Sarah's Story

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By Deborah J. Weatherston, M.A. Director,

Infant-parent Center for Clinical Service and Training, Merrill-Palmer Institute, Wayne State University, Detroit, Michigan

 

The confirmation of Jay’s diagnosis and his significant developmental delays had understandably left Sarah, a 27-year old mother, filled with despair. Described initially by the early intervention staff at the clinic as “overwhelmed, yet concerned,” Sarah appeared “increasingly inattentive and depressed” following the birth of her second child. She brought Jay to the clinic for his appointments, but sat with Rick in the hallway, “extremely quiet and self-absorbed.” The social worker that coordinated the case was sensitive to Sarah's sorrow and also to Rick’s lonely face. She recognized, too, that Jay was missing his mother’s involvement and care. In making the referral for infant mental health services, she explained to me that “Sarah doesn’t pay the kind of attention to her baby that I’d expect. He’s just beautiful! She doesn’t talk to him or pick him up if he cries. She doesn’t seem interested in responding to anything he does. She just sits there. Jay is beginning to be left out, too.” The social worker, a compassionate professional whose job it was to find and coordinate resources, felt that the family could use more intensive mental health treatment than she or the early intervention specialists at the clinic could provide. “Sarah needs someone who can listen to her, help her feel less depressed. I’m worried about the baby. He doesn’t smile or try to reach yet. I’m also worried about Jay. He needs more of his mother’s care. Would you be able to see them and offer your help?”

 

It is important for the reader to understand that infant mental health services were included in an array of services available to children and families in Michigan at the time this referral was made. Most of these programs are offered through the community mental health system. Up until several years ago, there was no charge to families for infant mental health services. Families who qualified could be seen regularly, for up to several years if necessary. Enrollment was not based on their ability to pay. The Michigan Department of Mental Health and local community mental health boards traditionally provided funding for infant mental health programs. Within the past few years, some infant mental health programs have received reimbursement for home visiting services through Medicaid. In these instances, the length of service to a family is determined by the degree of risk to the infant or caregiving parent. Families who do not qualify for Medicaid may be assessed a fee for infant mental health services based on their ability to pay. However, the mental health system has traditionally believed that infants and families have a right to infant mental health intervention through early and preventive services. As a consequence, for the past 10 years, more than 1200 families with children under three years of age have been served each year in Michigan through the community mental health system.

“What could an infant mental health specialist do that the others could not?” I asked myself. I could go to Sarah’s home weekly, or twice weekly if that seemed necessary at first. I could see all of them together. I could go without interruption for at least a year. I could listen and try to understand their sorrow and restore Sarah’s confidence. I could offer guidance about her baby’s care and development. I could offer emotional support to both parents related to Jay. I cold offer a relationship in which they could share thoughts and feelings awakened in the presence of their children that made caregiving difficult. I told the social worker that I would be pleased to offer my help. Actually, I was delighted! This team of early intervention professionals trusted me, a mental health practitioner, to work with one of their families. I was also nervous. Teamwork was new for me. Part H, Early On was a new adventure. As an infant mental health professional, I had most often worked alone with a family. I didn’t talk with others outside of my agency about my work. I knew little about disability. What if Sarah didn’t find me to be very helpful? What if I couldn’t understand what the difficulties were? What would my participation as a member of an “interdisciplinary team” really mean? I had to admit that I felt somewhat afraid as I embarked on an intervention in this new era of collaboration and shared family work.

The social worker spoke briefly to Sarah when she came to the clinic for Jay’s next appointment. She asked if Sarah would like to talk with a professional who specialized in helping parents through difficult times with their very young children, someone who could come out to their home and be available to her. The social worker called to tell me that Sarah was interested and expected my call. I called her the next day, described our services and offered to drive out to meet her, her children, and her husband, if it would be helpful. Sarah sounded willing, but nervous, not unlike me. “How can you help me? What will you do that is different from everyone else?” I could almost hear her ask me.

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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