Infant mental health is strongly connected to an infant's relationship with a responsive, warm, and available caregiver. However, maternal mental illness reduces a mother's ability to detect and respond to changes in her infant's expressions and communication, which may have important consequences for infant attachment and emotion regulation. The Shared Pleasure (SP) paradigm in parent-infant interactions is defined as 'the parent and the child sharing positive affect in synchrony' and is considered to be a possible screening marker for early identification of at-risk dyads. A paucity of data exists for the application of SP as a measurable paradigm in developing countries. This study aimed to evaluate the SP paradigm using women attending a tertiary psychiatric maternal mental health clinic in Cape Town, South Africa. A sample of mothers (N = 78) and young infants (2-6 months old) were assessed for SP moments using video recordings of the dyad in free play. SP moments occurred in only 20.5% of the sample. SP moments were more frequent in younger babies (under 3 months of age). There were significantly more SP moments in dyads where mothers had no mental illnesses (p = 0.021) or were married (p = 0.016). Black African mothers also experienced significantly more SP moments with their babies (p = 0.033) than their Caucasian or Mixed-ancestry counterparts. This study explored the application of the 'SP paradigm' on women with and without mental illness who attended a maternal mental health clinic. Tracking SP moments in a larger sample of culturally diverse, at-risk and, mentally-ill population of mothers and their infants offers the possibility of a simple language- and culture-free measure to identify at-risk dyads.