What is known about the NaP intervention?
NaP is based on mentalization theory (supporting parents’ mentalization abilities), emotional availability theory and Theraplay® interaction therapy. The developers of NAP are psychotherapists with extensive training and experience in various interactional approaches and mentalisation therapies (see the trainers’ introduction).
NaP is a practical, preventive, short-term, and manualised working method for strengthening interaction. It is based on working directly with the parent-child relationship, i.e., the child is intensely involved in the treatment from the time of pregnancy. Direct, experiential, and emotional attunement to sensitivity is a key feature of NaP. Many forms of parenting support are based on guiding through discussion or working with the parent’s images and experiences. NaP aims to combine interactive play and reflective work to support mentalisation systematically.
Theories and practices
NaP is based on the Emotional Availability Theory (www.emotionalavailability.com) of interaction (Salo & Flykt, 2013), emphasising sensitivity, controllability, non-hostility, and non-intrusiveness on the parent’s side as components of effective interaction. On the child’s side, responsiveness and initiative are emphasised. A functioning emotional connection is the basis for interaction.
There are hundreds of studies on the importance of emotional availability and how it relates to safe child development and effective emotional regulation (see www.emotionalavailability.com). NaP developer Saara Salo has been researching Emotional Availability since 2009 (Salo et al., 2009, 2010, 2021, 2022) with both standard and clinical data (see research list). Saara Salo has also developed a method for observing emotional availability during pregnancy (Pre-EA; Salo et al., 2019). The theory developer, Prof. Zeynep Biringen, collaborates continuously with Salo and has permitted using their material as part of the NaP intervention.
In practice, NaP is also based on the principles of Theraplay, a model for managing the child-parent relationship (www.theraplay.org).
Theraplay is an adult-led, active, play-based treatment that requires more training and is longer and more intensive in nature. Based on Theraplay, NaP involves active play designed to evoke positive emotions and help the parent guide and regulate the child. Both developers of NaP, Saara Salo and Hanna Lampi, have long been Theraplay trainers and supervisors.
NaP is also based on the mentalization theory of parenting (Pajulo et al. 2015). Mentalization refers to the parent’s ability to reflect on the child’s experiences behind the behaviour—feelings, thoughts, desires, etc. It is also an understanding of one’s feelings as a parent in relation to the child, how they relate, for example, to one’s childhood, and, on the other hand, how much the child senses about the parent’s experiences, including the non-verbal ones.
NaP aims to support the parent specifically in perceiving the child as a separate person, with their own experiences from the beginning. The mentalization interventions include a variety of tasks designed to stop the parent from observing and wondering about the child’s experiences here and now. Increasing mentalization skills is considered central to various early interaction interventions (Kalland & Salo, 2020). Both NAP developers have training and experience in strengthening mentalization as part of their psychotherapeutic work. Saara Salo is also an Anna Freud Center-accredited family mentalization intervention trainer and has an ongoing international collaboration with mentalization therapy training communities.
Parental emotional regulation plays a special role in the development of a functioning emotional and mentalizing relationship. Different sensory sensitivities, life stress or mood problems can influence this. Among NaP’s developers, Hanna Lampi is currently working on a PhD thesis at the University of Helsinki on the role of parental sensory regulation in early child development.
NaP studies
A randomized controlled trial (RCT) of NaP in a group setting has been conducted on depressed mothers during pregnancy. The results showed that mothers in the experimental group had better sensitivity and reflective ability in both interactions. This demonstrates the effectiveness of group NaP.
A new randomized controlled trial (RCT) of the effectiveness of working with babies is being launched in Buffalo. Data is currently being collected from babies aged 3-6 months.
A feasibility study has been conducted in the Helsinki Mother and Child Home Association, and the results were provisionally reported at the World Infant Mental Health Congress in summer 2023. The results showed that NaP is an easy-to-implement and well-established treatment method in the Mother and Child Home environment. A wider effectiveness study is being planned.
An interview study on the NaP for Foster Families intervention was carried out at the University of Jyväskylä, in which foster parents’ meanings, thoughts and feelings towards the group were mapped (Tuomi & Ala-Ruona, 2022). The study found that the intervention helps to deepen the parent-child bond and strengthen the attachment. The functionality of the group and peer support are also seen as important. The study’s results communicate well with attachment theory, supporting the assumption of the importance of family-centred intervention when working with foster families.
Kalland, M., & Salo, S. (2014). Lapsen mentalisaatiokyky. In Mentalisaatio perheiden kohtaamisessa (pp. 39-54). Mannerheimin lastensuojeluliitto.
Kalland, M., & Salo, S. (2020). Vanhemmuuden tukeminen vauva-ja lapsiperheissä. Duodecim.
Pajulo, M., Salo, S., & Pyykkönen, N. (2015). Mentalisaatio ihmistä suojaavana tekijänä. Duodecim, 131(11), 1050-1057
Pajulo, M., Salo, S., & Pyykkönen, N. (2016). Mentalisaatio-ydinalue lasta suojaavassa työssä. Perheterapia, 32(1), 34-44.
Peltokorpi, S., Salo, S., Nafstad, A., Hart, P., Tuomikoski, E., & Laakso, M. (2023). Bodily-tactile early intervention for a mother and her child with visual impairment and additional disabilities: a case study. Disability and Rehabilitation, 45(12), 2057-2072.
Salo, S., Tuomi, K., & Isoniemi, E. (2008). HoiLei: vauvan ja vanhemman vuorovaikutus. Psykologien kustannus.
Salo, S., Kivistö, K., Korja, R., Biringen, Z., Tupola, S., Kahila, H., & Kivitie-Kallio, S. (2009). Emotional availability, parental self-efficacy beliefs, and child development in caregiver-child relationships with buprenorphine-exposed 3-year-olds. Parenting: Science and Practice, 9(3-4), 244-259.
Salo, S., & Flykt, M. (2013). Lapsen ja vanhemman välisen emotionaalisen saatavillaolon merkitys lapsen kehityksessä ja hyvinvoinnissa. Psykologia, 48(5-6), 402-416.
Salo, S., & Pajulo, M. (2018). Huumeongelmaisen äidin ja vauvan varhaisen vuorovaikutuksen tukeminen. In Huume-ja lääkeriippuvuudet (pp. 280-283). Duodecim.
Salo, S. J., Flykt, M., Isosävi, S., Punamäki, R. L., Kalland, M., Biringen, Z., & Pajulo, M. (2019). Validating an observational measure of prenatal emotional availability among mothers with depressive symptoms. Journal of Prenatal & Perinatal Psychology & Health.
Salo, S. J., Flykt, M., Mäkelä, J., Biringen, Z., Kalland, M., Pajulo, M., & Punamäki, R. L. (2019). The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers. Primary Health Care Research & Development, 20, e157.
Salo, S. J., Pajulo, M., Vinzce, L., Raittila, S., Sourander, J., & Kalland, M. (2021). Parent relationship satisfaction and reflective functioning as predictors of emotional availability and infant behavior. Journal of Child and Family Studies, 30, 1214-1228
Salo, S. J., Sourander, J., Lipsanen, J., Pajulo, M., & Kalland, M. (2021). Isien ja äitien reflektiivinen kyky: seurantatutkimus raskauden ajalta kahteen ikävuoteen. Psykologia, 56(5), 472-495.
Salo, S., Widenius, L., & Kalland, M. (2021). Mentalisaatiopohjainen lapsikeskeinen perheinterventio-miten auttaa perhettä ymmärtämään toisiaan?. Perhe-ja pariterapialehti, 37(2).
Tuomi, K. (2018). Intervention for foster families with young children. Imagine – Early Childhood Music Therapy Online Magazine, 9(1), 66–68. https://doi.org/ISSN:2153-7879.
Tuomi, K. (2022). Potentials of music therapy with children and families. University of Jyväskylä. Retrieved from http://urn.fi/URN:ISBN:978-951-39-9258-3
Tuomi, K., & Ala-Ruona, E. (2022). Nurture and play for foster families with young children: Foster-parents’ reflections on attachment- focused group intervention. Approaches: An Interdisciplinary Journal of Music Therapy, First view.