Working with Parents and Infants: A Mind-Body Integration Approach

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Working with Parents and Infants is aimed at understanding the process of psychosomatic illness, exploring the embodiment of psychosomatic health and illness, and the inseparability of psyche and soma. Within this book, the author highlights the beneficial function of psychosomatic symptoms, such as mastitis, in signalling to the counsellor or therapist as well as the patient the need for change and the path through which it may occur. Research and clinical literature have often overlooked the relationship between the woman's attitude to her bodyself, thus her mind-body integration, breastfeeding and the quality of interactions with her baby. A psychosomatic disturbance is in this book conceived as an impaired sense of bodyself, or in other words, a lack of psycho-soma integration.Antonella Sansone presents a new approach to health and the healing relationship emerging from a meeting between Eastern meditative disciplines and Western psychological practise. On the same line as Buddhist philosophy, well-being is conceived in terms of full union of mind and body, not in the negative meaning of the absence of sickness.Central to a new psychophysiological theory of emotion adopted in this book, is the notion that healthy bonding relationships with the primary caregivers shape healthy brains and efficient connections of neurons in the brain.This book highlights the importance and effectiveness of early support. As a baby's brain is being wired, thus is very plastic, early support leads to better outcomes than years of treatment later in life. Improving the relationship between parents and their babies is much more cost effective than any adult therapeutic treatment.The author acknowledges the importance of infant observation as valuable training to prepare for working with parents and infants.

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CHAPTER 1: A historical examination of the psyche-soma

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In this Chapter I explore some theoretical gaps and imbalances in the psychoanalysis of the psyche-soma. The philosophy of dualism owes much to Christian theology. Descartes (1644) regarded mind and body as two separate entities, composed of different substances and governed by different laws. He deemed that the body being a material object, could be explored via scientifc investigation but that the mind could only be investigated via introspection. Since then, Western philosophers have struggled with the mind /body dilemma for over 300 years. This has profoundly affected the evolution of thinking in the feld of psychoanalysis about the psyche-soma.

Psychoanalysis has been involved with the psyche-soma from the very beginning, when Freud began to treat patients with the physical symptoms of conversion hysteria via a “talking cure” (Freud and Breuer, 1893). For Freud a diffcult task for the individual resided in controlling physically-based sexual drives seeking immediate gratifcation, and adapting them to the “reality principle” of social expectations (1911b). Although Freud described the ego as a “body ego’, he substantially deemed mental and bodily functions to be opposed rather than complementary.

 

CHAPTER 2: The psyche-soma within an object relations framework

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Winnicott put at the centre of his developmental model not a mythic confict between incompatible forces but the localisation of self in one's body. for Winnicott, there was the body at the root of development out of which a “psychosomatic partnership” evolved. The self was frst and foremost a body self and the “psyche” of the partnership meant the imaginative elaboration of somatic parts, feelings and functions, that is, of physical aliveness. (Phillips 1949, p. 244)

What I fnd particularly relevant was Winnicott's interest in distressing psychosomatic symptoms that he encountered in his psychoanalytic practice. Nevertheless, he was also interested in the relationship of psyche and soma in health and in normal development as well as in illness. Phillips (1988, p. 5) drew attention to Winnicott’ s questions: “What do we depend on to make us feel alive, or real? Where does our sense come from, when we have it, that our lives are worth living? Winnicott approached these issues through the observation-one of his favoured words-of mothers and infants, and what became in time the “transitional space” between them.”

 

CHAPTER 3: The “bodyself” in early relationship

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Research and clinical literature has paid very little attention to how a woman's bodyself may impinge on her parental skills and on the quality of her interaction with her baby which is what gave me the idea to write my frst book Mothers, Babies, and their Body Language (Sansone, 2004) and this chapter. In my frst book, the relation between the woman's bodyself and her parenting abilities is extensively considered for the frst time. Consideration is also given to how the mother's attitude to her bodyself can affect the development of the infant's bodyself. To nurture an integrated bodyself image and grow in self-confdence, a child needs a mother who values herself and has a fulflled relationship with her body and self. A sense of guilt, hatred of life, or fear sends signals about self-esteem and about the importance of motherhood. Parents teach their child assertiveness and self-trust through their confdent posture and frm way of holding, as their attitudes and feelings constantly take shape through their muscular tension and body language.

 

CHAPTER 4: Touch, movement, and integration of the psyche-soma

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Part and parcel of holding is whatWinnicott refers to as handling-the way the mother handles her infant in all the day-to-day details of maternal care. Here is included a mother's enjoyment of her baby, which is an expression of her love. (Abram, 1996, p. 187)

My primary focus here is on the early experiences of movement and touch, arising within the mother-infant relationship, described by Bick (1968) and Winnicott (1962b) as essential to the evolution of a sense of boundaries, a sense of skin, and a sense of bodyself.

The communication between mother and baby is triggered by a variety of channels: skin contact, smell, warmth, eye contact, interplay of facial expressions, vocalizing, movements-all sensual means, experienced by the infant as holding the parts of the personality together. All sensory experiences-sights, sounds, smells, etc .-have the potential to contribute to a sense of bodily aliveness, of feeling real (Winnicott, 1949). The sensory exchanges between mother and baby impinge on the infant's process of discovering her own being and boundaries. The mother's reproduction of the baby's facial expressions, sounds, and gestures encourages self-discovery even more than her stimulation and guidance (Sansone, 2004).

 

CHAPTER 5: Case illustration

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There is in the symptomatology an insistence on the interaction of psyche and soma, this being maintained as a defence against the threat of a loss of psyche-somatic union, or against a form of depersonalisation.

(Winnicott, 1962a, p. 62)

The following case is a vivid description of how failure in having been held herself may cause a mother's intolerance of physical contact with her baby and how this can manifest through the woman's use of her body. Mastitis, a breast infammation that may prevent a woman from breastfeeding, is seen here as a symptom of a psychosomatic dysfunction. It represents the tip of the iceberg of a confict between the mother's will to breastfeed and her inability to cope with the overwhelming feelings aroused by it.

Andrea and her baby received short-term counselling three times a week for a period of two months.

Andrea's case commenced on the day I was caught by remarkable human sounds from the labour room. The sounds were high and sharp and with their upward direction they seemed to go away from the woman's body and run through the ceiling. In my experience I have found that labour sounds are usually deep, primitive, and downward directed–towards the area that is more involved in the process, when they are emitted in tune with breathing and contractions as the baby descends through the pelvis. The outcome of labour seems to reside in a harmonious interaction of the mother's mind and body. Since it was the early stage of labour, when the contractions were not so powerful as to induce intense pain, Andrea's sounds seemed to be screams of fright. At one point, a midwife who had just left the labour room looked at me saying that this labouring woman had been behaving that way for a few hours, though she had not yet entered “physiological” labour (because there were no strong contractions).

 

CHAPTER 6: An east/west approach to working with parents and infants and the healing relationship

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This book presents a new perspective on health and the healing relationship, growing out of a meeting between Eastern meditative traditions and Western psychological practice. My regular practice of meditation and yoga helped me to heal Andrea's problem from within herself as well as within the relationship with her baby. I did not apply any therapeutic method but I was just led by “empathic perception” and “openness of the heart’. In our culture, the world “heart” has a rather sentimental meaning and is considered to be quite distinct from “mind”, the latter usually referring to our rational and thinking capacity. In Eastern traditions, for instance in Buddhism, the world “heart” does not denote sentimental feelings, and the words “heart” and “mind” are part of the same reality (“citta” in Sanskrit). In fact, when Buddhists refer to mind, they point not to the head, but to the chest. This unity of mind and heart brings a fundamental openness and clarity, a much larger kind of awareness that resonates directly with the world around us.

 

CHAPTER 7: Emotions and the primal brain

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There is no such thing as an infant…without maternal care there would be no infant. (Winnicott, 1960b, p. 39)

Neurobiological studies show that healthy brains depend on healthy bonding relationships with the primary caregivers and effcient connections of neurons in the brain. All these connections make the brain of a two-year-old four times heavier than the newborn's. Early events determine which circuits in the brain will be reinforced and maintained. It is the emotional environment in particular that reinforces this wiring system and determines the density and complexity of connections among the neurons. Neurobiologists show us that the wiring is related to the quality of the parent-infant relationship, the way the baby is cared for, and the quality of the baby's attachment to the parents and others.

Development is about incorporating experience into the developing brain, thus producing new connections and reinforcing them. The capacity of the brain to modify its own structure in response to the environment is called neuroplasticity. Perry, Pollard, Brakely, Baker, &Vigilante have stated (1995): “The single most signifcant distinguishing feature of all nervous tissue–of neurons–is that they are designed to change in response to external signals. Those molecular changes permit the storage of information by neurons and neural systems.”

 

CHAPTER 8: The effectiveness of early support

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My work with parents and infants is usually short term in nature. It is brief because the infant-parent relationship itself is very young and diffculties can usually be quickly rectifed. The earlier the psychotherapeutic work, the more effective it is. This means that the best outcomes will appear very quickly and last longer when the psychotherapeutic work is carried out very early.

The relationship between mother and baby cannot wait for the resolution of past conficts in the mother or the father through long-term psychoanalytic work, as Stella Acquarone explains in her book Infant-Parent Psychotherapy (Acquarone, 2004). A baby develops relatively quickly in the course of active interactions with the mother and father, so a baby cannot be understood outside of these interactions. Neither can the parents be understood without taking these interactions into account.

Psychotherapeutic work with parents and infants requires an integrated and creative use of ideas from child development research, neuropsychological research, infant observations, psychoanalytic literature, theories of infant evolution, psychology, and the arts (for instance, baby massage is the oldest and the most natural of all the healing arts). In my work, I also integrate an Eastern approach to the healing relationship. However, any theoretical background should be continuously fltered by the therapist's creative personality, as this is what enables him or her to truly connect with the parents” and baby's feelings and thus understand them. This makes this kind of work with parents and infants both an art and a science.

 

CHAPTER 9: Infant observation

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To see the dynamics between parent and infant, we need to be able to observe. Observation is the foundation of research and theory. It is a skill that is sharpened through experience. Infant observation is a valuable training to prepare for psychotherapeutic work with parents and infants and for the work of any health professional concerned with parents and infants. It consists of observing an infant from birth to two years with the mother or father (if he is the main caregiver) in their home, every week for an hour, making detailed notes afterwards, and discussing the observation in a small group. The observer should choose a healthy family.

The purpose of observation is to discern the development of emotions and interactions between mother and baby as well as within the observer, over a period of at least two years. The observer has to learn not to interfere with the dynamics between mother and baby and to bear the strong feelings and anxiety these may induce. By not feeling judged the parent will behave naturally and the observer will be able to witness parent-infant dynamics in a natural setting. Observing parent-infant dynamics is an important experience for the professional who wants to work with parents and infants and thus needs to understand early emotions and early interactions.

 

CHAPTER 10: Conclusions

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In this book, I have explored the philosophical framework of dualism and its formative infuence on the development of psychoanalytic psychosomatics. I have highlighted Winnicott’ s work on the psyche-soma as a break from the dualistic tradition that, unlike the work of existential analysts, resides within an object-relations perspective. I have built on Winnicott’ s work, on Pines’ thinking about a woman's unconscious use of her body, and on Kleinian and post-Kleinian visions, to highlight the benefts of baby massage classes as what I believe should be an integral part of psychotherapeutic work with parents and infants.

My exploration of certain philosophical and theoretical issues within psychoanalysis has been in the service of “building a home” for clinical work with parents and infants and for infant observation settings. Such a home should be built upon the three following principles:

1. It should combine a phenomenological perspective based on a vision of a unifed psyche-soma, with an object relations perspective, in order to draw connections between individual infant and individual adult experiences.

 

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