Psychodynamic considerations in the neonatal ICU

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Abstract
A description of the psychodynamic patterns of behavior among the Neonatal Intensive Care Unit staff, the parents, and the neonate is presented by a consulting child psychiatrist, who has spent three and one-half years working in an NICU. This is a clinical and empirical study that relied on informal and unstructured interviews with the staff and the parents, the short-term and long-term observations of their behavior, and the personal objective and subjective analysis of the psychiatrist. From this has emerged a picture of a dynamic that recreates the nuclear family within the confines of the NICU from the nurses and the physicians. These surrogate mothers and fathers play out unconscious parental roles with the neonate and with each other. Given this setting, inappropriate maternal attachment can occur between primary nurse and her charge, as well as inappropriate paternal attachment occurring between physician and infants under his medical care. Understanding of these psychodynamic reactions is basic to implement parental involvement in the NICU, so as to encourage the natural infant-parent bonding.

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