Abstract
Developmental research has shown that there are multiple pathways to positive mental health outcomes. Mainstream research on attachment and early triadic relationships has identified a number of early relational factors that appear to be highly correlated with later mental health parameters. However, as the social rules of relational life in Western industrialized countries become more diverse, young children may be conceived and born under diverse and different conditions. Furthermore, from a global perspective, there is a wide variety of social and cultural conditions under which young children grow up in different parts of the world. On the one hand, a culturally sensitive approach to infant mental health means looking at the diverse pathways to mental health rather than insisting on received wisdom about what kind of early relationships are ideal for the infant. On the other hand, we cannot accept cultural arbitrariness in the sense that all cultural practices are acceptable in terms of child development. I will explore this tension between acceptable diversity and unacceptable arbitrariness by looking at modern reproductive medicine, culturally different definitions of child maltreatment, and young children growing up in violent and neglectful environments.
Introduction
In the year 20 B.C., the Roman Emperor Augustus had a column erected in the Forum Romanum on which were written the names of all the capitals of the Roman provinces. As “curator viarum” (in charge of road construction), he wanted to connect all the provinces to Rome, which was the center of the Roman Empire. Probably based on this inscription, the phrase “Mille viae ducunt hominem per saecula Romam” (A thousand roads lead men forever to Rome) was created. Centuries later, Jean de La Fontaine took up this phrase in his fable “Juge Arbitre” (the arbitrator) and formulated: “Tous chemins vont à Rome.” (All roads lead to Rome).
In our field, scientists and clinicians are searching for pathways that lead diverse individuals from the early relational circumstances into which they are born to positive mental health outcomes. “Developmental psychopathologists have argued that there are multiple contributors to adaptive or maladaptive outcomes in any individual, that these factors and their relative contributions vary across individuals, and that there are myriad pathways to any particular manifestation of adaptive or disordered behavior.” (Cicchetti & Rogosch, 1996, p. 597)
“Equifinality refers to the observation that in any open system, a variety of pathways (…) can lead to the same outcome. In an open system, the same end state (e.g., healthy mental development) can be reached from a variety of different starting conditions and by different processes.” (Cicchetti & Rogosch, 1996, p. 597) Mulitifinality, on the other hand, means that the same environmental condition (e.g., an adverse social event) does not necessarily lead to the same psychopathological or non-psychopathological outcome in every individual. (……) Equifinality also encompasses psychological, biological, and environmental contextual processes that lead to diverse, resilient pathways to unexpected competencies, even when the starting point of development was adversity, such as experiences of childhood maltreatment. (Cicchetti & Blender, 2006)
The notion of equifinality, which I think is very important, leads to a number of methodological challenges. For example, a certain relational constellation, let’s say the presence of a caring and loving mother in the first year of life, is highly correlated with the ability of individuals to cope with later life crises in adulthood. We are accustomed to saying: the early condition predicts a later capacity. But unless the correlation is 100% (and such correlations never occur in our studies), there seem to be other pathways to this capacity. Thus, when we encounter other family constellations or cultural situations in which the presence of the mother during the first year of life is not guaranteed, we can only say that this may be a risk factor for the majority of babies in a given cultural context, but we need to look for other individual and contextual parameters that may also lead to healthy pathways. This nuanced view of early relationships is often lost in our clinical application of scientific knowledge.
This attention to the diversity of origins, processes, and outcomes in understanding developmental pathways should not lead to an assumption of arbitrariness about what is beneficial or harmful in child development. “There are limits to how much diversity is possible, and not all outcomes are equally likely.” (Cicchetti & Rogosch, 1996, p. 598) Many, but not all, roads lead to Rome. As clinicians and early childhood mental health professionals, we need to assess not which road is the best, but which roads lead to the destination, even if they take detours or overcome difficult obstacles, and which ones do not. What works for whom? Which path might work for which specific baby in a given cultural, social, and familial situation? What alternative paths, contrary to our established beliefs, also work and lead to favorable outcomes? And where are the limits of multiple pathways and diversity? In what situations do we need to intervene?
I will start with our well-established knowledge about development.
Dyadic aspects of early childhood
In the 1950s, a number of important pioneers, many of them from the field of psychoanalysis, began to question the customary way of dealing with babies at that time in Western societies. For example, René Spitz, an Austrian psychoanalyst, who began to observe babies in a systematic, empirical way especially later in his career in Denver, Colorado, found that babies in nurseries who were deprived of a continuously emotionally attuned caregiver developed severe forms of infant depression (ananclitic depression), findings that later led to a dramatic change in baby care practices in most Western industrialized countries. Many others, such as the Robertsons, Margret Mahler, Serge Lebovici, Robert Emde, to name but a few, came to similar conclusions. In modern times, the Romanion orphanage study has shown, in a rather systematic way of modern empirical research, that infants without a continuously attached caregiver are at risk to develop severe early psychopathological disorders, which can only be cured or limited if the relational conditions in which they live are changed for the better in time by placing them in healthy foster families. Another pioneer, John Bowlby, not only contributed his own careful scientific observations, but also developed his systematic evolutionary theory of attachment, which has been widely accepted and led to a scientifically useful operationalization of early mother-infant interaction patterns by Marie Ainsworth, which then became the basis of an almost exploding branch of attachment research.
The Pediatrician and psychoanalyst Donald Winnicott has opened our minds to a more dynamic view of the relationship between an infant’s early environment and his or her individual development. Since the human infant, in contrast to the offspring of many other species, seems to be born quasi prematurely in a state of almost complete helplessness, he or she is initially dependent on an almost perfect environment, in Winnicott’s words, on a perfect mother who is in an almost psychotic state in which she can anticipate and feel all the baby’s needs in order to satisfy them immediately. “There is no such thing as an infant” is one of the most famous quotations from Winnicott’s rich oeuvre. “Wherever there is an infant one finds maternal care, and without maternal care there would be no infant” (Winnicott, 1960, p.39)
The implication of this statement could be that babies need perfect mothers for their growth, or in other words, a perfect environment. This statement often shapes our attitudes toward the hypothetical early mother-infant dyad and, unfortunately, the expectations of many, especially first-time mothers. But we have to realize that the perfect mother or the perfect environment does not exist. If we observe very early mother-infant interactions, we soon realize that the periods of seemingly perfect harmony are relatively short, while longer periods of interaction are often characterized by misinterpretations of the baby’s states, misunderstandings, over- or under-stimulation by the mother. Beebe, Lachmann, and Jaffe’s (1997) micro-analyses of early interactions have alerted us to the importance of disruptions and subsequent repair in early interactions for the infant’s emotional development. Winnicott (1954) draws the following conclusions from similar observations. A mother, an environment, cannot be perfect, only “good enough”. This may be frustrating or disappointing for the baby at times, but the discrepancy between a perfect and a good enough environment also implies an impulse for the infant’s emotional development: he or she is forced to bridge the gap between the perfect and the good enough. This bridging activity is the starting point for the development of mental activity: thinking, the creation of internal representations of the self and the other, or, more importantly, representations of the relationship between the self and the other, the ability to calm oneself, to respond to frustration, the construction of emotionally rooted concepts of the other’s mind (mentalization) etc.
Triadic aspects of early childhood
But what about fathers, grandparents, siblings, etc.? Could it not be that the baby’s relational experiences with several different caregivers support developmental progress, especially if the interactional styles of these caregivers are different from one another? Or could the baby be overwhelmed by a disintegration of the relational context? In a landmark study, Feldmann examined 100 couples and their first-born five-year-old infants by videotaping them in face-to-face interactions. Parents’ and infants’ affective states were coded in one-second frames, and synchrony was measured with time-series analysis. The direction, intensity, and temporal pattern of infant arousal were assessed. The results demonstrated “that fathers and mothers are equally capable of engaging in second-by-second synchrony with their infant, suggesting that mothers are not unique in their ability to match microshifts in infant affect. Each parent, however, seems to offer infants different experiences and practice in affective sharing and arousal regulation. Mothers offer the coordination of socially oriented affective signals, and fathers offer the management of high-intensity turns in positive arousal.”(Feldman, 2003, p. 16)
In our own research group, we have tried to broaden our view of early relationships by moving from studying early dyads (mostly mother-child) to early triads (mostly mother-father-child). In several longitudinal studies with data assessment points from pregnancy through middle childhood, we have assessed the predictive value of parental triadic representations on the child’s emotional and relational functioning. Can the mother anticipate to involve the father in her relationship with her offspring. And can the father anticipate to play an important role in the life of his young child without excluding or devaluing the mother? By asking these questions, we sought to overcome the old traditional views of Western bourgeois societies (“; “babies are the mother’s business”;”the father does not matter in the first year”) and open the field to a broader, multi-person view of early childhood.
As a central concept, we defined triadic capacity (Klitzing, 2014) in the context of parenthood as the ability of fathers and mothers to anticipate their future family relationships without excluding themselves or their partners from the relationship with the infant.
We found the following longitudinal relationships:
- Mothers’ and fathers’ Triadic Capacity, assessed in a prenatally administered semi-structured interview, was associated with the quality of triadic interactions (assessed using the Lausanne Triadic Play Paradigm) (Klitzing, Simoni, & Bürgin, 1999).
- The higher the prenatal Triadic Capacity of the father, the more the four-month-old baby was able to establish a balanced contact with both parents when both parents played with him/her (phase three in the LTP) (Klitzing, Simoni, Amsler, & Burgin, 1999).
- The children of parents with high Triadic Capacities (measured during pregnancy) had fewer behavioral problems at age 4 and were able to tell more coherent stories with more positive themes in a Story Stem task compared to their peers of parents with low Triadic Capacities (Klitzing & Burgin, 2005).
- Finally, parental Triadic Capacities, this time assessed during the first year after birth, predicted positive family climate and fewer behavioral and emotional problems in children at age 9 (von Klitzing & Stadelmann, 2011).
These and many other findings show that there is overwhelming evidence that infants’ relational experiences not only with one caregiver but also with other relevant (parental) figures are important, even critical, for young children’s psychosocial and emotional development.
It is important
- that these caregivers are well attuned to the child;
- that they provide the infant with a variety of experiences with different interaction rhythms, styles, ways of emotional regulation, and different forms of visual, vocal, and physical messages; and
- that the infant is well integrated in a non-divisive overall relational system without disintegration.
The impact of pregnancy and the transition to parenthood
The interesting question is how parents or other caregivers develop the ability to provide developmentally appropriate care for babies. Most parents have this ability without having to learn it in school or other educational settings. Rather, intuitive parenting or intuitive parenting competence (according to Papousek & Papousek, 1983) is a biologically based pattern of experience and behavior that enables parents to respond developmentally and appropriately to the biological, social, and emotional needs of young children. It is strongly rooted in evolution and is controlled by endocrinological and other biological systems (oxytocin, vasopressin, prolactin, testosterone, and cortisol, among other hormones, regulate parental behavior; see Atzil, Hendler, Zagoory-Sharon, Winetraub, & Feldman, 2012).
In psychoanalytic theory, parental behavior is attributed to the human narcissistic libido system. Initially, parents turn to their babies because they seem to be a part of themselves and promise to fulfill narcissistic needs beyond the parental life span. But the narcissistic satisfaction of having a child comes into competition with the parents’ own egoistic needs, the envy of the young generation that seems to have all these opportunities in the future, quite in contrast to the finiteness of the own life cycle. Normally, parents develop a positive balance between narcissistic love and hate, and slowly develop an adequate relationship that evolves from the “enfant dans la tete” to the baby as a real person (Soulé, 1982).
Pregnancy plays a crucial role in this process. Pregnancy is not only an important biological developmental phase for the embryo and fetus, but also an important preparatory process for the parents, in which they slowly move from their fantasies about the future child and their ambivalent feelings to a more coherent attitude toward the coming child. The impact of a pregnancy that is not fully experienced and suddenly comes to a disturbing end can be seen in cases of premature birth, when this essential biological and psychological process is abruptly interrupted.
It is therefore understandable that many studies, both in the field of attachment and in the context of the broader triadic approach, have found many measurable parameters during pregnancy that have proven to be predictive of later mental health outcomes in infancy and childhood, both in terms of children’s mental health and in terms of parents’ mental health.
However, most of these studies have been conducted in samples with traditional family constellations (mother – father – children) within samples from wealthy Western countries. Furthermore, even in these societies, much has changed in recent decades, and new ways of living together and producing children have developed.
New technologies of “producing” children
For example, in contrast to earlier times, a range of “alternative” ways of conceiving and raising children are becoming more common. From the perspective of infant mental health, our findings must be validated for other family structures, such as single parenthood, mother-mother-infant, or father-father-infant constellations. We should also consider children who grow up with genderqueer parents.
Today, modern reproductive techniques open up countless possibilities for “producing” children without relying on intimate parental relationships. In vitro fertilization is the process of creating a human being outside the womb in a Petri dish. IVF is a proven method of treating parents with infertility issues, but this method also allows homosexual couples and singles to fulfill their desire to have children. In a further development, scientists have developed the intrazytoplasmic injection of morphologically selected spermatozoa, which can be obtained directly from the testes by microsurgical epididymal aspiration (MESA). As in the case of sperm and oocyte donation, previously fertilized oocytes are also donated. Cryopreserved, deep-frozen embryos donated by a couple who do not want to use them for their own children, are available for embryo donation. The genetic and social parents do not know each other and are not related to each other. The number of siblings and half siblings is unknown to the parents and children. Chromosomal abnormalities can be excluded before the embryo is transferred. Preimplantation genetic diagnosis (PID) can be used to select embryos of a certain sex and with certain characteristics for transfer. The procedure of transfer of the uterus during pregnancy is in progressive development. In Texas, reproductive technicians successfully fulfilled the wish of a lesbian couple to have both parents participate in the pregnancy. The embryo developed for a week in the uterus of one of them before being transferred to the other. Transgender individuals can preserve male or female gametes or embryos at minus 196 degrees Celsius before sex reassignment surgery, so they can become somatic parents even if they identify as the same sex. U.S. companies recommend and financially support so-called “social egg freezing,” which allows women to postpone family planning so as not to jeopardize their careers. In November 2018, Chinese biophysicist He Jiankui announced at an international genetic engineering conference that he had succeeded for the first time in intervening in a human genome using the CRISP/Cas9 gene-editing machine and delivering genetically optimized twin girls. He was severely criticized by the scientific community and even sentenced, but he is now free and continues his research (the information is taken from Lebersorger, 2022, pp. 15–20).
The term “artificial maternity” is used to describe a situation in which a gestational carrier gives birth to a genitically foreign child. We’ve all seen the images of hundreds of newborns born to Ukrainian surrogate mothers waiting to be picked up by their intended parents, who couldn’t get to Kiev because the Russian-led war of aggression had just broken out. Gestational surrogacy is prohibited in most European countries. As a result, there is a private market for gestational surrogacy, where women in poor countries offer gestational surrogacy for money. About 3000 to 3500 babies leave Ukraine annually in this way, which is more than the number of children deported by Russia. In the United States, gestational surrogacy is legal, and we estimate that about 10,000 children are born this way each year. The German government is currently planning to legalize “altruistic” surrogacy. For example, a grandmother could carry a girl to term for her daughter so that the baby and her daughter would become sisters (Kelle, 2024). In April 2024 the international fair “Men Having Babies” took place in Berlin. This fair was aimed at men who wanted to have a child through surrogacy. The organizers announced on their website: “This conference provides a unique opportunity (…..) to consult with over 35 reputable gay-friendly agencies, clinics, law firms and other surrogacy providers.” (https://menhavingbabies.org/surrogacy-seminars/berlin/)
When we look at all these developments, we have to consider that the typically close connection between the intimate relationship of a couple, the act of procreation by genetically different parents, pregnancy, and the birth of a child is becoming more and more disconnected. The early stages of a child’s development take place in a truly multifaceted way. Compared to this development, our knowledge of the consequences for the child’s mental health is relatively limited. There has been some research on the well-being of same-sex parent families, but the socio-demographic approach obviously cannot capture the wide range of diverse contemporary forms of parenting. Manning, Fettro, and Lamidi (2014) conclude from their review of over forty studies of U.S. families that children living with two same-sex parents fare as well as children living with two different-sex parents on a wide range of well-being measures (academic performance, cognitive development, mental health, etc.). Schumm et al. (2016) summarize from their systematic literature review that that there are no differences in terms of child outcomes as a function of parental sexual orientation, but that this conclusion is premature given severe methodological limitations (sampling limitations, bias of results due to social desirability in parental self-reports, etc.).
Our unsolved problems are twofold. First, we have an ethical dilemma to solve. Second, we need to think scientifically about infant mental health from the perspective of equifinality that I discussed at the beginning of my paper.
- The ethical dilemma is that we are dealing with two facets of human rights, the rights of adults to fulfill their desire to have children, and the rights of unborn and newborn children to develop and grow up under the best possible conditions. Human rights lawyer Bruce Adams (Abramson B., 2004) addressed this dilemma in his presentation to the Committee on the Rights of the Child on September 17, 2004. Article 5 recognizes parents (even if they are only future parents), but also babies before birth as rights holders. Conceptually, the interests of both individuals may be different: “they are on two sides of the balance”. So, when we talk about “rights”, we should not think of rights in absolute terms. “Few human rights are absolute. Almost all rights require balancing decisions before the abstract statement of the right”. In this regard, Abraham distinguishes between absolute rights (such as freedom from torture) and contextual rights. This is very logical. There is the right of, say, a homosexual couple to fulfill their deep desire to have children as a way of giving meaning to their existence, just as there is for heterosexual couples. But there could be a competing right of the future child not to be conceived and born in a way that could pose a great risk to its own development.
- And here we come to another dilemma caused by our lack of scientific knowledge. We usually argue: The rights of young children, including unborn or yet-to-be-conceived children, must be defined and promoted. But do we really know what is good for a future child? Is it the beginning of a very unhealthy development with a lot of suffering when the child is created in a petri dish by two deep-frozen gamets, then put into the uterus of a woman in a poor country who earns her living as a surrogate mother, and after birth is taken away from this carrying mother and given to a couple from a rich country who seek the final narcissistic satisfaction of having their own child? I intuitively say yes. This procedure violates the rights of several players: first, the carrying mother, who develops feelings for the child in her womb, and second, the child, who is taken from the carrying mother immediately after birth to make the new parents happy.
But we do not really know. Remember what I mentioned at the beginning. Many roads may lead to Rome. But does everything really work in child development? Or should we, as child mental health specialists and advocates, define limits and criteria for basic conditions of healthy child development that we should advocate for from a child rights perspective? In the Winnicottian sense: Under what conditions can a particular way of conceiving and raising a child be good enough? Of course, we are against childhood under abusive environmental conditions such as violence, sexual abuse and neglect, which exist for more than 10% of all children in our rich societies (Klitzing, 2022).
The parents who use artificial child-producing techniques usually claim that they are characterized by a high level of desire for children, which protects them from neglecting their offspring. This may make it more difficult and controversial for us to decide whether we should define limits from a child rights perspective. Here I would like to recommend drawing on the old but very well thought-out concepts of the French child psychiatrists and psychoanalysts Serge Lebovici and Michel Soulés, who belonged to the founding generation of WAIMH, who saw parenthood as a process of transition from the imaginary (“enfant dans la tete”) to the real child (Lebovici, 1988; Soulé, 1982). In order to become good, caring parents, we have to use our narcissistic love of self and partially transfer it to the coming baby (“his majesty, the baby,” as Freud said) in order to love and care for the baby from the beginning. But in the process of further development, we must also withdraw our narcissistic love and begin to love and care for the baby as a real person who is different from us and has the right to develop independently. As long as we in the medical field continue to create new, seemingly ominipotent medical techniques for producing babies, and as long as adults from wealthy countries take advantage of the plight of women in poor countries to use their bodies to fulfill their own desire for children, babies run the risk of being used primarily for adult self-fulfillment, without being granted the right to their own individual development.
Cultural diversity
Let me conclude my remarks with a brief look at the call for more cultural diversity in our field. There is no question that more than 90% of the studies on which our common theories of early development are based are studies in the so-called WEIRD countries (Western, Educated, Industrialized, Rich and Democratic). I agree with those who say that many of our developmental norms are an expression of a late colonialist monocentric view of human relations. We have seen that the traditional relational norm of growing up in a mother-father-children context is diminishing even in our Western societies, but even more so in other cultural contexts. The notion of equifinality supports the approach that our beliefs about the centrality of attachment and triadic relationships, as I described them in the first part of my paper, describe one way of early development, but there are multiple others that can also lead to positive mental health development. Scientific observation of aspects of adult-child interaction is often culturally biased. The same observations can mean very different things in different cultures. For example, Feldman, Masalha, and Alony (2006) examined mother-child, father-child, and triadic interactive behaviors in 141 Israeli and Palestinian couples and their firstborn child at 5 and 33 months of age as antecedents of child competence. They found that maternal sensitivity in infancy facilitated social competence only in Israeli children. In contrast, paternal control in toddlerhood negatively affected social functioning among Israeli children but contributed to competence among Palestinians. The authors conclude that different early relational experiences lead to different adaptations of children to different social environments.
Keller, H. & Chaudhary, N. (2017) have criticized current attachment research for being heavily biased toward the mother as the primary attachment figure in the life of the developing child. In this context, they question whether attachment is a truly universal concept and argue for a more culturally sensitive approach to early childhood. They argue that in order to be more universal, the construct of attachment needs to shift its focus from the individual child to the network of relationships that surround the child. Multiple caregivers are the norm in many non-Western societies and contribute to the development and growth of young children. For example, in their study involving 58 families living in and around Delhi (North India) across social class and ecological settings, they found that older children were expected to be caring and nurturing towards young siblings and cousins. In one rural family with multiple generations of relatives living together, a 5.2-year-old girl took care of her 3.1-year-old sister’s needs when the mother and other adults were unavailable for an extended period of time. As I read this description, I thought about the widely used Barnett, Manly, and Cichetti (1993) maltreatment classification system, which we also use in our studies for clinical assessment, in which such care for a very young sibling would be an example of inadequate care, which is part of the definition of neglect. The authors describe a number of different rearing settings in Asian or African cultures that are quite different from what we describe in our infant mental health textbooks. Gaskins et al. (2017) list a number of parental behaviors that are viewed differently in different cultures, such as
- the use of corporal punishment and disciplinary measures.
- the practice of leaving young children home alone or under the supervision of other pre-adolescent children.
- forms of co-sleeping between older children and their parents.
- separation of parents and children, e.g. when children are left in the home country to be cared for by relatives.
- the role of fathers, e.g. when fathers are not allowed to see their children in order not to impair the close bond with their mothers
The developmental outcomes of different parenting practices in different early environments in terms of mental health appear to be quite diverse. Much depends on the context. For example, in the case of left-behind children whose parents have migrated to find work, the consequences for their mental health development depend strongly on the relational situation of the surrogate parents who take over. Diverse parenting practices in diverse early environments lead to diverse mental health outcomes, quite apart from the fact that infant mental health might be defined differently in different cultures. As I said at the beginning: Many roads lead to Rome.
But does everything work in early child development?
The answer is clearly no! Keller and Chaudhary (2017) themselves set limits to their description of multiple caregiving as a fundamental social practice in many cultures. They make “a clear separation between multiple caregiving as a normative practice and the social neglect of children in disadvantaged contexts (e.g. institutional care, war, extreme poverty, or any situation where care is constantly changing and disconnected), where children are likely to face ignorance, aggression, or abuse.” p. 120. For example, I would see it as critical when the child’s right to grow up in a non-violent relational context is limited by the parents’ claim to authority and autonomy to regulate their children’s care and behavior. Gaskins et al. (2017) for example, point out that in some cultures, a strong commitment to parental authority allows the use of corporal punishment to teach children what they need to learn. The norm of non-violence in the education of children, which has only recently been established in Western industrialized societies, could be seen as a danger that leads to the erosion of the authority and autonomy of parents in the care of their children.
At this point, I would say that the claim that cultural diversity can be a legitimate reason for accepting violent parenting practices fails. Violence in the relationship with young children exists in Western industrialized societies as well as in all other cultures around the world. Millions of young children grow up in conditions of war, neighborhood and family violence. The experience of violence and neglect in early childhood is one of the reasons why the intergenerational cycle of violence is perpetuated within and between many societies. It is one of our goals to combat these practices wherever they exist, because violence, in whatever form, cannot be accepted as a healthy means of raising young children.
In conclusion, many roads lead to Rome, but not all. Individual Cultural diversity is an important claim that cannot be misused to accept behavior toward young children that violates their right to grow up in healthy conditions. We need to move toward cultural sensitivity, but not cultural arbitrariness or relativism. It is a long road, but we must travel it in order to define global minimum standards of child rearing, without being exclusive of diversity and difference.
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Authors
Kai von Klitzing, University of Leipzig, Germany
Kai von Klitzing, M.D., is Professor of Child and Adolescent Psychiatry at the University of Leipzig, Germany. He is a psychoanalyst for adults, adolescents and children, and a member and training analyst of the International Psychoanalytical Association. His clinical specialties are parent-infant psychotherapy and psychotherapy with young children. He has developed an evidence-based brief psychoanalytic therapy for preschool children with anxiety and depression disorders. His research includes early triadic development, developmental psychopathology, childhood depression, causes and consequences of childhood maltreatment, and psychoendocrinology.
He was a member of the Board of Directors of the World Association for Infant Mental Health (WAIMH) from 2004 to 2024, and President of WAIMH from 2016 to 2020.
Email: kai.vonklitzing@medizin.uni-leipzig.de
