The psychic landscape of mothers-to-be: The role of attachment organization in pregnancy

1. The psychic landscape of mothers-to-be: The role of attachment organization in pregnancy Nataša Hanak Faculty of special education and rehabilitation University of Belgrade IAC Oslo 2011

2. Pregnancy: transition to motherhood • Maternity is too complex form of the social behavior to be explained only by activation of presumed maternal instinct. Although there are biological, hormonal bases of maternity, it depends on personal history of a woman and many situational factors (Hrdy, 1999; Pryce, 1995). • Mother-role attainement, mother-identity development, transition to motherhood? • A transitional period begins sometimes before pregnancy, usually during the pregnancy and lasts for many months while caring for the baby (Cohen & Slade, 2009; Stern & Bruschweiler-Stern, 1998). IAC Oslo 2011

3. Theoretical contributions to the research of transition to motherhood • Early conceptualizations and research • T. Benedek: parenting as developmental phase (1952) • G. Bibring: pregnancy as developmental crisis (1959; 1961) • Donald Winnicott: Primary maternal preoccupation (1956) • Daniel Stern: The motherhood constellation (1995) IAC Oslo 2011

4. Attachment theory as a broad research framework Personal history of attachment relationships Context Culture Socio-economic background Quality of the relationship with the partner Etc. Motivation for parenting Subjective experience of pregnancy Representations of the self-as-a-mother Representations of the child Parenting DEVELOPMENT Child Temperament Female/male Health issues IAC Oslo 2011

5. Daniel Stern: Becoming a mother • During the pregnancy a woman performs the mental work preparing her for the motherhood, for the new identity • “During these nine months, a woman’s imagination is fully engaged in hopes, dreams, fears, and fantasies about who her baby will be, what she will be like as a mother, and how her husband will be as a father. (…) …a woman is free to project all kinds of ideas onto the stage of her mind about what life will be like when the baby arrives. This is vital preparation for becoming a mother”. (Stern & Bruschweiler-Stern, 1998, 17-18.) IAC Oslo 2011

6. Mental preparation for motherhood • Revival of conflicts from earlier developmental phases and ambivalency (Bibring, 1959; Raphael-Leff, 1995; Schleske, 2007) • Anxiety(Faisal-Curyl & Rossi Menezes, 2007; Fava Vizziello, Antonioli, Cocci & Invernizzi, 1993; Lester & Notman, 1986; Stern & Bruschweiler-Stern, 1998) • Development and elaboration of the representations of self-as-a-mother and the child (Ammaniti et al, 1992; Fava-Vizielo et al, 1993; Raphael-Leff, 1995; Schleske, 2007) • Growing emotional investment into the fetus (Laxton-Cane & Slade, 2002; Leva-Giroux, 2003; Schleske, 2007). IAC Oslo 2011

7. Mental work during the pregnancy • Changes in the representational world • Development of expectations about the future child and self-as-a-mother • Anxieties about the basic tasks of the motherhood • Make the baby grow and thrive • Develop an intimate, loving relationship with the baby • Making the network for social support (affirming matrix) • Transform own identity IAC Oslo 2011

8. Aim of the study • Explore differences in mental representations, motherhood-related expectations and anxieties, and prenatal attachment in pregnant women with secure and insecure organizations of attachment IAC Oslo 2011

9. Method IAC Oslo 2011

10. Sample • Women expecting their first child, examined between 20th and 32nd week of gestation (M = 26.5) with self-report measures (N = 323 with complete data) • 20% had risk pregnancy • Age range 18-44 (M = 27.3) • Majority of them were married (86.1%), the others lived unmarried together with the father of the child (12.7%), or seldom lived without a partner (1.2%) • Most of the women had planned their pregnancy (81.5%) IAC Oslo 2011

11. Procedure • 150 women were recruited within the health institutions. The rest of the sample was recruited through private contacts of the principal investigator or the field assistants. • The general purpose of the research, the confidentiality issues and the use of the data was explained to the women and they have given their written consent for the participation • The participants filled out the instruments individually, at home. They returned completed battery of the instruments in a sealed envelope upon the next visit to the health institution or handed it directly to the field assistants. IAC Oslo 2011

12. Variables and instruments • Attachment organization • QAA-R (Hanak, 2004, 2010), measuring seven domains of attachment. 7 scales with 11 items each: • Use of the secure base (Cronbach’s alpha= .77) • Anxiety about losing the secure base (alpha= .85) • Unresolved family traumatization (alpha= .87) • Negative working model of self (alpha= .82) • Negative working model of others (alpha= .87) • Poor anger management (alpha= .79) • Capacity for mentalization (alpha= .71) • By the means of K-means cluster analysis four clusters were obtained, identified as secure, fearful, preoccupied and dismissing attachment organization. IAC Oslo 2011

13. Profiles of the four clusters on the attachment measure IAC Oslo 2011

14. Variables and instruments 2. Content of the mental representations • Modified IRMAG adjectives lists (Ammaniti et al., 1992), with 11 adjectives each, were used for the rating of • The imaginary child (alpha= .78) • Self-as-a-mother (alpha= .69) • Own-mother-as-a-mother (alpha= .83) • Partner-as-a-father (alpha= .76) • Semantic differential method was used, rating was made on the 10 point scale. IAC Oslo 2011

15. Variables and instruments 3. Anxieties about the future maternal role • AMR scale, constructed for the purposes of the research, 24 items, four subscales measuring anxieties about • the loss of freedom and unaccomplishment in the maternal role (alpha= .81) • not loving the baby and not having sufficient support (alpha= .78) • having a “difficult” baby (alpha= .80) • not being competent in the maternal role (alpha= .80) IAC Oslo 2011

16. Variables and instruments 4. (Potentially disfunctional) expectations about the role of the child in the personal and family life • PDE scale, constructed for the purposes of the research, 19 items (alpha= .89). It includes the following sets of the expectations: • The child as a compensation of the disturbed family dynamics or structure • The child securing the future of the family • The child as a source of life and love for the mother • The child satisfying mother’s narcisstic needs • The child as a gift IAC Oslo 2011

17. Variables and instruments 5. Prenatal attachment (PA) • MPAS, 33 items, measure comprised of selected items from PAI (Mueller, 1993), MFAS (Cranley, 1981) (see also Hsu & Chen, 2001), and few additional items (alpha= .85). • Three components: • Positive feelings and fantasy (alpha= .81). • Differentiation and contact (alpha= .83). • Responsibility and care (alpha= .71). IAC Oslo 2011

18. Results IAC Oslo 2011

19. The structure of mental representations • The imaginary child: 2 components (53.791% var. explained) • socialized and easy (obedient, calm, tidy, lovable, skilful, sociable) • active and positive (enterprising, lively, independent, cheerful, curious, sociable) • Self-as-a-mother: 3 components (50.927% var. explained) • secure base and affect regulation (patient, skillful, can be depended on, calm) • commitment and activity (warm, enterprising, playful, committed) • promotion of exploration (supporting, gives free reign, permissive) • Mother-as-a-mother: 2 components (55.193% var. explained) • secure base and affect regulation (supporting, can be depended on, permissive, gives free reign, patient, cheerful, calm) • commitment and activity (enterprising, committed, skillful, warm, calm) • Partner-as-a-father: 3 components (58.122% var. explained) • commitment and activity (warm, committed, playful, enterprising) • secure base and affect regulation (patient, calm, can be depended on, skillful) • promotion of exploration (gives free reign, permissive, supporting) IAC Oslo 2011

20. Differences between att. organization on the representations, anxieties, expectations and PA (ANOVA) IAC Oslo 2011

21. Discriminant analysis IAC Oslo 2011

22. Discriminant analysis – structure matrix IAC Oslo 2011

23. Predicted group membership IAC Oslo 2011

24. Discussion IAC Oslo 2011

25. Psychic landscape of mothers-to-be with different attachment organization • The aim of the study was to explore differences between some of psychic contents and processes that are important in the transition to motherhood, in the pregnant women with secure and insecure attachment organization • All variables entered in the analysis (content of the representational world, anxieties, expectations, prenatal attachment) have significant contribution whether in discriminating between secure and fearful or preoccupied from dismissing attachment organization IAC Oslo 2011

26. Secure vs. fearful attachment: summary • Pregnant women with secure attachment organization have more positive representations of self-as-a-mother and their mother-as-a-mother, than women with fearful attachment. They see themselves as commited, enterprising, warm and playful, as well as calm, patient and skillful mothers and they tend to experience their mothers in a similar way, as competent and trustworthy. • Secure mothers have more positive representations of the partners-as-a-father and also of the child – expectim him/her to be more socialized and easy than the fearful mothers do. • Fearful mothers have representations of the child that are closer to the negative pole of the measured extremes – disobedient, untidy, clumsy, anxious and detached child. More negative view of self, partner, child and own mother is coupled with anxiety about the loss of freedom and unaccomplischment in the future maternal role and lower prenatal attachment in fearfully attached pregnant women. IAC Oslo 2011

27. Preoccupied vs. dismissing attachment: summary • The hallmark of the psychic landscape in pregnant women with preoccupied attachment organization are high and also likely disfunctional expectations about the role of the child in the personal and family life, such as to compensate disturbed family dinamics/structure or to satisfy mother’s narcisstic needs (to be like mother, to make her more complete as a person, to be the primary object of mother’s love, etc.) • Preoccupied women differ from the dismissing in their representations of the child on the dimension of the activity and positive affects; they expect their child to be more shy, dependant, detached, serious and quiet. • Preoccupied women demonstrate more anxieties than dismissing women, in particular anxiety about incompetence in the mother role and anxiety about having baby with a “difficult” temperament. IAC Oslo 2011

28. Conclusions and limitations • The results of the study are in line with attachment theory and research (Burton, 1995; Polock & Persy, 1999 ; Priel & Besser, 2000; Raphael-Leff, 1995), especially with the view of Stein et al (2002) arguing that fearfull attachment may be seen as opposite of the secure on the underlying dimension of (in)security, while preoccupied and dismissing organizations have different strategies in coping with the moderate to high insecurity in the close relationships • The study points to several variables which can be relatively easily and reliably measured, that could be used in screening for a vulnerability for a non-optimal transition to motherhood, and also used as a target in an intervention process. • Use of adapted or newly developed instruments calls for their further examination, validation and improvement IAC Oslo 2011

29. Thank you for your attention! IAC Oslo 2011