development, 15, 349–367. doi:10.1080/14616734.2013.782651CrossRefGoogle ScholarPubMed
Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Suchman, N. E. (2016a). Mothering from the Inside Out: A mentalization-based therapy for mothers in treatment for drug addiction. International Journal of Birth and Parent Education, 3, 19–24.Google Scholar
Suchman, N. E. (2016b). Mothering from the Inside Out: A mentalization-based therapy for mothers in treatment for substance misuse. Zero to Three, 39, 35–40.Google Scholar
Suchman, N. E., & DeCoste, C. L. (2018). Substance abuse and addiction: Implications for early relationships and interventions. Zero to Three, 38, 17–22.Google ScholarPubMed
Suchman, N. E., DeCoste, C., Borelli, J. L., & McMahon, T. J. (2018). Does improvement in maternal attachment representations predict greater maternal sensitivity, child attachment security and lower rates of relapse to substance use? A second test of Mothering from the Inside Out treatment mechanisms. Journal of Substance Abuse Treatment, 85, 21–30. doi:10.1016/j.jsat.2017.11.006CrossRefGoogle ScholarPubMed
Suchman, N., DeCoste, C., Leigh, D., & Borelli, J. (2010). Reflective functioning in mothers with drug use disorders: Implications for dyadic interactions with infants and toddlers. Attachment and Human Development, 12, 567–585. doi:10.1080/14616734.2010.501988CrossRefGoogle ScholarPubMed
Suchman, N. E., DeCoste, C. L., McMahon, T. J., Dalton, R., Mayes, L. C., & Borelli, J. (2017) Mothering from the Inside Out: Results of a second randomized clinical trial testing a mentalization-based intervention for mothers in addiction treatment. Development and Psychopathology, 29, 617–636. doi:10.1017/S0954579417000220CrossRefGoogle ScholarPubMed
Suchman, N. E., DeCoste, C., McMahon, T., Rounsaville, B., & Mayes, L. (2011). The Mothers and Toddlers Program, an attachment-based parenting intervention for substance-using women: Results at 6-week follow-up in a randomized clinical pilot. Infant Mental Health Journal, 32, 427–449. doi:10.1002/imhj.20303CrossRefGoogle Scholar
Suchman, N. E., DeCoste, C., Ordway, M., & Bers, S. (2013). Mothering from the Inside Out: A mentalization-based individual therapy for mothers with substance use disorders. In Suchman, N., Pajulo, M., & Mayes, L. (Eds.), Parenting and substance addiction: Developmental approaches to intervention (pp. 407–433). New York: Oxford University Press.Google Scholar
Suchman, N. E., DeCoste, C., Rosenberger, P., & McMahon, T. J. (2012). Attachment-based intervention for substance using mothers: A preliminary test of the proposed mechanisms of change. Infant Mental Health Journal, 33, 360–371. doi:10.1002/imhj.21311CrossRefGoogle ScholarPubMed
Suchman, N. E., Ordway, M. R., de las Heras, L., & McMahon, T. J. (2016). Mothering from the Inside Out: Results of a pilot study testing a mentalization-based therapy for mothers enrolled in mental health services. Attachment and Human Development, 18, 596–617. doi:10.1080/14616734.2016.1226371CrossRefGoogle ScholarPubMed
Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9, 117–125. doi:10.1353/hpu.2010.0233CrossRefGoogle ScholarPubMed
Tomlinson, M., O'Connor, M. J., Le Roux, I. M., Stewart, J., Mbewu, N., Harwood, J., & Rotheram-Borus, M. J. (2014). Multiple risk factors during pregnancy in South Africa: The need for a horizontal approach to perinatal care. Prevention Science, 15, 277–282. doi:10.1007/s11121-013-0376-8CrossRefGoogle ScholarPubMed
van Heyningen, T., Honikman, S., Myer, L., Onah, M. N., Field, S., & Tomlinson, M. (2017). Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: A cross-sectional study. Archives of Women's Mental Health, 20, 765–775. doi:10.1007/s00737-017-0768-zCrossRefGoogle ScholarPubMed
van IJzendoorn, M. H. (1995). Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychological Bulletin, 117, 387–403.CrossRefGoogle ScholarPubMed
van IJzendoorn, M. H., & Sagi-Schwartz, A. (2008). Cross-cultural patterns of attachment: Universal and contextual dimensions. In Cassidy, J. & Shaver, P. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 880–905). New York: Guilford Press.Google Scholar
Verhage, M. L., Schuengel, C., Madigan, S., Fearon, R. M. P., Oosterman, M., Cassibba, R., … van IJzendoorn, M. H. (2016). Narrowing the transmission gap: A synthesis of three decades of research on intergenerational transmission of attachment. Psychological Bulletin, 4, 337–366. doi:10.1037/bul0000038CrossRefGoogle Scholar
Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7, 312–323. doi:10.1177/1524839906289376CrossRefGoogle ScholarPubMed
Wan, M. W., & Green, J. (2009). The impact of maternal psychopathology on child-mother attachment. Archives of Women's Mental Health, 12, 123–134. doi:10.1007/s00737-009-0066-5CrossRefGoogle ScholarPubMed
Ward, C., Makusha, T., & Bray, R. (2015). Parenting, poverty and young people in South Africa: What are the connections? South African Child Gauge 2015 (pp. 69–74). Cape Town, South Africa: University of Cape Town, Children's Institute.Google Scholar
Zeanah, C. H., & Benoit, D. (1995). Clinical applications of a parent perception interview in infant mental health. Child and Adolescent Psychiatric Clinics of North America, 4, 539–554. doi:10.1016/S1056-4993(18)30418-8CrossRefGoogle Scholar
Zeegers, M. A. J., Colonnesi, C., Stams, G.-J. J. M., & Meins, E. (2017). Mind matters: A meta-analysis on parental mentalization and sensitivity as predictors of infant-parent attachment. Psychological Bulletin, 143, 1245–1272. doi:10.1037/bul0000114CrossRefGoogle ScholarPubMed