The Evidence-Base for Psychodynamic Interventions with Children Under 5 Years of Age and Their Caregivers: A Systematic Review and Meta-Analysis

Figures & data

Figure 1. Flow diagram of the study.

Table 1. Paper selection flow chart.

Author, country	Caregiver	Demographic	Infant	Study design	Presenting problem	Therapy	Delivery setting
Mentalization based interventions
Attachment & Child Health (Attach)
Anis et al. (2020) and N. Letourneau et al. (2020), Canada	Mothers (N = 30)	57% Caucasian; low SES	<36 months	Controlled (N = 10); RCT (N = 20)	Socially disadvantaged/high risk families	ATTACH 10 sessions with mother and therapist. Coparenting support person joining 2–3 sessions	Home-based
Mothering from the inside out (MIO)/Mothers and toddlers program (MTP)
N. Suchman et al. (2008), USA	Mothers (N = 14)	72% Caucasian, 14% Hispanic, 14% African American; 71% unemployed; 64% married or cohabiting	M = 26.4 months (SD = 8.02)	Cohort	Parental substance abuse	Mothers and Toddlers Program 12 session individual therapy with parent	Outpatient
N. E. Suchman et al (2010, 2011, 2012), USA	Mothers receiving MTP (N = 23) or parent education (N = 24)	70.8% Caucasian, 20.8% African American, 38.3% Hispanic or Latino; 87% unemployed	M = 18.54 months (SD = 12.27)	RCT	Parental substance abuse	Mothers and Toddlers Program As above	Outpatient
N. E. Suchman et al.(2016), USA	Mothers (N = 17)	44.4% Caucasian, 33.3% Hispanic or Latina, 22.2% African American; 55.6% had never been married; 94.1% living independently	M = 38 months (SD = 23.51)	Cohort	Parental mental health	Mothering from the Inside Out (MIO) As above	Outpatient
N. E. Suchman et al. (2017), USA	Mothers receiving MIO (N = 40) or parent education (N = 47)	77% Caucasian, 13.8% African American, 3.4% Hispanic/Latino, 5.7% mixed race; 42.5% never been married; 69.8% living independently	M = 27.62 months (SD = 14.73)	RCT	Parental substance abuse	Mothering from the Inside Out (MIO) As above	Outpatient
Minding the baby
Condon et al. (2022), USA	Mothers (N = 97)	33% Black, 62% Hispanic, 5% other	M = 6 years	RCT	Socially disadvantaged/high risk families	MTB Weekly-biweekly home visits from pregnancy − 2 years, delivered by pediatric nurses and social workers	Home-based
Ordway et al. (2014), USA	Mothers (N = 50)	22% Hispanic, 15% White, 5% Black, 1% Native Hawaiian/Pacific Islander, 3% Other	M = 51.8 months; age ranges from 3 to 5 years	Cohort	Socially disadvantaged/high risk families	MTB As above	Home-based
Ordway et al. (2018), USA	Mothers in MTB (N = 106) and control group (N = 95)	77.2% Hispanic, 5.4% White, 14.1% African American, 1.1% Native Hawaiian/Pacific Islander	M = 38.5 weeks (SD = 2.9)	RCT	Socially disadvantaged/high risk families	MTB As above	Home-based
Sadler et al. (2013), USA	Mothers receiving MTB (N = 60) or TAU (N = 45)	28% Black, 62% Latina, 10% Other; 83.8% never married or single	M = 39 weeks (SD = 2.4)	RCT	Socially disadvantaged/high risk families	MTB As above	Home-based
Slade et al. (2020), USA	Mothers in MTB (N = 77) or control group (N = 79)	67% Hispanic or Latino, 24% African American, 5% White, and 4% Other; 84% single or never married	MTB: M = 38.8 weeks (SD = 2.6)	RCT	Socially disadvantaged/high risk families	MTB As above	Home-based
Infant mental health home visiting (IMH-HV) – “the Michigan Model”
K. L. Rosenblum et al. (2020), USA	Mothers (N = 78)	55% White, 45% Black or African American, 4% American Indian or Alaskan Native, 5% Hispanic/Latina, 1% as Native Pacific Islander; low SES	M = 9.8 months (SD = 8.4); age ranges from prebirth to 24 months	Cohort	Socially disadvantaged/high risk families	IMH-HV 1–2 hour home visit/week by trained home visitor; pregnancy to 3 years	Home-based
Stacks et al. (2019), USA	Parents (N = 16)	75% Black; 68.8% female; 50% were in foster care as children; 43.8% had not completed high school; 81.3% single parents; low SES	M = 18.57 months (SD = 7.10); age ranges from 7 to 32 months	Cohort	Socially disadvantaged/high risk families	IMH-HV Weekly sessions with parent(s) and child(ren) and court IMH-HV therapist	Home-based
Stacks et al. (2022), USA	Parents (N = 75)	57.30% White, 42.70% Black; 77.33% not married; low SES	M = 9.64 months (SD = 8.39)	Cohort	Socially disadvantaged/high risk families	IMH-HV 1–2 hours of home visiting/week by trained home visitor; from pregnancy to 3 years.	Home-based
Developmental Individual-Difference, Relationship-Based/Floortime (DIR/FT)
Sealy and Glovinsky (2016), Barbados	fathers (N = 5) mothers (N = 33), grandmother (N = 1), aunt (N = 1)	45% high school, 32.5% university, 17.5% college, 5% primary school	Age ranges from 2 to 6 years 11 months	RCT	Child symptoms (neuro-developmental disability)	DIR/FT 24 hours of individual therapy with trained therapist over average of 12 weeks	Outpatient
The Clinician Assisted Videofeedback Exposure Session (CAVES)
Schechter et al. (2006), USA	Mothers (N = 32)	88% Hispanic, 12% African American; 61% immigrants; 52% had less than a high-school education; 75% received public assistance or were eligible for it; 67% single mothers	M = 32 months; age ranges from 8 to 50 months	Cohort	Parental mental health	CAVES Single session of video-feedback and semi-structured interview with clinician-researcher	Outpatient
Nurture And Play (Nap)
Salo et al. (2019), Finland	Mothers receiving NaP (N = 24) or TAU (N = 21)	NaP: 50% low educational level, 17.4% single	Age ranges from 1 to 12 months	RCT	Parental mental health	NaP 4 biweekly pregnancy groups + 7 weekly postnatal groups (1.5 hours each)	Outpatient
Mentalization Based Ultrasound Sessions
Jussila et al. (2021), Finland	Mothers (N = 90)	41% low SES	Prenatal	RCT	Parental substance abuse	Mentalization-based ultrasound 3 ultrasound sessions + mentalization focused diary	Outpatient
Lighthouse Parenting Program
Byrne et al. (2019), UK	Parents (N = 16)	88% white, 12% other; 81% unemployed	<2 years	Cohort	Socially disadvantaged/high risk families	Lighthouse Parenting Program. 20 weekly parent 90 min group sessions and 10 fortnightly 60 min individual MBT sessions.	Outpatient
DUET Parenting Model
Menashe-Grinberg et al. (2022), Israel	Mothers (N = 30)	28% low SES	M = 4.3 years; range 1–6 years	Cohort	Community sample	DUET 12 session group intervention	Outpatient
Attachment-Based Interventions
Banking Time
Williford et al. (2017), USA	Teachers (N = 183)	53% White, 41% Black, 6% other	M = 4 years; age ranges from 3 to 4 years (N = 470)	RCT	Community sample (schools)	Banking Time One-to-one meetings (10–15 minutes) between teacher and child, 2–3 times per week for 7 weeks.	School
Mom Power (MP)
Muzik et al. (2015), USA	Mothers (N = 99)	48.4% Caucasian, 44.1% African American, 7.5% biracial/Hispanic; 73% reported direct interpersonal trauma; low SES	M = 21.5 months (SD = 17.2)	Cohort	Parental mental health	MP 13 sessions (3 individual, 10 group) with trained community clinicians	Home-based
K. Rosenblum et al. (2018), USA	Mothers receiving MP (N = 42) or in the control group (N = 33)	31% White, 61.9% Black, 4.8% mixed, 2.4% other; over a half single; over a half exposed to interpersonal trauma; low SES	MP: M = 15.07 months (SD = 12.22);	RCT	Socially disadvantaged/high risk families	MP As above	Outpatient
Parental Training for Lone Mothers Guided By Educators (PALME)
Franz et al. (2011), Germany	Lone Mothers (N = 88)	Single mothers (unmarried, separated, or divorced); low SES	Age ranges from 3 to 6 years	RCT	Socially disadvantaged/high risk families	PALME 20 weekly group sessions (90 minutes)	Outpatient
Weihrauch et al. (2014), Germany	Lone Mothers intervention (N = 26) control (N = 35)	Single mothers (unmarried, separated, or divorced); about a half unemployed	Age ranges from 4 to 6 years	RCT	Socially disadvantaged/high risk families	PALME As above	Outpatient
Circle Of Security Parenting (CoS-P)
Huber et al., (2015a, 2015b), Australia	Biological parents (N = 73), foster or adoptive parents (N = 5), kinship carers (N = 5)	39% single parents; 24% from culturally or linguistically diverse backgrounds; 4% indigenous Australians	M = 47 months; age ranges from 13 to 88 months	Cohort	Community sample	COS 20 weekly parent group sessions of 90 minutes	Outpatient
Kohlhoff et al. (2016), Australia	Mother (N = 15)	100% married or in a relationship, 66% university or tertiary education; 50% moderate to high income	<24 months	Cohort	Community sample	COS-P 8 weekly parent group sessions, 90–120 minutes each.	Outpatient
Maupin et al. (2017), USA	Mothers (N = 117), other relatives (N = 14)	44% Hispanic, 29% Caucasian, 13% Black, 2% Asian, and 12% other; 60% low SES	M = 4.11 years; age ranges from 0 to 6 years	Cohort	Socially disadvantaged/high risk families	COS-P As above	Outpatient
Maxwell et al. (2021), Australia	Mothers (N = 221)	81% Australian; 67% high SES	<72 months	Controlled	Community sample	COS-P As above	Outpatient
Sadowski et al. (2022), Australia	Parents receiving GCCOS-P (N = 7) or IHCOS-P (N = 7)	71.4% single parents; 78.5% born in Australia; 71.4% had less than a university certificate	N/A	Cohort	Community sample	COS-P Group center-based (GCCOS-P)− 8 sessions; Individual home-based (IHCOS-P) 8–14 sessions)	Outpatient and home-based
Video-Feedback Intervention- Representations (VIPP-R)
Klein Velderman et al. (2006), Netherlands	Mothers (N = 55)	The majority are at low educational level	M = 6 months	Cohort	Community sample	VIPP (including VIPP-R) 4 home visits of 3 hours	Home-based
Dyadic/Triadic Psychodynamic/Psychoanalytic Psychotherapy
New Beginnings
Bain (2014), South Africa	Mothers receiving treatment (N = 16), control (N = 6)	Black population; low SES	Age ranges from 9 days to 2 years and 6 months	RCT	Socially disadvantaged/high risk families	New beginnings 12-session group parent-infant psychotherapy	Temporary accommodation
Sleed et al. (2013b), UK	Mothers receiving treatment (N = 88) or in the control group (N = 75)	Intervention group: 43.2% White, 42% Black, 4.8% Asian, 8% Mixed Control group: 68% White, 20% Black, 5.3% Asian, 5.3% Mixed, 1.3% Other	Intervention group: age ranges from 2 to 23 months, (M = 4.9, SD = 4.5)	RCT	Socially disadvantaged/high risk families	New beginnings 8-session group parent-infant psychotherapy delivered over 4 weeks	Temporary accommodation (prisons)
Child – Parent Psychotherapy (CPP)
Ghosh Ippen et al. (2011), USA	Mothers (N = 75)	38.7% mixed ethnicity (predominantly Latino/White), 28% Latino, 14.7% African American, 9.3% White, 6.7% Asian, and 2.6% other; low SES	Age ranges from 3 to 5 years old	RCT	Socially disadvantaged/high risk families	CPP Weekly mother-child sessions with therapist for 50 weeks.	Outpatient
Hagan et al. (2017), USA	Parents (N = 199)	54.0% Hispanic, 19.7% Caucasian, 9.1% African American, 7.6% Asian American, 5.6% multiracial, 3.5% other; low SES	M = 49.14 months	Cohort	Socially disadvantaged/high risk families	CPP Weekly hour-long mother-child sessions with therapist, average 21 sessions.	Outpatient
Lavi et al. (2015), USA	Mothers (N = 64)	86% Latina; low SES	<6 months	Cohort	Parental mental health	Perinatal CPP Weekly hour-long parent sessions antenatally, followed by weekly parent-infant sessions with therapist, average 27 sessions.	Outpatient
Lieberman et al (2005, 2006), USA	Mothers (N = 75)	38.7% mixed ethnicity (predominantly latino/white); 28% Latino; 14.7% African American; 9.3% white; 6.7% Asian; 2.6% other ethnicity; low SES	M = 4.06 years; age ranges from 3 to 5 years	Cohort	Socially disadvantaged/high risk families	CPP Weekly mother-child sessions with therapist for 50 weeks.	Outpatient
Paris et al. (2015), USA	Mothers (N = 66)	79% Caucasian, 17% African American, 22% Hispanic, 2% Native American, 1% Asian American; low SES	M = 21.05 months	Cohort	Parental substance abuse	CPP + additional support (Project BRIGHT) 6–22 sessions, 1–1.5 hours with therapist and mother-infant	Temporary accommodation (Residential treatment)
Toth et al. (2015), USA	Mothers receiving CPP (N = 44), PPI (N = 34), community services (N = 27), non-maltreated group (N = 52)	An ethnic minority, high-risk, and low-income population	M = 13.30 months (SD = 0.80)	RCT	Socially disadvantaged/high risk families	CPP Mother-child sessions with therapist over 12 months	Home-based
Stronach et al. (2013), USA	Mothers (N = 189)	74.6% from minority ethnic groups, 12.7% married. 79.4% maltreated when they were children, 89.9% experienced at least one traumatic event.	M = 13.31 months (SD = 0.81)	RCT	Socially disadvantaged/high risk families	CPP Weekly home visits for 12 months by a trained master’s level therapist	Home-based
Waters et al. (2015), USA	Pregnant women (N = 52)	86.5% Latina; 48.1% single, separated, or divorced; low SES	M = 6.57 months (SD = 0.72); age ranges from 4.53 to 8.28 months	Cohort	Socially disadvantaged/high risk families	CPP Average of 5 prenatal and 14 postnatal sessions with therapist	Outpatient
Zarnegar et al. (2016), USA	Adoptive caregivers (N = 16)	80% Caucasian	M = 35 months; age ranges from 10 to 53 months	Cohort	Child symptoms (fetal alcohol spectrum disorder)	CPP + mindful parenting education Twice weekly sessions with parent and child for 6–12 months	Outpatient
Toddler-Parent Psychotherapy (TPP)
Cicchetti et al. (1999), USA	Mothers (N = 63)	95% Caucasian; 74% high SES	M = 20.4 months	RCT	Parental mental health	TPP Joint mother-child sessions with therapist over approximately 12 months	Outpatient
Cicchetti et al. (2000), USA	Mothers (N = 158)	92.4% Caucasian; 73.4% high SES	M = 20.47 months	RCT	Parental mental health	TPP As above	Outpatient
Guild et al. (2021) & Toth et al. (2006), USA	Mothers with depression receiving TPP (N = 130),non-depressed (N = 68)	72.7% high SES; 54.5% college graduates; 92.9% European American ethnicity; 87.9% married.	M = 20.34 months (SD = 2.50)	RCT	Parental mental health	TPP As above	Outpatient
Parent/Mother – Infant Psychotherapy (PIP/MIP)
Fonagy et al. (2016), UK	Mothers (N = 76)	58% White; 40% low SES	<12 months	RCT	Parental mental health	PIP Joint mother-child sessions with therapist over approximately 12 months	Outpatient
Ransley et al. (2019), UK	Mothers (N = 61)	62% white British, 15% Black, 13% Asian, 7% Mixed-race, 3% Arabic; 57% low SES	M = 4.29 months	Observational	Parental mental health	PIP As above	Outpatient
Salomonsson and Sandell, 2011a, 2011b, 2015a, 2015b), Sweden	Mothers receiving MIP (N = 38) or CHCC (N = 37)	MIP: 11% immigrant; 5% single CHCC: 22% immigrant; 8% single	MIP: M = 4.4 months (SD = 2.4) CHCC: M = 5.9 months (SD = 3.8)	RCT	Parental mental health	MIP Average of 29 sessions with mother, infant and therapist	Outpatient
Tambelli et al. (2015), Italy	Intervention involving both parents (N = 22), and involving only the mother (N = 22)	88% middle SES; 92% intact family groups in which the child was the firstborn for both parents; 91% Caucasian; 71% more than one income	Age ranges from 3 to 12 months	RCT	Parental mental health	Relationship-based PIP with mother & baby or mother, father, and baby 15 hour-long sessions, twice a month	Outpatient
Dyadic Group Psychotherapy
Belt et al. (2012), Finland	Mothers (N = 101)	Low SES	<12 months	Cohort	Parental substance abuse	Mother-infant group psychotherapy 20–24 weekly 3-hour group sessions starting prenatally	Outpatient
de Camps Meschino et al. (2016), Canada	Mothers (N = 70)	92.3% married	Age ranges from 6 to 12 months	Cohort	Parental mental health	Mother-infant dyadic group therapy 12 weekly 2-hour group sessions	Outpatient
Sleed et al., (2013a), UK	Mothers in the PIP Hostel (N = 30) or in the Comparison Hostel (N = 29)	32.2% White, 39% Black, 25.4% Asian, 3.4% Other ethnicity; 57.7% GCSE or less, 7.7% high school, 21.2% NVQ; 13.5% higher education	PIP Hostel: M = 7.5 months (SD = 3.9); comparison group: M = 9.4 months (SD = 4.7)	Controlled	Socially disadvantaged/high risk families (Homeless)	PIP group Weekly drop-in parenting group in homeless hostel, facilitated by parent-infant psychotherapist	Temporary accommodation
Brief Mother/Parent – Infant Psychotherapy (Brief-MIP/PIP)
Cohen et al. (1999), Canada	Mothers receiving PIP (N = 33) or WWW (N = 34)	Low-medium SES	M = 21 months	Controlled	Child symptoms OR parental mental health (Functional and behavioral disturbances)	Brief PIP & Watch, Wait & Wonder Average 14–15 weekly 1-hour sessions with parent, infant and therapist	Outpatient
Cohen et al. (2002), Canada	Mothers receiving PIP (N = 31) or WWW (N = 26)	Low-medium SES	Age ranges from 10 to 30 months	Controlled	Child symptoms OR parental mental health (Functional and behavioral disturbances)	Brief PIP & Watch, Wait & Wonder As above	Outpatient
Cramer et al. (1990), Italy	Mothers (N = 38)	22% professional, 41% employed, 35% laborers	<30 months	RCT	Child symptoms (Functional and behavioral disturbances)	Brief-MIP Up to10 one-hour sessions with parent-infant and therapist	Outpatient
Georg et al. (2021), Germany	Mothers (N = 154)	86.36% German origin; 77.92% married; 73.37% had high school or higher education	Age ranges from 4 to 15 months	RCT	Child symptoms (Early regulatory disorders)	Focused- PIP One 90-minute session and three 50-minute sessions with one or both parents and infant	Outpatient
Murray et al. (2003), UK	Mothers (N = 193)	30% low SES	<18 weeks	RCT	Parental mental health	Brief psychodynamic psychotherapy 10 weekly sessions with trained therapist	Home-based
Nanzer et al. (2012), Switzerland	Mothers receiving PCP (N = 40) or in the control group (N = 88)	16% non-European origin in the treatment group and 8% in the control group; 68% employed in treatment group and 83% in the control group	<6 months	Cohort	Parental mental health	Psychotherapy centered on parenthood (PCP) 4 individual sessions- two antenatal and two postnatal	Outpatient
Pozzi-Monzo et al. (2012), UK	Mothers (N = 7), fathers (N = 7)	N/A	M = 45 months	Cohort	Child symptoms (Referred to CAMHS)	Brief -MIP Up to 5 weekly sessions with mother, infant and therapist	Outpatient
Robert-Tissot et al. (1996), France	Mothers (N = 75)	Majority Caucasian; 58% medium-high SES	M = 15.6 months	Cohort	Parental mental health	Brief-MIP Average 5–6 weekly sessions with mother, infant and therapist	Outpatient
B. Salomonsson et al. (2021), Sweden	SPIPIC: mothers (N = 100), fathers (N = 59) Norm group: mothers (N = 81), fathers (N = 60)	SPIPIC: 14% immigrant; M = 15 (SD = 2.8) education years Norm group: 6% immigrant; M = 15 (SD = 2.5) education years	SPIPIC: Range 1 to 23 months, mean 4.8 months (SD = 4.5)	Controlled	Parental mental health	Short-term Psychodynamic Infant – Parent Interventions at Child Health Centers (SPIPIC) 4 weekly or biweekly 45-minute therapy sessions with mother and (optionally) infant and/or father	Outpatient
Other Psychodynamic/Psychoanalytic Psychotherapies
Kurzweil (2008b), USA	Mothers (N = 14)	99% Caucasian; 100% lower to upper middle-class SES	Age ranges from 5 months to 3 years	Cohort	Parental mental health	PLAYSPACE Open-ended, minimum 6 months of bi-monthly sessions, parallel parent group and infant group	Outpatient
Kurzweil (2008a), USA	Mothers (N = 49)	Majority are Caucasian; middle-class SES	<6 months	Cohort	Parental mental health	Relational-Developmental psychodynamic therapy Open-ended, minimum 6 months of bi-monthly sessions, parallel parent and infant group	Outpatient
Kurzweil (2012), USA	Mothers (N = 58)	70% Caucasian; middle-class SES	<7 years	Cohort	Parental mental health	Psychodynamic therapy Psychotherapy for mother; Average 4 hours/month over average of 17 months	Outpatient
Lowell et al. (2011), USA	Mothers (N = 157)	57% Latino, 32% African American, 9% Caucasian, 1% Other; 65% unemployed	Age ranges from 6 to 36 months	RCT	Child symptoms (social/emotional/behavioral problems)	Child FIRST Weekly visits from clinician and/or care coordinator, average 22 weeks	Home-based
Müller et al. (2015), Germany	Mothers (N = 185)	30.9% completed 9 years of secondary school, 39.7% completed 10 years of secondary school, and 24.3% completed 12–13 years of school	M = 4.33 years	Cohort	Child symptoms (Children with psychiatric disorders)	Multi-modal behavioral and psychodynamic treatment Average 51 treatment days, delivered in intensive 3 day blocks	Outpatient
Rosen et al. (1994), USA	N/A	All Caucasian and from middle- or upper-middle-class families	Age ranges from 4 to 6 years (N = 14)	RCT	Community sample	Psychodynamic child psychotherapy Weekly 30-minute session with child and therapist for 8 weeks	Outpatient
Target and Fonagy (1994), UK	Not reported	Not reported	Age ranges from 2 to 5.11 years (N = 127)	Cohort	Child symptoms (Children with mental health problems)	Child psychotherapy Delivered 1–5 times/week for an average of 1.6 years.	Outpatient
Thome and Skuladottir (2005), Iceland	Mothers (N = 33), fathers (N = 30)	15.2% mothers worked full-time outside the 83.3% fathers worked full-time outside the home	Age ranges from 6 to 23 months (N = 33)	Cohort	Child symptoms (Infant sleep disorders)	Family-centered intervention for infant sleep 4 sessions (2–3 hours each) delivered by pediatric nurses	Inpatient

Table 2. Summary of the outcomes by grouped by intervention model description.

Author, country	Intervention effectiveness of pre-post intervention in the treatment group							Moderator	Mediator
	PRF	Parent-infant interaction	Parental depression	Infant Attachment	Parenting Stress	Infant social-emotional-behavioural	Infant development
Mentalization Based Interventions
Attachment & Child Health (Attach)
Anis et al. (2020) and N. Letourneau et al. (2020), Canada	“+”	“+”	“0”	“0”	n/a	n/a	“+”	n/a	n/a
Mothering From The Inside Out (MIO)/Mothers And Toddlers Program (MTP)
N. Suchman et al. (2008), USA	“+”	“0”	n/a	n/a	n/a	n/a	n/a	n/a	n/a
N. E. Suchman et al (2010, 2011, 2012), USA	“+”	“+”	n/a	n/a	n/a	n/a	n/a	n/a	Maternal Reflective Functioning
N. E. Suchman et al. (2016), USA	“+”	“0”	“+”	n/a	“+”	n/a	n/a	n/a	n/a
N. E. Suchman et al. (2017), USA	“+”	“+”	n/a	“0”	n/a	n/a	“0”	Addiction severity	n/a
Minding The Baby
Condon et al. (2022), USA	“n/r”	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Ordway et al. (2014), USA	“0”	n/a	“0”	n/a	n/a	“+”	n/a	n/a	n/a
Ordway et al. (2018), USA	“0”	n/a	“0”	n/a	“0”	n/a	n/a	n/a	n/a
Sadler et al. (2013), USA	“+”	“+” (teen mothers only)	“0”	“+”	n/a	n/a	n/a	n/a	n/a
Slade et al. (2020), USA	“n/r”	“n/r”	“n/r”	“n/r”	n/a	n/a	n/a	Disrupted communication	n/a
Infant Mental Health Home Visiting (IMH-HV) – “The Michigan Model”
K. L. Rosenblum et al. (2020), USA	“+”	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Stacks et al. (2019), USA	“+”	“+ partial”	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Stacks et al. (2022), USA	n/a	“0”	n/a	n/a	n/a	n/a	“+”	n/a	n/a
Developmental Individual-Difference, Relationship-Based/Floortime (DIR/FT)
Sealy and Glovinsky (2016), Barbados	“+”	n/a	n/a		n/a	n/a	n/a	n/a	n/a
The Clinician Assisted Videofeedback Exposure Session (CAVES)
Schechter et al. (2006), USA	n/a	n/a	n/a	n/a	n/a	n/a	n/a	Higher baseline RF associated with better outcomes	n/a
Nurture And Play (Nap)
Salo et al. (2019), Finland	“+”	“+”	“+”	n/a	n/a	n/a	n/a	n/a	n/a
Mentalization Based Ultrasound Sessions
Jussila et al. (2021), Finland	n/r	n/a	n/r	n/a	n/a	n/a	n/a	n/a	n/a
Duet Parenting Model
Menashe-Grinberg et al. (2022), Israel	“+”	“+”	n/a	n/a	n/a	“+”	n/a	SES, child sex, and parental well-being	n/a
Lighthouse Parenting Program
Byrne et al. (2019), UK	“0”	“0”	“0”	n/a	“+”	n/a	n/a	n/a	n/a
Attachment Based Interventions
Banking Time
Williford et al. (2017), USA	n/a	“+”	n/a	n/a	n/a	“+”	n/a	n/a	Quality of the teacher – child interactions
Mom Power (MP)
Muzik et al. (2015), USA	“+”	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a
K. Rosenblum et al. (2018), USA	“+”	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Parental Training For Lone Mothers Guided By Educators (PALME)
Franz et al. (2011), Germany	n/a	n/a	n/a	n/a	n/a	“+”	n/a	n/a	n/a
Weihrauch et al. (2014), Germany	n/a	n/a	n/r	n/a	n/a	n/r	n/a	n/a	n/a
Circle Of Security Parenting (CoS-P)
Huber et al., (2015a, 2015b), Australia	“+”	n/a	n/a	“+”	n/a	n/a	n/a	baseline presenting problems	n/a
Kohlhoff et al. (2016), Australia	“0”	n/a	n/a	n/a	“+”	n/a	n/a	n/a	n/a
Maupin et al. (2017), USA	“0”	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a
Maxwell et al. (2021), Australia	“+”	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a
Sadowski et al. (2022), Australia	“+”	n/a	n/a	n/a	“+”	n/a	n/a	n/a	n/a
Video-Feedback Intervention- Representations (VIPP-R)
Klein Velderman et al. (2006), Netherlands	n/a	n/r	n/a	n/r	n/a	n/r	n/a	n/a	Maternal Sensitivity
Dyadic/Triadic Psychodynamic/Psychoanalytic Psychotherapy
New Beginnings
Bain (2014), South Africa	“0”	“+”	“-“	n/a	n/a	n/a	“+”	n/a	n/a
Sleed et al., (2013b), UK	“+”	“+ partial”	“0”	n/a	n/a	n/a	n/a	n/a	n/a
Child – Parent Psychotherapy (CPP)
Ghosh Ippen et al. (2011), USA	n/a	n/a	n/a	n/a	n/a	“+”	n/a	n/a	n/a
Hagan et al. (2017), USA	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Lavi et al. (2015), USA	n/a	n/a	“+”	n/a	n/a	n/a	n/a	Maternal-fetal attachment, dosage	n/a
Lieberman et al (2005, 2006), USA	n/a	n/a	n/a	n/a	n/a	“+”	n/a	n/a	n/a
Paris et al. (2015), USA	“+ partial”	n/a	n/a	n/a	n/a	“+ partial	n/a	n/a	n/a
Toth et al. (2015), USA	n/a	n/a	n/a	n/a	“+”	n/a	n/a	n/a	n/a
Stronach et al. (2013), USA	n/a	n/a	n/a	“+”	n/a	“0”	n/a	n/a	n/a
Waters et al. (2015), USA	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Zarnegar et al. (2016), USA	n/a	n/a	n/a	n/a	“+”	n/a	“+”	n/a	n/a
Toddler-Parent Psychotherapy (TPP)
Cicchetti et al. (1999), USA	n/a	n/a	“+”	“+”	n/a	n/a	n/a	n/a	n/a
Cicchetti et al. (2000), USA	n/a	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a
Toth et al. (2006) & Guild et al. (2021), USA	n/a	n/a	“+”	“+”	n/a	n/a	n/a	n/a	n/a
Parent/Mother – Infant Psychotherapy (PIP/MIP)
Fonagy et al. (2016), UK	“0”	“0”	“+”	“0”	“+”	n/a	“0”	n/a	n/a
Ransley et al. (2019), UK	“+”	“+”	“0”	n/a	“0”	n/a	n/a	n/a	Treatment expectations
Salomonsson and Sandell, (2011a, 2011b, 2015a, 2015b), Sweden	n/a	“+”	“+”	n/a	“0”	“0”	n/a	Infant and maternal types	n/a
Tambelli et al. (2015), Italy	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Dyadic Group Psychotherapy
Belt et al. (2012), Finland	n/a	“+”	“+”	n/a	n/a	n/a	n/a	n/a	n/a
de Camps Meschino et al. (2016), Canada	n/a	n/a	“+”	n/a	“0”	n/a	n/a	n/a	n/a
Sleed et al., (2013a), UK	n/a	“0”	n/a	n/a	n/a	n/a	“+”	n/a	n/a
Brief Mother/Parent – Infant Psychotherapy (Brief-MIP/PIP)
Cohen et al. (1999), Canada	n/a	“+”	“+”	“+”	“+”	n/a	“+”	n/a	n/a
Cohen et al. (2002), Canada	n/a	“+”	“+”	“+”	“+”	n/a	“+”	n/a	n/a
Cramer et al. (1990), Italy	n/a	“+”	“+”	n/a	n/a	n/a	n/a	n/a	n/a
Georg et al. (2021), Germany	“0”	“0”	“+”	n/a	“+”	n/a	n/a	n/a	n/a
Murray et al. (2003), UK	n/a	“+”	n/a	“0”	n/a	n/a	“0”	n/a	n/a
Nanzer et al. (2012), Switzerland	n/a	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a
Pozzi-Monzo et al. (2012), UK	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Robert-Tissot et al. (1996), France	n/a	“+”	n/a	n/a	n/a	n/a	n/a	n/a	n/a
B. Salomonsson et al. (2021), Sweden	n/a	n/a	“+”	n/a	n/a	“+”	n/a	n/a	n/a
Other Psychodynamic/Psychoanalytic Psychotherapies
Kurzweil (2008a), USA	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Kurzweil (2008b), USA	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Kurzweil (2012), USA	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Lowell et al. (2011), USA	n/a	n/a	“+”	n/a	“+”	“+”	n/a	n/a	n/a
Müller et al. (2015), Germany	n/a	n/a	n/a	n/a	n/a	“+”	n/a	n/a	n/a
Rosen et al. (1994), USA	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Target and Fonagy (1994), UK	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a	n/a
Thome and Skuladottir (2005), Iceland	n/a	n/a	“0”	n/a	“+”	n/a	n/a	n/a	n/a

“+” = Statistically significant improvement over time; “0” = No or Mixed effect over time; “–“ = Statistically significant deterioration over time; “n/r” = Outcome collected but pre-post data not reported; “n/a” = Outcome in this domain not collected.

Figure 2. Forest plot of comparison: intervention vs control group on parental reflective functioning.

Figure 3. Forest plot of comparison: intervention vs control group on maternal depression.

Figure 4. Forest plot of comparison: intervention vs control group on infant behaviour.

Figure 5. Forest plot of comparison: intervention vs control group on infant attachment security.

Figure 6. Forest plot of comparison: intervention vs control group on parent-infant interaction.

Figure 7. Forest plot of comparison: intervention vs control group on parental stress.

Table 3. Quality assessment of controlled intervention studies**.

Author, country	Item*														Quality Rating
	1	2	3	4	5	6	7	8	9	10	11	12	13	14
MENTALIZATION BASED INTERVENTIONS
Anis et al. (2020) and N. Letourneau et al. (2020)	Y	Y	Y	N	Y	Y	Y	Y	NR	Y	Y	NR	Y	Y	Poor
N. E. Suchman et al (2010, 2011, 2012), USA	Y	Y	Y	N	Y	NR	Y	Y	Y	Y	Y	NR	Y	NR	Poor
N. E. Suchman et al. (2017), USA	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	NR	Y	Y	Good
Ordway et al. (2014), USA	Y	Y	Y	N	Y	N	Y	Y	NR	Y	Y	NR	Y	NR	Fair
Ordway et al. (2018), USA	Y	Y	Y	N	NA	Y	N	Y	NR	Y	Y	NR	Y	Y	Fair
Sadler et al. (2013), USA	Y	Y	Y	N	Y	Y	N	Y	NR	Y	Y	NR	Y	NR	Fair
Slade et al. (2020), USA	Y	Y	Y	N	Y	Y	N	Y	Y	Y	Y	NR	Y	Y	Fair
Sealy and Glovinsky (2016), Barbados	Y	Y	Y	N	Y	Y	Y	Y	NR	Y	Y	NR	NR	NR	Fair
Salo et al. (2019), Finland	Y	Y	Y	N	NR	Y	Y	Y	NR	Y	Y	NR	Y	NR	Poor
Jussila et al. (2021), Finland	Y	Y	Y	N	NR	Y	Y	Y	NR	Y	Y	NR	Y	Y	Good
ATTACHMENT BASED INTERVENTIONS
Steele et al. (2019), USA	Y	Y	Y	N	Y	Y	N	Y	Y	Y	Y	Y	Y	NR	Fair
Williford et al. (2017), USA	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Good
K. Rosenblum et al. (2018), USA	Y	Y	Y	N	Y	Y	N	Y	Y	Y	Y	N	Y	NR	Fair
Franz et al. (2011), Germany	Y	Y	Y	N	NR	N	N	N	Y	Y	Y	NR	N	Y	Poor
Weihrauch et al. (2014), Germany	Y	Y	Y	N	Y	N	N	N	Y	Y	Y	N	Y	NR	Fair
Maxwell et al. (2021), Australia	N	N	N	N	N	N	N	N	Y	Y	Y	NR	Y	N	Fair
DYADIC/TRIADIC PSYCHODYNAMIC/PSYCHOANALYTIC PSYCHOTHERAPY
Bain (2014), South Africa	Y	N	N	N	N	Y	N	N	N	NR	Y	N	NR	N	Poor
Sleed et al., (2013b), UK	Y	Y	N	N	Y	N	N	N	NR	Y	Y	NR	NR	Y	Fair
Lieberman et al (2005, 2006). & Ghosh Ippen et al. (2011), USA	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Fair
Toth et al. (2015), USA	Y	Y	Y	N	NR	Y	Y	Y	Y	Y	Y	NR	Y	Y	Good
Cicchetti et al. (1999), USA	Y	Y	Y	N	Y	N	N	N	Y	Y	Y	NR	Y	NR	Fair
Cicchetti et al. (2000), USA	N	Y	Y	N	Y	Y	N	N	Y	Y	Y	NR	Y	NR	Fair
Toth et al. (2006) & Guild et al. (2021), USA	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	NR	Y	Y	Good
Fonagy et al. (2016), UK	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Fair
Georg et al. (2021), Germany	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Good
Sleed et al., (2013a), UK	N	N	N	N	Y	Y	Y	Y	NR	Y	Y	NR	Y	NR	Poor
Cramer et al. (1990), Italy	N	N	N	N	N	Y	Y	Y	NR	Y	Y	NR	N	NR	Poor
Salomonsson and Sandell, (2011a, 2011b, 2015a, 2015b), Sweden	Y	Y	Y	N	Y	NR	Y	Y	Y	Y	Y	NR	Y	Y	Fair
B. Salomonsson et al. (2021), Sweden	N	N	N	N	N	N	Y	Y	N	Y	Y	NR	N	NR	Poor
Lowell et al. (2011), USA	Y	Y	Y	N	N	Y	Y	Y	Y	Y	Y	NR	Y	Y	Good
Murray et al. (2003), UK	N	Y	Y	N	Y	NR	Y	Y	NR	Y	Y	NR	Y	NR	Good
Rosen et al. (1994), USA	N	Y	Y	N	Y	NR	Y	Y	Y	Y	Y	NR	N	NR	Poor
Cohen et al (1999, 2002), Canada	N	Y	Y	N	Y	Y	Y	Y	NR	Y	Y	NR	Y	N	Fair

* Items for Quality Assessment of Controlled Intervention Studies.

• 1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?

• 2. Was the method of randomization adequate (i.e., use of randomly generated assignment)?

• 3. Was the treatment allocation concealed (so that assignments could not be predicted)?

• 4. Were study participants and providers blinded to treatment group assignment?

• 5. Were the people assessing the outcomes blinded to the participants’ group assignments?

• 6. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

• 7. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

• 8. Was the differential drop-out rate (between treatment groups) at endpoint 15% points or lower?

• 9. Was there high adherence to the intervention protocols for each treatment group?

• 10. Were other interventions avoided or similar in the groups (e.g., similar background treatments)

• 11. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

• 12. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?

• 13. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

• 14. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?

**Y = Criterion met; N = Criterion not met; CD = cannot determine; NA = not applicable; NR = not reported.

Table 4. Quality assessment** for pre-post studies with no control group.

Author, country	Item*												Quality Rating
	1	2	3	4	5	6	7	8	9	10	11	12
MENTALIZATION BASED INTERVENTIONS
N. Suchman et al. (2008), USA	Y	Y	Y	Y	N	N	Y	NR	N	Y	N	N/A	Poor
N. E. Suchman et al. (2016), USA	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	N	N/A	Poor
K. L. Rosenblum et al. (2020), USA	Y	Y	Y	N	Y	Y	Y	N	N	Y	N	N/A	Good
Stacks et al. (2019), USA	Y	Y	Y	Y	N	Y	Y	N	NR	Y	N	N/A	Poor
Stacks et al. (2022), USA	Y	Y	Y	N	Y	Y	Y	Y	NR	Y	N	N/A	Good
Schechter et al. (2006), USA	Y	Y	Y	N	N	Y	Y	NR	NR	Y	N	N/A	Fair
Byrne et al. (2019), UK	Y	Y	Y	NR	N	Y	Y	Y	NR	Y	N	N/A	Fair
Menashe-Grinberg et al. (2022), Israel	Y	N	Y	NR	Y	Y	Y	Y	NR	Y	N	Y	Fair
ATTACHMENT BASED INTERVENTIONS
Muzik et al. (2015), USA	Y	Y	Y	N	Y	Y	Y	Y	NR	Y	N	Y	Good
Kohlhoff et al. (2016)	Y	Y	Y	Y	N	Y	Y	NR	Y	Y	N	N/A	Poor
Klein Velderman et al. (2006), Netherlands	Y	Y	Y	NR	Y	Y	Y	Y	NR	Y	N	N/A	Good
Huber et al., (2015a, 2015b), Australia	Y	Y	Y	NR	Y	Y	Y	Y	Y	Y	N	N/A	Good
Maupin et al. (2017), USA	Y	N	N	NR	Y	Y	Y	NR	NR	Y	N	N/A	Fair
Sadowski et al. (2022), Australia	Y	Y	Y	NR	N	Y	Y	Y	NR	NR	Y	N/A	Fair
PSYCHODYNAMIC/PSYCHOANALYTIC PSYCHOTHERAPY
Hagan et al. (2017), USA	Y	Y	Y	Y	Y	Y	Y	NR	NR	Y	N	N/A	Good
Lavi et al. (2015), USA	Y	Y	Y	NR	Y	Y	Y	NR	NR	Y	Y	N/A	Good
Lieberman et al (2005, 2006), USA	Y	Y	Y	NR	Y	Y	Y	Y	NR	Y	Y	N/A	Good
Paris et al. (2015), USA	Y	N	Y	NR	Y	Y	Y	NR	NR	NR	Y	N/A	Fair
Waters et al. (2015), USA	Y	Y	Y	N	N	Y	Y	NR	NR	Y	N	N/A	Good
Zarnegar et al. (2016), USA	Y	Y	Y	N	N	Y	Y	Y	NR	Y	N	N/A	Poor
Ransley et al. (2019), UK	Y	Y	Y	Y	Y	Y	Y	NR	NR	Y	Y	N/A	Good
Belt et al. (2012), Finland	Y	N	Y	NR	N	Y	Y	Y	NR	Y	N	N/A	Good
de Camps Meschino et al. (2016), Canada	Y	Y	Y	NR	N	Y	Y	NR	NR	Y	Y	N	Fair
Nanzer et al. (2012), Switzerland	Y	Y	Y	NR	N	Y	Y	NR	NR	Y	N	N/A	Fair
Pozzi-Monzo et al. (2012), UK	Y	Y	Y	Y	Y	Y	Y	NR	NR	Y	Y	N/A	Good
Robert-Tissot et al. (1996), France	Y	N	Y	NR	Y	Y	Y	Y	NR	Y	Y	N/A	Good
Kurzweil (2008b), USA	Y	N	Y	NR	Y	Y	Y	NR	NR	Y	N	N	Good
Kurzweil (2008a), USA	Y	N	Y	NR	Y	Y	Y	NR	NR	Y	N	N	Good
Kurzweil (2012), USA	Y	N	Y	NR	Y	Y	Y	NR	NR	Y	N	N	Good
Müller et al. (2015), Germany	Y	Y	Y	NR	Y	Y	Y	NR	NR	Y	Y	N/A	Good
Target and Fonagy (1994), UK	Y	Y	Y	N	Y	Y	Y	NR	NR	Y	Y	N/A	Good
Thome and Skuladottir (2005), Iceland	Y	Y	Y	NR	N	Y	Y	NR	NR	Y	N	N/A	Good

* Items for Quality Assessment Tool for Pre-Post Studies with No Control Group.

• 1. Was the study question or objective clearly stated?

• 2. Were eligibility/selection criteria for the study population prespecified and clearly described?

• 3. Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?

• 4. Were all eligible participants that met the prespecified entry criteria enrolled?

• 5. Was the sample size sufficiently large to provide confidence in the findings?

• 6. Was the test/service/intervention clearly described and delivered consistently across the study population?

• 7. Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?

• 8. Were the people assessing the outcomes blinded to the participants’ exposures/interventions?

• 9. Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?

• 10. Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?

• 11. Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention (i.e., did they use an interrupted time-series design)?

**Y = Criterion met; N = Criterion not met; CD = cannot determine; NA = not applicable; NR = not reported.

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