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Chapter One - Recognising the Infant as Subject

Frances Thomson-Salo Karnac Books ePub

This book describes a therapeutic approach with a focus on interventions that are infant-led. Engaging infants engages the change processes. The therapeutic interventions I describe are mostly short-term when infant and parent are referred in the perinatal period and the first three years. The infant is viewed as a person in his or her own right and is involved in the intervention, in an approach that upholds the rights of infants. In recognising an infant's intentional self from birth (Stern, 1985), this interactive approach with awareness of the infant's theory of mind is likely to contribute to developing the infant's sense of self even if in a small way. An early sense of self crystallises around an infant being treated as a psychological being who possesses a mind so that the infant develops a sense of self and identity through interactions with an adult carer who reflects on his or her mind. Even a single meeting with a therapist can contribute to this.

When describing the interventions, I try to convey the transformational nature of a therapist's embodied communication (Shai & Belsky, 2011) with an infant. In the infants becoming meaningful to the therapist, they usually become more meaningful to their parents; parents often need to first see change in their infants before they can become more reflective. (Reflectiveness is here used as a thoughtful and open way to appreciate feelings and intentions in others as well as in oneself.) Seeing an infant responding to a therapist often triggers a reflective moment for the parent. This way of interacting with an infant can also be successful on those occasions when a therapist needs to intervene with an infant alone, when a parent is not available (see Dee, Chapter Six). What also has the possibility of being transformational are certain aspects of therapist engagement, such as at times accepting being used as needed (Chapter Nine), or at times trying to find a sense of acceptance for parents (in the face of evoked hateful feelings in the therapist), and may be particularly needed in longer term work arising out of evoked childhood hurts that a parent has experienced.

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Chapter Three - Infants and their Parents in the Perinatal Period

Frances Thomson-Salo Karnac Books ePub

Many women struggle with transition to parenthood for several reasons, and with the conflicting feelings roused by love and regression. They may have considerable ambivalence about pregnancy, birth, and child rearing, such as child abuse, or difficulty facing the dependence of a needy infant, or trauma (from any point in her life including a difficult pregnancy). Anxiety symptoms are one of the commonest complications of pregnancy, and include a reactivation of past trauma, particularly the stress of lack of partner support, and the lived experience of mental illness in one, or both, of the partners. Parents may be caught up in old conflicts with their own parents, and childhood experiences of deprivation are triggered in looking after their baby. Some mothers find the changes to their body during pregnancy, birth, and breastfeeding frightening, disgusting, or traumatic and feel the need to take their body/privacy back. A mother may feel that if her infant is “bad”, she is bad. Infants in the first year can show difficulties in every physical and emotional domain including post-traumatic stress disorders. The mental health needs in vulnerable women with borderline personality difficulties or with symptoms of anxiety and depression, substance use, intimate partner violence, and/or psychotic disorders, unstable accommodation, and contact with protective services, multiply difficulties for them and their infants, and rapid discharge from hospital may exacerbate bonding difficulties.

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Chapter Four - Infants with Young Parents

Frances Thomson-Salo Karnac Books ePub

While many adolescent mothers use their pregnancy as a catalyst for positive change, about half may struggle as this population carries disproportionate risks, presenting considerable developmental challenge for many infants and their mothers. The risks include generations of poverty, mental illness, and sometimes a history of neglect and abuse, depression, substance use, and coercive partner relationships. For the infants, there is a risk of developmental delay and later of conduct disorder and depression. Targeting the relationship that the mothers have with their infants is a window of opportunity for intervention in that the infants are less likely to be securely attached at one year of age. A young mother is negotiating herself through the adolescent process as well as the new experience of becoming a mother. She needs support so that she can participate in some teenage life, with professionals seeing some health in rebellious behaviour, mindful that an adolescent mother may hardly be cognitively ready to be a parent. She may use less mind-related comments in interaction with her infant. She may find it hard to empathise with her infant, as she may be hardly out of childhood herself, and may at times be rough. When her infant cries, the helplessness and terror may remind her of her own helplessness and if she feels very persecuted, she may walk away abruptly, increasing her infant's anxiety and anger.

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Chapter Five - Infants and their Parents in Neonatal Intensive Care Units

Frances Thomson-Salo Karnac Books ePub

Working as an infant therapist in a NICU could be subtitled, “Finding the baby whom parents do not feel able to interact with”. Parents with an infant in NICU face many stresses—the total experience and their anxiety about their infant's physical and emotional struggle to survive contribute to most parents suffering symptoms of post-traumatic stress. Many parents are terrified to attach to their baby in case he or she dies. I try to suggest meaning in how their baby is and in his or her behaviour. Some parents need to care for a surviving infant when they are simultaneously grieving the loss of a dead twin. Parents may want to talk about unbearable and unmentionable feelings of rejection for a baby with a disability, or previously undisclosed family violence.

With advances in medical and neurodevelopmental care, premature or seriously medically ill babies may have admissions of many months’ duration and there is increased awareness that the quality of social interactions between parents and babies in NICU can lessen adverse effects of preterm birth and guides therapeutic interventions. A multidisciplinary team works in partnership with families to understand the complexity of the needs of baby and family, to increase sensitivity and bonding, and decrease parental stress, and an infant therapist particularly contributes an infant perspective: I may do a consultation with a baby, for example, whose parents are not able to visit or engage in therapeutic interventions with infants and parents in the parent–infant relationship, and families of a long stay infant may need specialised help. While much work is with the staff, and it is often helpful to be around for staff to talk with in an informal way, I have focused here more on direct interventions with babies and their parents. Many parents and staff attribute intentionality and a thinking mind to babies from the first day so that babies may from the beginning have a sense that their experiences are thought about by others interested in them.

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Chapter Two - What an Infant Brings

Frances Thomson-Salo Karnac Books ePub

Here I describe the active contribution that even young infants make to the therapeutic encounter and their therapeutic alliance. I take for granted their expectable endowment of their capacity to communicate from birth, including triadic intersubjective communication, and their resilience. I highlight some emotions (Thomson-Salo & Paul, 2009), while aware that these concepts may not apply in all cultural contexts, beginning with a sense of immediacy, with both positive and negative emotions, and potential for playfulness and humour. An infant's moral capacities emerge quite early, along with the wish to know and be known in a truthful experience. Infants bring a willingness to enter the therapeutic process and often take a risk to do so. They look at the therapist so attentively that they seem to have an awareness of being in an emotionally meaningful encounter, gazing at the therapist to find out how available for interaction they are. They also bring a wish to be creative, free, integrated, and “alive”, and a capacity to pace their engagement. Even infants with an insecure attachment seem prepared to take this risk in the therapeutic process.

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