The Montevideo study of attachment and narratives

Altmann de Litvan, M. (2015). Encuentros clinicos madre-infante "Estructuras relacionales subyacente en procesos psicoterapeuticos breves" {Clinical encounter of mother and child: Underlying structures of mother-infant interaction at brief psychotherapeutic processes}. Ediciones Biebel, Buenos Aires.

Altmann de Litvan, M. (2014). Diferentes caminos hacia la Mentalización: Exploración de los estados prereflexivos y su relación con el sì mismo, AÑO I - NUMERO II – ABRIL 2014,

Altmann de Litvan, M.; Procopio, R.; & Szteren, L. (2014). Intervenciones en psicoterapia madre-bebé tendientes a disminuir el riesgo de un apego inseguro. En Torres, B.; Causadioas, J.; & Posadas, G. (2014). La teoría del apego: investigación y aplicaciones clínicas. Psimatica Editorial S.L. ISBN: 9788488909879.

Brief Summary

This is a process study of psychoanalytic infant – mother consultations. It attempts to bring the advances of psychoanalytic process research in the traditional consulting room encounter to the applied context of mother – infant interaction. This is a therapeutic setting that shares some features with the psychoanalytic but, in addition has a developmental focus.

Ten mother baby dyads were selected at random from the regular treatment program at the Pediatric University Hospital in Montevideo. The babies were aged from 3 to 18 months and showed psychofunctional disorders. The dyads received 3 to 4 therapeutic interviews. The goal of these psychoanalytically oriented consultations with mothers and their babies is to help the mother to better understand her emotions, especially when interacting with her child in the therapeutic situation itself. A psychotherapeutic objective is to enable the mother to (re)adjust to her baby in direct response to its non-verbal interventions by connecting the baby’s gestures and behavior with emotions and by verbal expressing of emotions. The verbal exchange of therapist and mother is being empirically assessed using computer assisted language measures. Narrative Style is measured using a computer-based measure of Referential Activity developed by Mergenthaler & Bucci. The analysis of the text material utilizes the Cycles Model Program (CM, available from the Ulm Textbank website). The non-verbal interactions between mother and baby during the interview will be empirically assessed using Massie and Campbell’s attachment indicators (gazing, vocalizing, touching, affect, proximity, holding), both from mother to baby and the baby to mother, following the word block segmentation. Subprojects were:

- The study of risk in attachment

- The study of productivity in the session according to clinical and empirical criteria

- The validation of the Therapeutic Cycles Model into Spanish language

- The study of the impact of interventions in the developmental process

- The implementation of training programs for health care groups and mothers in the topic of attachment

- The Underlying structures of the mother-infant interaction at brief psychotherapeutic processes


The psychotherapeutic interviews had an effect on the attachment indicators: the subjects changed from the extreme points (insecure, avoidance and over-anxious) towards the middle range (secure attachment). In the last sessions both mother and baby are closer to the middle range (3: secure attachment), and all the attachment indicators are closer to the middle range in the last sessions both in the mother and the baby. All linguistic and non-verbal variables were correlated in a block by block basis and no significant correlations were found between the verbal measures in the mother and therapist’s speech and the attachment indicators in the mother-baby dyad (Pearson correlation). Moments of productive speech between mother and therapist were not always moments of activation of the non-verbal indicators between mother and baby. These results showed the independence of the 2 levels: therapeutic discourse, and the non-verbal exchanges between mother and baby. Patterns of mother-baby interaction for each dyad were found using Box & Jenkins times series analysis. The interchanges that are repeated during the interpersonal communications and can be conceptualized as patterns of interaction –automatic procedures of how to relate with others and the world. These patterns constitute ways of organizing experience; schemes to coordinate affects, ideas, actions, which together with fantasies activate our unconscious processes. The relevance of these patterns for psychotherapy roots in that they are the ports of entry to therapeutic action, to “moments of meeting” that constitute the way to change the mental organization at a procedural level. One year old cases were analyzed in depth at empirical and clinical levels. The authors found that each dyad has a particular and unique pattern of interaction.


In interpreting the present results, several limitations to this study should be considered. One of the problems of this study is the limited number of cases. Nevertheless, for many of the sub-studies performed the sampling frame was the number of blocks of 150 words. This design enabled the study of the relationship between verbal and non-verbal measures but didn’t permit the study of the reasons for the changes that take place during the psychotherapeutic process.

Overall, the study has several strengths. First, the data showed that this model of psychotherapeutic intervention had a positive impact on the attachment indicators as measured by Massie and Campbell. Second, moments of productivity in the verbal exchange between the mother and the therapist are not necessarily moments of activation of non-verbal attachment indicators between the mother and the baby. These results may have practical implications for therapeutic interventions. In order to improve the mother’s attachment to the baby these interventions should stimulate her to gaze, to vocalize and to touch the baby and also to avoid using abstract words as a means of communicating with the baby.


Dr. Marina Altmann de Litvan

Rambla Armenia 3783 piso 10

Montevideo 11326, Uruguay