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Infant-Parent Psychotherapy

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This is a comprehensive handbook, full of vital information on the theory and practice of infant-parent psychotherapy, that will revolutionise the treatment of babies. It is essential reading for all professionals working with children.This volume is based upon the author's observations and treatment of over 3,500 parents and their infants throughout several decades. With its roots in the major fields of psychology, such as developmental psychology and psychoanalysis of early life, she has created an exciting and ground-breaking new field of psychoanalytic psychotherapy - infant-parent psychotherapy. It focuses on pre-verbal communication with babies, using the simple tools of experience and observation.In the first chapters, the history and background of infant-parent psychotherapy are laid out. Then, its application to understanding babies is detailed, demonstrating the psychodynamic approach in theory and in practice. Once the basics are explained, the author presents a step-by-step guide on how to assess, diagnose and treat babies, including case studies for practical illustration. She also provides separate chapters on special needs babies and troubled mothers, again using case studies for examples. Quick reference tables, maps, matrices and indexes are all provided.

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Chapter 1: The dynamics of the infant space

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The process of development in infancy seems magical. Everything happens very fast, following patterns that develop through the interaction of genetics and the environment, the positive stimulus of good relationships, or the damning effects of bad ones. Traumatic or pleasant experiences are imprinted on the brains of tiny infants, working hand in hand with unpredictable physiological changes, for the better or for the worse.

When the effects of this process are harmful, are they permanent, or can we alleviate them? If so, how can we change the inevitable, what kind of help is available, and where can we find it?

Answers to such questions are offered throughout this volume, and the when, where, and what of the kind of help babies and parents need is described. There are many possibilities, but common to them all is the understanding that infants carry within them their own story, each a particular vision of the world put together in response to the difficulties confronting them and their parents. It may well be that much of their story is a response to the expectations and reactions of parents, in whom the infant may have awakened unresolved conflicts, but it is still the infant who comes first to the consultation. Whatever the cause of the problem, the answer is to be found, first and foremost, in the baby.

 

Chapter 2: The dynamics of the parent–infant space

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The parent–infant space is complex. To walk into it is to walk into known and unknown risks. It is a seemingly endless walk in a seemingly never-ending maze of rooms and corridors, where the walls, ceilings, and floors can move and what is done in one part of the maze seems to affect what difficulties are encountered in other parts. Everywhere there are restrictions and constraints that can add to feelings of anxiety, fatigue, or hopelessness.

But the shape of the space and the dynamics of walking through it are not so complex. The integrity of the parent–infant space—what pulls, shapes, holds, and collapses it—is based on two triangles: a real relationship triangle and an internalized one. The points of the triangle are held together by invisible bonds. Although we cannot actually see these bonds, we certainly can feel them. They keep us together. Without them, we gradually grow apart.

Mother–baby–father are bonded in their inner, real worlds and imagined dynamics of attachment and separation. Development and relationships play out with anxiety and repression, and the parent’s own memories of growing up—good ones along with long-held resentments and buried trauma—are important factors for the professional to consider. Without early intervention and a professional to provide a reflective space, these conflicts are replicated, renegotiated, or stay unresolved.

 

Chapter 3: The psychodynamic approach, observation, and interaction time

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In this volume, we consider babies who are mentally troubled, at risk, or suffering from physical disabilities, and through case histories we examine various conditions and ways of minimizing the attendant emotional complications. But first some basic concepts must be outlined. Though the language we use may be simplified, the method and aim are complex: to define a prevalent psychic dysfunction and personal structure and determine how this can be modified in subsequent development.

We start in this chapter with an overview of the research in developmental psychology. With this background, we are better able to think about “derailed” development, about responses and integration in development, and about the normal ways of adapting to the world. And, with psychoanalytic tools from psychoanalysis—transference, counter-transference, a clear setting, and free-floating attention—we can form a picture of our patients’ troubled internal worlds and think with them about aims in the consultation and what is the best therapy available for them to move forward emotionally. Accompanying this is another essential tool—the infant observation technique—through which we can learn to observe our patients in a passive, receptive, and attentive manner. Finally, interaction time—where the therapist deliberately engages with the child—may provide a means for discovering how communication processes within a family work and can be therapeutic in itself.

 

Chapter 4: The assessment procedure

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When an infant is referred, either the infant or the parents are experiencing unhappiness. To develop a professional opinion on the problem, we will need to explore the parents, the parenting, and the infant, why difficulties have appeared, and how and when this process started. Overall, the procedure works like this: a baby and a family are in trouble; we attend to the referral, exploring the meaning in the parent’s mind of having been referred, and by whom and why. We create a suitable setting to work in, observe the individuals and the surrounding situation, and give ourselves time to reflect in order to evaluate the sort of help that is suitable and safe for this baby and this family.

This process will be understood through information that comes from infant research, developmental psychoanalysis, and the transference and countertransference, to reach an overall picture and respond with the appropriate help needed. Sometimes this procedure is therapeutic in itself; sometimes it takes several sessions and a team of professionals to gain a clear understanding of parental mental functioning and parenting capacities and to reach a plan of action possible in the community (or hospital) and safe and convenient for the infant and the family.

 

Chapter 5: Diagnosing troubled babies: disorders in infancy

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This chapter chronicles the major disorders in infancy. Whereas diagnosis in early childhood has been studied from a medical point of view for some time, we classify disorders on a different basis: the child’s personality, for example, or the origin of the trauma, or the regulation of inner and/or outer states, moods, communication, or habits related to sleeping, eating, and crying.

The four classification groups presented here—primary, relational, environmental, and medical—address the child, the parents, their personalities, and the way in which to treat the child. Examples are discussed and presented in order to promote thinking on various degrees of severity.

The classification aims at encouraging reflection in the psychotherapist in relation to possibilities in a distressed young child who has entrenched problems and developmental difficulties. It is of help, therefore, in positioning the “concern” or problem and remaining focused in a skilful way. Rather than leave the young child with a label, the aim is to design assistance around specific individual needs.

 

Chapter 6: Treating troubled babies: infant–parent psychotherapy

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From my exploration of the background of adult, adolescent, and child cases, I came to the realization that signs of being in trouble or of not coping with many difficult family situations became apparent early in life. The challenge that faced me as I worked year after year with cases of severe disturbance was whether these processes could be halted, and how. The more I saw different clientele with early difficulties in health centres, mother and baby units in prisons, neonatal intensive care units, and paediatric wards, the more I could see the wide range of normality, the different degrees of conflict, and the possibilities for help.

As I learned how to help, I needed to adjust my technical instruments and knowledge. Learning from this experience, and hand-in-hand with psychoanalysts, primary care givers, and paediatricians, the art and skill of early interactions evolved into the method of infant–parent psychotherapy, with variations necessary for complex family dynamics. Of primary importance to this approach has been the discovery of the infant’s personality, capacities, and communications, as well as the parent’s. This is why I call it infant–parent psychotherapy, as it started by an infant in difficulties with his parents. One could say that the infant brings the parents to the consultation.

 

Chapter 7: Special-needs babies: helping to secure attachment

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Arriving in this country as a young professional, speaking a different language, produced a certain ambivalence in me. Lack of knowledge of the cultural ground rules, looked down on as foreign, not being understood properly, and appearing mentally slow because of difficulties in following conversations produced a feeling of being disabled. On the positive side, the parallel thinking I developed led to a better understanding of autism and special-needs infants. How much more difficult it must be for a fragile or special-care or special-needs child, who has to face the parents’ failed expectations and is misunderstood, mistreated, and undervalued. I explored the possibility of becoming a last resource, when all other professionals had given up or could not work with a family, to try to find the unique challenges facing the infant and the family.

It is terribly painful for parents who have produced a deformed child, or a child with severe, possibly life-threatening difficulties, to admit their love. But it is that possibility for love and good attachment that will make life worthwhile and fuller for family and professionals. The problem is how the professionals can contain the parents without themselves adopting the same devastating defensive mechanisms employed by the parents, leaving the child with a double deficiency: the syndrome, and an outside world that has difficulty accepting them.

 

Chapter 8: Borderline and psychotic mothers: moving to insightful parenting

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The extended psychotherapeutic work necessary with mothers in an extremely vulnerable state arises from their sudden or chronic disorganization of thoughts. If proper work cannot take place, the ground must be prepared by making emotions sufficiently flexible. “Proper work” is usually taken to mean making conscious the unconscious and helping patients reach an understanding of what is happening in their lives and why it is happening. However, I consider that preparing the ground is in itself proper work, because we have to contain their transference of chaos, fear, panic, persecution, or distress and be in it with them, by acting as a different kind of mother from the one transferred.

The state of disorganization does not allow good integration at a rational level; containment by the therapist, with a description of that attitude to the patient, gives the patient the feeling of strength and sympathy emitted from the therapist. Therapists sometimes lend themselves as containers; at other times they lend capacities to think or function. It is from the continuity, availability, and flexibility of the therapist that the patient finds her identity and learns to understand and integrate her experiences. In due course, the work ends when attachments and separations have been properly exposed, experienced, and assimilated.

 

REFERENCES & BIBLIOGRAPHY

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Acquarone, S. (1986). Early interventions in cases of disturbed mother– infant relationships. Infant Mental Health Journal, 8 (4).

Acquarone, S. (1987). Psychotherapeutic interventions in cases of impaired mother-infant relationships. Journal of Child Psychotherapy, 13: 45-63.

Acquarone, S. (1990). “Warning Signals of Emotional Disturbance in Neo-nates.” Unpublished paper presented at WAIMNH Congress, Lugano, Switzerland.

Acquarone, S. (1992). What shall I do to stop him crying? Journal of Child Psychotherapy, 18 (1): 33–56.

Acquarone, S. (1995). Mens sana in corpore sano: Psychotherapy with a cerebral palsy child aged nine months. Psychoanalytic Psychotherapy, 9 (1): 41–57.

Acquarone, S. (2002). Mother-infant psychotherapy: A classification of eleven psychoanalytic treatment strategies. In: B. Kahr (Ed.), The Legacy of Winnicott: Essays on Infant and Child Mental Health (pp. 50-78). London: Karnac.

Acquarone, S. (2003). Feeding disorders. In: J. Raphael-Leff (Ed.), Parent– Infant Psychodynamics (pp. 283–293). London: Whurr.

 

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