Innovations in Parent-Infant Psychotherapy

Views: 653
Ratings: (0)

Innovations in Parent-Infant Psychotherapy has emerged from the authors' and contributors' excitement about the proliferation of parent-infant psychotherapy work around the world. This model of parent-infant work has increasingly been taking place in community settings, adapting to the needs of emotionally deprived people such as refugees and ethnically diverse groups.Skilled workers from a variety of disciplines have benefited from psychodynamic thinking and supervision without necessarily being formally trained psychoanalytically. Innovations in Parent-Infant Psychotherapy refers here to talented clinicians - such as speech and language therapists, health visitors, specialist nurses, child psychiatrists and paediatricians, family therapists, and psychologists, etc - not just child and adult psychotherapists and psychoanalysts.This book coincides with a global consciousness about the necessity to take care of the early years in order to create good outcomes for all young children, to reduce inequalities, and provide more cohesive and accessible early childhood services.

List price: $28.99

Your Price: $23.19

You Save: 20%

 

13 Slices

Format Buy Remix

1: Looking at the symptom as a starting point for understanding

ePub

Pamela B. Sorensen

Working with very young children and their families presents the clinician with special problems and special opportunities. The problems revolve around the fact that young children do what they cannot say. Therefore, we must be prepared, both through training and temperament, to regard behaviour as communication. If we are so prepared, then working with young children and their families allows for opportunities to understand problems at a deep level of psychological truth.

Because small children do what they cannot say, our work must be based on careful observation. For this reason we pay special attention to the sequence and detail of material as it unfolds in the session. It is especially important that we do not interfere with the unfolding of material by too many questions arising from our own preconceived notions about what may be important. Rather, we try to use our inquiries to clarify the issues brought spontaneously, either consciously or unconsciously, to our attention by young children and their parents.

 

2: Echoes from overseas: Brazilian experiences in psychoanalytic observation, its developments and therapeutic interventions with parents and small children

ePub

Marisa Pelella Mélega and Mariângela Mendes de Almeida

The development of psychoanalytic observation in Brazil was greatly stimulated by the foundation of the Mother-Infant Relationship Study Centre in São Paulo in 1987 by Dr Marisa Pelella Mélega, a psychiatrist and psychoanalyst, always concerned with the promotion of individual and family mental health.

The Centre adapted the Psychoanalytic Observational Studies course model developed by the Tavistock Clinic and gained accreditation from the Centro Studi Martha Harris (Italy), through its chair Gianna Williams, a consultant child and adolescent psychotherapist at the Tavistock Clinic.

Initially, the main aim of the Centre was the training of professionals working in the field of mental health and education. Infant observation was introduced as an innovative tool to deepen the professionals’ contact with the mental life within themselves and others. This complemented their work with patients and pupils, whether privately or in institutions. Later, Dr Mélega used the psychoanalytic observation to improve the professionals’ psychotherapeutic skills. This technique and its applications became the central pillars of a training in child psychotherapy.

 

3: Multidisciplinary early intervention with infants and young children presenting emotional, physical and speech difficulties

ePub

C. Bernasconi, D. Gilardoni, M.E. Pozzi, and M.L. Terragni

This chapter owes its existence to some of the members of the workshop entitled “Zero to Five”. This is part of the Italian-Swiss Association “Zero-Cinque”. A small group of Swiss and Italian professionals from various disciplines, working with infants, small children, and their families, gathered together several years ago to address their growing concern regarding the age group neonate to five years old. Psychopathology among infants and young children was increasing in an alarming way; families and professionals were respectively, needing help, and needing to know more about this age group and what to offer these families in trouble. A monthly multidisciplinary workshop “Zero to Five” was then set up, led by Pagliarani and Pozzi, a child and adult psychoanalyst and psychotherapist respectively. They met to discuss worrying situations encountered by the multi-professional members, and to read about and to deepen their understanding of early infancy and parenthood. Amongst the participants there were child psychiatrists and paediatricians, child psychologists and psychotherapists, occupational, speech and language therapists, nursery teachers, and paedi-atric nurses. All the participants, as well as having years of experience in their respective professional fields with children, had undertaken infant observation based on Esther Bick’s methodology, as well as individual psychotherapy or psychoanalysis. In October 2004 the Associazione Insubrica Zerocinque (the Zero-Five’s Centre for Insubria) was legally founded in Vacallo, in the Canton Ticino, where the workshop had been taking place. This offered a more formalized structure for training professionals in counselling infants, small children, and their families. (Insubria is an Italian-Swiss region that includes the Italian cities of Como, Varese, Lugano, and the Swiss Canton Ticino.)

 

4: Brief mother-father-infant psychodynamic psychotherapy: clinical and technical aspects

ePub

Francisco Palacio-Espasa and Dora Knauer

Brief parent-infant psychotherapy is a short-term psycho-therapeutic intervention method (Cramer 1974) targeting parents with their child. It has been employed in Geneva according to the technical principles described by Fraiberg (1980). This type of psychotherapeutic intervention was principally created for babies presenting functional symptoms (sleep or food disorders) or behavioral disorders (opposition, aggressiveness, hyperactivity, etc.). At the Infant Psychiatric Clinic, Geneva, the initial research on these psychotherapeutic processes was carried out by a psycho-analytically oriented psychotherapist. Mother-infant dyads were studied during three to ten weekly sessions. The therapist attempted to focus on the elements troubling the mother-infant interactions that were responsible for the appearance of the infant’s symptoms. This interactive network was interpreted in relation to the mother’s infantile experiences with her own parents and family. This therapeutic approach yielded quite positive results, not only at the level of the infant’s symptoms, but also at the level of the mother-child interactions (Cramer et al. 1990; Robert-Tissot et al. 1996).

 

5: The role of the infant in parent-child psychotherapies

ePub

A. Watillon-Naveau

When I started to work with young children and their parents some twenty years ago, my background was essentially psychoanalytical, but I could also make use of my experience as a seminar leader in infant observation following the Esther Bick technique (Bick 1964).

The first case I treated was a baby girl, three months old, suffering from primary anorexia. It was for me a dramatic experience, which I described in an article in the International Review of Psycho-Analysis (Watillon-Naveau 1992). Alice and her mother could be helped thanks to my analytical understanding of her mother’s discourse and dreams. Although Alice was present during some interviews, she did not play an active role in my understanding of the psychic dynamics that had disturbed the mother-daughter relationship.

It is only with my second case that I became aware of the importance of the child’s presence and participation. Let me tell you the story of Lea. She was five years old when her parents consulted me because of her encopresis. During the first consultation, Lea plays peacefully, sitting on the floor between her mother and myself. Father is present but her ten-month-old brother remains at home. I ask Lea why she does not go to the toilet. She tells me that at school, the toilets are dirty and situated far from the classroom. She is afraid. Father agrees with this hypothesis, but mother does not. She ignores the reason for Lea retaining her faeces but she can give a precise description of how things happen. When Lea feels a bowel movement, she controls herself with such effort that she gets tears in her eyes. If she succeeds in retaining her faeces, the pressure will come back later. If not, she soils her pants.

 

6: Therapeutic consultation: early detection of “alarm symptoms” in infants and treatment with parent-infant psychotherapy

ePub

Romana Negri

The term “therapeutic consultation” is used here to mean the treatment of disorders of a psychopathological nature, which manifest themselves as difficulties in parent-child relationships. The treatment addresses parents and infants together and usually concerns children from birth to five years of age. The work is not recent. Literature includes a number of pioneering articles that are still considered milestones in terms of methodology and the ways in which treatment is carried out. I refer in particular to Winnicott’s “The observation of small children in a pre-established situation” (1941), and Martha Harris’ “Therapeutic consultations” (1966). The first writer proposed a setting for the observation of the small child that still represents a model for workers who intend to perform this type of intervention with babies of a few months of age. Mrs Harris’s work is extremely illuminating for its understanding of the parental experience and the child’s emotional situation. It also seems highly significant in that it delineates the role of the therapist within the consulting room itself. Over a considerable period of time this intervention on very small children has been used by an ever-increasing number of therapists, prevalently with a psychoanalytical orientation (Cramer & Palacio-Espasa 1974; 1993; Lebovici 1983; Pozzi 2003; Stern 1995; Watillon-Naveau 1993). A significant breakthrough came with the experience acquired through the observation of the newborn baby as promoted by Esther Bick over sixty years ago (1964). In the same way, expansion of the intervention has been encouraged by the rapid and efficient results obtained, since it enables elements of a psychopathological nature to be tackled at the onset and at an increasingly early age. My parent-child consultation work started back in the late 1970s and, in contrast to the findings of other authors such as Watillon-Naveau (1993), it concerns above all very small children. This is because I began this work as a consultant infant neuropsychiatrist at the Children’s Neonatal Pathology Department of the Treviglio Caravaggio Hospital (Bergamo, Italy).

 

7: Transformational process in parent-infant psychotherapy: provision in community drop-in groups

ePub

Judith Woodhead and Jessica James

This chapter is about the provision of psychoanalytic parent-infant psychotherapy within community drop-in groups in order to support and repair relationships between parents and infants. The Anna Freud Centre has responded to the need for such innovative services, in ways that are in keeping with its traditions from the establishment of the War Nurseries onwards. Collaborating with health care professionals to establish drop-in groups for parents and infants has extended the Parent-Infant Project’s model of parent-infant psychotherapy. The first drop-in group is in a health centre and the second in a hostel for homeless families. The model for these groups is underpinned by principles derived from group analysis and parent-infant psychotherapy, along with neuroscientific, attachment, and infancy research. Early parent-infant relationships are the crucible within which experiences can occur that spark and sustain the development of the infant self. In psychoanalytic parent-infant psychotherapy, experiences of the self arise through, and are transformed by, emotionally contingent intimate relationships with others. Furthermore, at a time of rapid brain development, therapeutic intervention supports the infant in the process of developing “a more complex level of brain organisation” (Tronick 1998: 295).

 

8: Babies in groups: the creative roles of the babies, the mothers and the therapists

ePub

Campbell Paul and Frances Thomson Salo

Babies and parents spend quite a considerable time in group contexts, and babies have been in group situations or interacting with each other since the beginning of time. In this chapter we look at some ways that four kinds of groups using a psychoanalytically informed group therapy model could be therapeutic. In an earlier paper we discussed the development from 1990 of a mother-baby therapy group particularly from the perspective of the way a baby might take the lead in therapeutic work and is therefore present as an equal member (Paul & Thomson-Salo 1997). Since we started that group there have been many developments, with an increasing acknowledgement of broader social relationships, and of connectedness with babies. In this paper we will consider developments in therapeutic work with infants in groups that retained the idea of viewing the baby as subject in his or her own right. Three others groups grew out of this model that we describe: the Very Premature Babies Group, the Stargate Infant-Parent Group (for infants who were in care for the first time), and the Peekaboo Club (for mothers and infants who had witnessed violence in the first year of life).

 

9: Parent-infant psychotherapy: when feelings of futility are prevalent

ePub

Amanda Jones

The focus of this chapter is very specific. It is written out of a motivation to share some of my difficulties working with babies, who, I feel, have given up reaching out for human contact. The babies I am thinking of actively sever human connection by avoiding eye contact, stilling or startling when touched, and sleeping too much. They are also quiet: the mouth, usually a place of passionate expression is flat, as if the lips are glued together; or sometimes the lips and tongue are floppy, lacking tone. The absence of appetite for interaction is noticeable. Moreover, the babies look lethargic; their eyes are dull. There is no sense of mastery when making a gesture, or manipulating an object. Although these babies look depressed, I do not think this captures the experience of futility and hopelessness they feel. The fifteen or so babies I have worked with who presented in this way were between four weeks and six months old.

I describe an intervention I undertook with a very quiet and disconnected seven-week-old baby to explain what I think was starting to happen in his developing internal object-relational world and then how I helped his seventeen-year-old mother to reach him. This brief introduction is to give a flavour of Nat and Natalie. Although I have changed their names, I have Natalie’s permission to share aspects of their therapy. Natalie was referred to the Parent-Infant Mental Health Service by her health visitor. On completing the Edinburgh Post Natal Depression Scale Natalie had said in a flat voice—as if in passing—that she felt suicidal and cut herself. Her health visitor sensitively said that Nat was doing well, but Natalie seemed low. Natalie nodded and agreed to the referral.

 

10: The health visitor’s role in promoting emotional well being in families

ePub

Maggie Harris

Iam a health visitor and work in the UK where health visitors are registered nurses with post-registration training. We are based in the community and traditionally work with all newly born infants and their families in whatever context we encounter them: at home, occasionally in a hospital, and through an open service at community clinics.

We operate on four core principles:

1. The search for health needs.

2. Stimulation of awareness of health needs.

3. Influence on policies affecting health.

4. Facilitation of health enhancing activities (CETHV 1977).

We prioritize our work in order to maximize preventative care and promote health and general well being for the whole family. However the models of prevention and the framework for health visiting continue to follow a medical or treatment model. This is not always appropriate when considering the emotional health of the family, particularly of infants.

The health visiting service in England is continually undergoing organizational change. Resources for the health visiting service have been reduced in many areas, necessitating the formation of multi-skilled teams including general nurses, nursery nurses, and health care assistants. Working within a climate of change has been a challenge for the profession. This is magnified when working with vulnerable children. We need to ensure that we create robust teams that do not replicate the vulnerability of our clients. Consequently, the support for the teams within the organization becomes equally important.

 

11: “It wasn’t meant to happen like this”: the complexity of mourning great expectations

ePub

Lynne Cudmore

In this chapter I will discuss some aspects of my clinical work in the perinatal service, part of the specialist service for the under-fives age group, based in the Child and Family Department at the Tavistock Clinic in London. The majority of the individuals, couples, parents, and families that I meet struggle with the emotional aftermath of living through traumatic experiences that have occurred during pregnancy, the infant’s birth or the months following. The experience of feeling catapulted into a disaster area where they had previously had great expectations of joy is one they share. There is an inevitable emotional fallout for each individual internally and externally; on relationships within the family, between the parental couple, between parent and infant and with already existing children. Trauma always involves loss (Levy & Lemma 2004) so these experiences need to be mourned if development is to occur; loss has to be acknowledged, grief expressed. But a mourning process might be inhibited by trauma if there is a breakdown in symbolic functioning, the capacity to reflect on lived experience (Garland 1998). The losses that my patients describe can be actual, such as the death of a child, or the loss of an “inside” baby because of a very premature birth; and also symbolic, such as the loss of a sense of self as good and strong, the loss of hope, trust and faith in a benign world. Working through these different layers and aspects of loss is painful to bear and rarely linear. Many factors, both internal and external, influence the meaning that is generated from the experience of “it wasn’t meant to happen like this”.

 

12: Ten years of parent-infant psychotherapy in a township in South Africa. What have we learnt?

ePub

Astrid Berg

Since 1995 we have run a weekly mental health service in a Well-Baby Clinic in Khayelitsha, a formal and informal settlement outside of Cape Town. This service forms part of the Infant Mental Health Unit of the Division of Child & Adolescent Psychiatry at the University of Cape Town. To our knowledge it is the only such service in the country and probably in sub-Saharan Africa.

The majority of the nearly two million people living in Khayelitsha have come to the city from the traditional “homeland” of the Eastern Cape—a rural area where medical and educational provisions as well as job opportunities are scarce. However, life in the city is not easy either, and the burdens that are carried by many of the people in terms of poverty, illness, and single parenthood are immense. Having a baby is a given for women—is part of their life cycle—but under these circumstances is not always easy.

The question that therefore arose for us when first entering this community was: can infant mental health have a place in the minds of the mothers and clinic nursing staff when the main task is the physical welfare of the child? The answer lies in the response we have had to our being there: a yearly average of 300 infants with their parents have been seen with half of those being repeat visits; this can only mean that a need is being met. What thus started off as a pilot site has now become an established, integral part of the Clinic.

 

13: Intervention in parent-infant psychotherapy in Japan: the infant reveals family trauma

ePub

Hisako Watanabe

Clinical practice in infant mental health reveals that an infant is capable of actively informing us of problems in his intimate relationships. Often he reveals a family trauma, which the whole family has long forgotten. The past that is not reflected upon will continue to repeat itself (Santayana 1905). An infant evokes unresolved family conflicts. Fraiberg coined this phenomenon “ghosts in the nursery” (Fraiberg 1975). The infant takes on a dual role of an active agency and receptor for the evocation of the unresolved conflicts.

How and why does the infant take on such a role? Recent research in affective neuroscience and psychoanalytic developmental psychology reveal the powerful force at work in infancy and the perinatal period. Soon after birth the infant actively perceives emotional states of the mother (Schore 1998; Panksepp 1998; Trevarthen 1983.). The baby keenly engages in nonverbal dialogue with her through gaze, voice, and gestures. The mother, in turn, intuitively responds in infant-oriented rhythmical, melodious voice, and facial expressions named motherese (Trevarthen 1983). The contingency and rhythmicity found within this dyadic interaction led to the theory of communicative musicality by Trevarthen and Malloch (1999–2000). When the mother becomes confused and distressed by uncomfortable feelings when she is with her baby, this will emerge as a less than optimal quality of interaction and communicative musicality (Malloch 1999–2000).

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781780494913
Isbn
9781780494913
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata