Parent-infant psychotherapy is a small but growing field in South Africa. Its potential to contribute to mental health services in South Africa is, by contrast, vast. This thesis contributes towards much-needed research on the state of the field in the country and its potential applications across different sectors. Drawing on Daniel Stern’s concept of ports of entry, it is argued that an expansion of ports of entry offers an important integrating tool through which different aspects of parent-infant psychotherapy can be examined and adapted to the South African context. A history of parent-infant psychotherapy in South Africa is offered, together with an analysis of the experiences of current practitioners in the field. These aspects of the thesis draw on interviews with key stakeholders. The dominant context of private practice is then explored through two case study based papers. The first explores the meaning of symptoms in parent-infant psychotherapy. The second introduces the ‘grandmaternal transference’ as an important but under developed port of entry. These different aspects of parent-infant psychotherapy in South Africa are then considered through the prism of ports of entry in order to argue for a flexing of the psychoanalytic frame. Implications for the growth of the parent-infant psychotherapy field in South Africa are considered.

The aim of this study is to give an in-depth understanding of the representations of a depressed woman who killed her baby. The representations under study is based on “The motherhood constellation” by Stern (1995) and focus on the woman’s representation of her mother as mother-of-herself-as-child, herself-as-mother and her representations of her children. Pregnancy is an important phase in a woman’s life. Parent-infant psychotherapies are a rapidly growing field of infant mental health as many psychological problems have their roots in infancy. Neglect, trauma and abuse and prolonged maternal depression can cause a child to develop a range of problems. The work of Winnicott (1965a) and Bion (1988) put the mother’s fantasy life about her infant as one of the major building blocks of the infant’s construction of a sense of identity (Stern, 1995). Fraiberg (Fraiberg, Adelson&Shapiro, 1980) with her “ghosts in the nursery” revolutionised this perception by placing the maternal representation at the core of the parent-infant clinical situation (Stern, 1995). The way the research developed and the nature of the research problem necessitated a pure qualitative mode of enquiry. A single case study was done about the representations (of self-as-mother, mother-as –mother–of–self-as-child- and of the children) in an extreme case where the mother’s depression led to her murdering her baby. Data collection was done through semi-structured interviews and documents from the psychiatric hospitals she attended. Data was also obtained from field notes, before and after the interviews and also while transcribing the audio-taped interviews. Data analysis was done by the procedures of data reduction and organising it into categories on the basis of themes as described by Neuman (2000). Coding and analytic memo writing were done. The relationships between concepts were examined and linked to each other and interweaved into theoretical statements. The researcher argues that not enough is done to enhance the relationship between a mother and her foetus, and later her baby. The concept of maternal representations is the only approach that opens the possibility to start working at the earliest point of prevention, because intervention can start during pregnancy. Intervention during pregnancy is ideal because defence mechanisms are less rigid during pregnancy and women are more in touch with their entire life cycle and the whole system is more open for change. The ghosts can be chased out of the nursery by helping the mother to see the repetition of the past in the present. The affective link, recognising and remembering the feelings help a parent not to repeat the past in the present - “…it is the parent who cannot remember his childhood feelings of pain and anxiety who will need to inflict his pain upon his child” (Fraiberg, Adelson&Shapiro, 1980, p. 182). / Thesis (PhD (Psychotherapy))--University of Pretoria, 2006. / Psychology / unrestricted