Maternity Research Article Critique
This study explores the effects of a brief individual psychoanalytic therapy on perinatal depressive symptoms. A group of 40 women presenting depressive symptoms (treatment group) participated in a four-session intervention called ‘Psychotherapy centered on parenthood (PCP)’. It consists in two antenatal and two postnatal sessions and is focused on changing problematic representations of parenthood. This treatment group was compared to a control group of 88 women without depressive symptoms and following the usual obstetrical care.
Edinburgh postnatal depression scale:
The EPDS is a questionnaire widely used ...view middle of the document...
The pregnant women were enrolled between July 2006 and July 2007; they were referred by health professionals (gynecologists, pediatricians, midwives) of the city of Geneva (Switzerland). All French-speaking pregnant women were included, except those with a known severe psychiatric pathology (substance abuse, bipolar disorder, schizophrenia, or mental retardation).
In the control group, 52 of the 88 women participated at the 3 months follow-up (T2) and 41 were present at the 6 months follow-up (T3). Women of the treatment group had a mean gestational age of 29 weeks (SD04.05) at the first treatment session (S1) and a gestational age of 33 weeks (SD 0 4.4) at the second session (S2). The two postnatal sessions (S3–S4) occurred at 4.9 weeks (SD 0 1.9) and 9.4 weeks (SD 0 3.3) after birth.
The treatment group women participated in a four-session individual psychotherapy based on Cramer and Palacio Espasa’s manual (Cramer 1995) of mother–infant therapy which focuses on parental representations.
It consists of two antenatal sessions (during the second or third trimester of pregnancy, depending on the moment of referral and on the clinical needs) and two postnatal sessions (1 and 2 months after delivery). The treatment goal is to identify and modify the nature of the core conflicting themes concerning motherhood which are responsible for the woman’s feelings of guilt and mood disturbances.
Clinical practice of brief mother–infant psychotherapy shows that the main psychic themes observed during pregnancy and early motherhood are: (1) the fear of not being a good mother, (2) the fear to reproduce the patterns that the mother suffered during her childhood, (3) the existence of a too high maternal ideal. These conflicts are connected to unconscious or non-elaborated bereavements of the woman’s past, with more or less conscious reproaches addressed to her parents, which are returned against herself when she becomes a mother. The intervention leads to an improvement of the mother’s mood by relieving the anxiety and guilt, allowing her to engage in an active psychological process and to be emotionally ready for motherhood.
In our study, 50 % of the 129 women never heard about the existence of postpartum depression before their participation in the study, even if they had already suffered from depression. These facts indicate the urgent need for more information concerning PD and its treatment, addressed not only to future parents but also to their caregivers in perinatal services.
1. Lack of a control group including depressive women who did not undergo the intervention. For ethical reasons, PCP was proposed to all identified depressed pregnant women in order to minimize the effects of depression on the developing fetus and to avoid future disturbances of the mother–infant relationship.
2. The sociodemographic characteristics of the sample which include an important percentage of women with a mean/high...