The psychic landscape of mothers-to-be: The role of attachment

organization in pregnancy

Nataša HanakFaculty of special education and rehabilitation

University of Belgrade

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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).

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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)

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ContextCultureSocio-economic backgroundQuality of the relationship with the partnerEtc.

Parenting

Attachment theory as a broad research framework

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Motivation for parenting

Personal history of attachment relationships

Subjective experience of

pregnancyRepresentations

of the child

Representations of the self-as-a-

mother

Child TemperamentFemale/maleHealth issues

DEVELOPMENT

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.)

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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).

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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

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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

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METHOD

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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%)

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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.

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Variables and instruments

1. 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.

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Profiles of the four clusters on the attachment measure

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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.

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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)

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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

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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).

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RESULTS

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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)

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Differences between att. organization on the representations, anxieties, expectations and PA

(ANOVA)

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scales F Sig.

CHILD socialized and easy 7,899 (3, 319) .000

CHILD active and positive 10,121 (3, 319) .000

SELF affect regulation and secure base 13,222 (3, 319) .000

SLEF committement and activity 13,967 (3, 319) .000

MOTHER promotion of exploration 2,593 (3, 319) .053

M. MOTHER affect regulation and secure base 9,221 (3, 319) .000

M. MOTHER competence and commitment 11,7693 (3, 319) .000

FATHER committment and activity 10,333 (3, 319) .000

FATHER affect regulation and secure base 5,675 (3, 319) .001

FATHER promotion of exploration 0,169 (3, 319) .917

anx iety - loss of freedom 10,626 (3, 319) .000

anx iety - not enough love and support 3,651 (3, 319) .013

anx iety - difficult baby 5,151 (3, 319) .002

anx iety - incompetence 3,081 (3, 319) .028

expectations total 13,968 (3, 319) .000

prenatal attachment total 13,634 (3, 319) .000

Discriminant analysis

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Function Eigenvalue % of Variance

Cumulative %

Canonical Correlation

Wilks' Lambda

Chi-square

df Sig.

1 0.371 55.7 55.7 .52 .559 182.385 39 .000

2 0.253 38.1 93.8 .45 .766 83.547 24 .000

Discriminant analysis – structure matrix

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Function

Secure vs fearfulPreoccupied vs

dismissingSELF commitment and activity 0,575 -0,161Prenatal attachment 0,557 0,188SELF affect regulation and secure base 0,546 -0,232M. MOTHER competence and commitment 0,540 0,095Anxiety - loss of freedom, unaccomplishment -0,507 0,122FATHER commitment and activity 0,492 0,157M. MOTHER affect regulation and secure base 0,446 0,155CHILD socialization 0,428 0,159(disfunctional) expectations 0,045 0,715CHILD activity and positive affects 0,346 -0,416Anxiety – incompetence 0,014 0,328Anxiety - difficult baby -0,052 0,393Anxiety - not enough love and support -0,231 0,208

Predicted group membership

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Predicted Group Membership

secure fearful preoccupied dismissing

Original % secure 63,74 9,89 18,68 7,69

fearful 6,67 66,67 11,11 15,56

preoccupied 23,53 17,65 50,00 8,82

dismissing 21,18 18,82 14,12 45,88

55,1% of original grouped cases correctly classified

DISCUSSION

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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

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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.

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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.

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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

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THANK YOU FOR YOUR ATTENTION!

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