An Infant Mental Health Intervention

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She needed to Talk and I Needed to Listen:
 

By Deborah J. Weatherston, M.A. Director, Infant-parent Center for Clinical Service and Training, Merrill-Palmer Institute, Wayne State University, Detroit, Michigan

Understanding the importance of caregiving practices that nurture and protect babies, Selma Fraiberg and her colleagues designed a treatment model in he late 1960’s referred to as the practice of “infant mental health.” (Fraiberg, Shapiro & Adelson, 1976; Fraiberg & Adelson, 1977). Regarded as a unique approach to the treatment of very young children and families, this model embraces early developing relationships, holding parent(s) and infant together most frequently in the intimacy of their own homes and offering a context for shared observations, careful listening and empathic response. Infant mental health services offer an array of strategies for relationship-focused intervention: emotional support, concrete service support, developmental guidance, advocacy, and infant-parent psychotherapy (Lieberman & Pawl, 1988; McDonough, 1993; Weatherson & Tableman, 1989; Weatherson 1995; and Wright, 1986). Each strategy helps parents and practitioners to understand development and nurture relationships in the early years.

Included here is a very brief description of infant mental health strategies integral to the nurturing of developmental and relationships in the first years of life.

  • Emotional support may be defined as compassion offered to a parent who faces a crisis in caring for a baby. Alone or without emotional reinforcement, a parent needs someone who is able to be present, listens carefully, and holds the many feelings that threaten to make the care of a baby difficult.
  • Concrete resource assistance refers to the meeting of basic needs for food, clothing, medical care, shelter, and protection. The infant mental health practitioner who feeds or clothes or takes a family to the clinic assures them that she/he cares about them and will work to ease their burdens of care.
  • Developmental guidance is the offer of information to a parent about the baby’s development and specific needs for care. The practitioner carefully identifies emerging strengths, holding parent and infant together with consistent presence, attention and words.
  • Advocacy extends the infant mental health therapist’s role by identifying the baby’s needs for attention and caregiving, as well as the parent’s capacity to provide that care. The therapist may need to speak on behalf of a baby who has no words or a parent who is silent, further protecting their right to be safe and secure.
  • Infant-parent psychotherapy offers a parent the opportunity to explore thoughts and feelings that are awakened in the presence of the baby. In the intimacy of the home visit, a parent may share stories of past experiences and significant relationships, major fears, disappointments, and unresolved losses as they affect the care of a baby and their early developing parent-child relationship. In sum, the infant mental health practitioner holds and supports families as parents assume care for their babies, in face of difficulties, past and present.
     

Crucial to the effectiveness of these strategies within the infant mental health model is the working relationship that develops between each therapist and parent (Lieberman & Pawl, 1993). Respectful and consistent, the practitioner remains attentive to each parent’s strengths and needs. Within the safety of this relationship, parents feel well cared for and secure, held by the therapist’s words and in her mind (Pawl, 1995). The practitioner listens carefully, follows the parent’s lead, remains attuned, sets limits, and responds with empathy. Well-held, the parent experiences possibilities for growth and change in relationship to her own child(ren).

The intent of this article is to examine the relationship of infant mental health services to the network of early intervention services most commonly offered to children 0-3 years of age and their families through intermediate school districts, public agencies or departments of health. There are many questions to consider. Are mental health services appropriate for young children and families whose needs are defined by the identification of significant risk, developmental delay or disability? How will the infant mental health therapist clarify his/her role and work with other members of the early intervention team? How will he/she maintain a confidential relationship that shelters the family, at the same time working within a larger network of care? Relationships with individual families have helped us to understand and answer these questions.

The following story provides us with a careful recounting of one infant mental health practitioner’s experiences with a family who was referred when the youngest child, Rick, was 3 months old. The firstborn son, 2-year-old Jay, had recently been diagnosed as having cerebral palsy and significant developmental delays. He qualified for early intervention services and was enrolled in a developmental clinic for physical and occupational therapies once a week. In addition, an in-home teacher consultant was available through the school system, but the family was, so far, reluctant to have her work with Jay. A center-based parent-toddler group was available for additional experiences as support, but because Jay had never been immunized, they could not begin to attend. There were clearly many worries about the family, most particularly Sarah’s sorrow, her inability to follow through with the services Jay needed now, and the baby’s needs for attention and affectionate response. Although these worries were recognized by the early intervention team and clinic staff, there was no one whose job it was to help Sarah cope with her feelings about being a mother, the reasons for her despair, her caregiving responsibilities, and Rick’s development in his first year.

Sarah's Story

References

Fraiberg, S. & Adelson, E. (1977( An abandoned mother, an abandoned baby. Bulletin Menninger Clinic, 41, 162-180

Fraiberg, S., Shapiro, V. & Adelson, E. (1976). Infant-parent psychotherapy on behalf of a child in a critical nutritional state. Psychoanalytic Study of the Child, 31, 461-49).

Lieberman, A. & Pawl, J. (1988). Clinical applications of attachment theory. In J. Belsky & T. Nezworski (Eds.). Clinical implication of attachment. Hillsdale, NJ Lawrence Erlbaum Associates.

McDonouch, S. (1993). Interaction guidance: Understanding and treating early infant-caregiver relationship disturbances. In C. Zdeanah (ed.) Handbook of infant mental health. New York: The Guilford Press.

Weatherston, D. & Tableman, B. (1989). Infant mental health services Supporting competencies/reducing risks. Lansing, MI: Michigan Department of Mental health

Wright, B. (1966). An approach to infant-parent psychotherapy. Infant Mental Health Journal, 7.

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