“The Psychological Treatment of Perinatal Psychological Distress in function of the Well-Being of the Mother/Father-Child Dyad: An Innovative Area of Application of Analytical Psychology in the Horizon of Primary Care Psychology and in the Context of the National Public Health System” is a project promoted and realized under the long-time program of the IPAP-ASL TO4 Primary Care Clinical-Psychological Center [CCP IPAP-ASL TO4] in Ivrea (Piedmont Region, Italy), with funding provided by the International Association for Analytical Psychology (IAAP) – Outreach Working Party.
The proponents of the CCP IPAP-ASL TO4 are the Association for the Study of Analytical Psychology and Jungian-Oriented Psychotherapy (APAP), through its Institute of Analytical Psychology and Psychotherapy (IPAP), and the Local Health Authority ASL TO4 of the Piedmont Region, Italy.
The CCP IPAP-ASL TO4 was created in 2018, as a unique experience in Italy of public-private collaboration and as an application project of Jungian thought and practice in the Italian National Health System. The CCP IPAP-ASL TO4 originated from the need to introduce in the Piedmont territorial reality (North-West Italy) a psychological service specialized in Primary Care, easily accessible to the users of the territory, thus proving to meet a health and social need that until then was not adequately answered. In particular, it has arisen from the need to cope with the significant increase in the population of psychological distress and minor mental disorders (anxiety disorders, somatoform disorders, depressive disorders…), which are the cause of individual suffering, relational difficulties, impairment of work capacity, and huge health and social costs. The CCP IPAP-ASL TO4 intends to treat these mental disorders at the Primary Care level, offering the professionalism of young Psychologists specializing in Jungian Psychotherapy and newly trained Jungian-oriented Psychotherapists to users in the territory, in close coordination with the territorial network of General Practitioners (GPs), in a facilitated access mode and with a view to supporting weak categories.
The users attended to by the CCP IPAP-ASL TO4 are often residents of rural and mountainous areas, characteristic of the naturalistically marvelous as well as rugged territory of Piedmont: to reach such patients, who often do not have easy access to public and private systems of care, the CCP IPAP-ASL TO4 has studied how to apply Jungian-oriented psychological and psychotherapeutic work through telemedicine, with the use of state-of-the-art devices and technology, yet easy to access and apply.
The CCP IPAP-ASL TO4 has received Europe’s highest honor for mental health: the 2021 EU Health Award – Mental Health. As part of the EU4Health 2021-2027 Program, the EU Health Award aims to raise awareness of the vital role that cities, local authorities, civil society, and educational institutions play in strengthening participatory democracy and active citizenship in public health. Since 2015, the EU Health Award has been honoring organizations across Europe for their successful public health initiatives. The 2021 edition of the Award honored the project “Psychological Assistance in Primary Care to Counteract the Psychosocial Effects of the COVID-19 Emergency: Support to Individuals, Families, Caregivers, and Communities of Help”, launched by the CCP IPAP-ASL TO4 in April 2020 in order to cope with the COVID-19 emergency. The project, presented in response to the Call for Proposals “Together Everything will be Fine” of the Compagnia di San Paolo Foundation and with the support of the Fund for charitable, social and cultural contributions of Intesa Sanpaolo, was intended to offer psychological support to COVID-19 patients; family members and caregivers of COVID-19 patients; health care personnel engaged in pandemic management; and the broader population indirectly affected by the pandemic. This is the first Jungian-inspired initiative to receive this outstanding recognition from the European Commission (https://iaap.org/european-commission-eu-health-award-to-iaap-colleague-riccardo-bernardini/).
After these first years of activities mainly dedicated to coping with the psychological implications of the COVID-19 emergency, the IPAP-ASL TO4 CCP now intends to direct its clinical and research activities to the psychological treatment of the Perinatal Psychological Distress in function of the well-being of the mother/father-child dyad, again from the perspective of Primary Care Psychology and in the ambitious project of continuing the teaching, application, and dissemination of Analytical Psychology in the National Health System.
This new phase of the IPAP-ASL TO4 CCP moves from an awareness of how becoming a parent is a path of personal growth that parallels the growth of one’s child, and like all evolutions it can be linear or follow tortuous and difficult tracks. With the birth of a son/daughter, multiple relational plans are articulated that require continuous readjustments to rapid and sometimes unpredictable changes. We witness significant changes in the emotional relationship with one’s own body, in the couple’s relationship and sexual intimacy, in the generational dimension in assuming new roles of all the protagonists involved, in the assumption of responsibility and dependence in the attachment bond with the unborn child, in the change of life rhythms, etc. The intensity of these changes, however positive and desirable, need to develop new coping skills, which we can summarize in the term “mindful parenting”: i.e., a parenting capable of attunement and relational contingency to the present moment through mental presence, which facilitates the construction of the parent-child relationship.
Parenting is one of the most arduous, challenging, and stressful tasks on earth. It is also one of the most important, because how it is done greatly influences the hearts, souls, and consciousness of future generations, their understanding of values and relationships, their idea of necessary life skills, their deeper feelings about themselves, and their possible role in a rapidly changing world. However, those who become parents do so with almost no preparation or training, with little or no guidance, and in a world that considers it far more important to produce than to nurture, doing much more than being. Being a “mindful parent” is not synonymous with “perfect” parenting, as Donald Winnicott recognized, so much as it is for parents to be “good enough” or, to paraphrase a concept of Carl Gustav Jung’s, “complete.” The construction of the child’s inner world, as it unfolds, as also studied by Erich Neumann and Michael Fordham, is in good part the fruit of a creation of an ongoing dialogue with the minds of others, which Daniel Stern calls the “intersubjective matrix”: everything we think we feel and desire is influenced by the thoughts, feelings, and intentions we perceive from others, in an incessant real or virtual dialogue.
We can imagine, what it might mean, in the midst of the exchange parent-child interactive, a maternal or paternal mental presence permeated with worries, trauma, anxiety, and depression, which often bring with them experiences of dissociation and mental displacement into the dimension of the past or future disconnecting from the psycho-body present in which the child lives. Often women who manifest perinatal psychological distress and need the psychological therapeutic interventions come to consultation for the following critical clinical issues: 1. post-traumatic birth disorder; 2. adjustment disorder with depression and anxiety; 3. difficulty in relational investment toward the child; 4. child birth with physical problems; 5. abandonment by partner; 6. relationship problems in couple or extended family; 7. rigidity and hypercritical self; 8. feelings of loneliness; 9. criticality in one’s childhood with dysfunctional or traumatic attachments; 10. psychosomatic issues.
The desires, fears, and fantasies that accompany women during the nine months of gestation and the early stages of motherhood also take shape. According to Stern, they are organized into four main themes: 1. the physical survival of the child (life-growth theme); 2. the ability to engage emotionally with the child (primary relationality theme); 3. the mother’s need to be supported by significant others (support matrix); 4. changes related to the self (identity reorganization). These experiences are also documented in the dream life of pregnant women and young mothers, as documented by colleagues Regina Abt, Irmgard Bosch, and Vivienne MacKrell.
Careful intervention to intercept perinatal psychological distress is a preventive action, both in the immediate term, in the onset of anxiety-depressive manifestations in pregnancy and postpartum, and in the long term, i.e., in the parent-child relationship. It is well known in the literature what can be the prognostic impact on the child’s growth of an early relationship with a mother with a mental disorder and/or postpartum depression. A relational difficulty of attuning interaction of the mother with the child can often lead to difficulties in attachment and the occurrence of disturbances in the relationship by developing insecure attachments. If it was difficult for the mother in the early months of the child’s life to maintain her emotional state within a window of tolerance this difficulty has repercussions over time in the adolescent’s and adult’s ability to manage their emotions. The “good enough” or, in Jungian terms, “complete” parent ensures this ability to stay within a window of emotional tolerance such that adequate cognitive relational and affective skills can be developed. If we look at psychological distress in the adolescent stage (apart from should be considered the physiological developmental crisis), we find teens who are unable to modulate emotions or in more extreme cases do not have “emotional literacy” and often manifest emotional instability in the expansive direction i.e., discontrol or in the opposite we are faced with adolescents or young adults pervaded by anxieties and inhibitions that lead them to close in on themselves or create bonds only within the virtual world.
It is precisely in the period marked by the pandemic of COVID-19 that, in September 2021, the ASL TO4 Corporate Network of Support for Perinatal Psychological Distress has already successfully introduced a hospital psychological presence dedicated to new mothers, with the aim of promoting the emotional well-being of women in some critical phases of hospital stay and in continuity and consolidation of the already operational “Network of Interception and Taking Charge of Perinatal Psychological Distress,” in the direction of a constant humanization of the health services offered. The project now needs to be revitalized, building on this highly significant data with an additional focus also on young fathers and an approach to such parenting issues that can further deepen the theoretical and clinical contribution of Analytical Psychology.
The clinical intervention of prevention diagnosis and treatment of perinatal mental distress within Local Health Authority ASL T04 has been, since 2005, guaranteed by the Adult Health Psychology Simple Structure, through the integrated presence of Psychologists at the Family Consultatories of the Piedmont territory. In 2018, the Piedmont Region joined the Ministry of Health project entitled “Measures pertaining to the Prevention, Diagnosis, Treatment, and Care of Postpartum Depressive Syndrome.” With this projectuality, a contact person was identified for each regional public health agency for the implementation of the experimental project of corporate activation of a multi-professional and interdepartmental network for the implementation of screening and taking care of women who manifest perinatal psychological distress, with particular attention to the first 1’000 days from pregnancy to postpartum.
The project of the CCP IPAP-ASL TO4 is jointly promoted by the Association for the Study of Analytical Psychology and Jungian-Oriented Psychotherapy (APAP) through its training body, the Institute of Analytical Psychology and Psychotherapy (IPAP), Postgraduate School of Psychotherapy, and the Local Health Authority ASL TO4. The two entities, which have an agreement with each other for this purpose (General Director’s Resolution No. 561 of May 9, 2018), have entrusted the shared management and coordination of the CCP IPAP-ASL TO4 project to the ASL TO4 Adult Health Psychology Simple Structure, currently represented by its Director, Dr. Marcello Giove, and to the Institute of Analytical Psychology and Psychotherapy (IPAP), currently represented by its Director, Dr. Riccardo Bernardini; for the specific project “The Psychological Treatment of Perinatal Psychological Distress in function of the Well-Being of the Mother/Father-Child Dyad,” ASL TO4’s operational manager is Dr. Alda Piera Pastore, Head of the Life Cycle Area at the ASL TO4 Adult Health Psychology Simple Structure, Regional Referent of the Corporate Perinatal Psychic Distress Network and of the Network Against Gender Violence.
The CCP IPAP-ASL TO4 is based at the headquarters of the ASL TO4 Adult Health Psychology Simple Structure, i.e., the Outpatient Clinic “Community,” Via Natalia Ginzburg, 7, 10015 Ivrea (Italy), with a space dedicated to the conduct of psychological interviews, organizational and secretarial tasks, and training and supervision of the operators involved in the project.