Principles of Infant Mental Health for all disciplines
Although the field of Infant Mental Health has been around for many years now, the ideas and methods of intervention are still new to many practitioners across fields of intervention. Some practitioners imagine a tiny infant reclining on the couch, and being asked to talk about his mother with a psychoanalyst. In reality, many practitioners still go through the training in their field without any coursework or supervision regarding their work with parents, with the family as a whole, or in the context of home visits. The following principles of infant mental health lay the groundwork for practitioners in all fields.
We are no longer treating individuals, we are working with relationships
The effectiveness of interventions in every field depends upon the provider’s capacity to create and maintain a supportive and trusting working alliance with all the family members. The comfort and confidence a parent feels in his or her relationship with a provider transfers to the parent-infant relationship, enabling the parent to experience competence and the baby to feel secure. We have learned through research and experience that the parents’ relationships with the child are central to development in all domains. This puts parents in the best position to help a child learn and grow.
All of our interventions should be in collaboration with parents, with the parents in the room, and with the parents interacting with the child. This means that therapeutic home visits are not designed to give parents a break from childcare. The home visit is a sacred time for practitioners to work together with parents, supporting or clarifying parental perceptions, empathizing with the parent’s struggle, promoting self-reflection and building the strength, stamina and empathy the parents need to feel effective in their capacity to help their child learn and grow.
Respect for individual differences
If we respect the individual differences related to how each family member receives and processes information, we will enhance our ability to both connect affectively and to understand how each family member responds and adapts to their environment. If we attend to how the individual characteristics of the baby and parent match or complement one another, we will have more insight into how the child’s development is supported or undermined than if we look only at the constitutional characteristics of the child alone.
Treating a child who is sensitive to light and noise or has difficulty with transitions from waking to sleep, will be more successful when the practitioner empathizes with the father who reports he too is sound sensitive and must “hear” a hotel room before he can agree to take the room. The practitioner’s empathy for the parent’s constitutional sensitivities supports the parent’s ability to then sustain empathy for their child’s sometimes challenging sensitivity and behavior.
View behavior from the inside out
What we see on the outside in the form of external behavior is not necessarily what is experienced internally by parents or by young children. Parents’ efforts to be self-protective can mask the real underlying feelings.
A parent who appears aloof and difficult to engage on behalf of the child’s needs may actually be struggling with her own worries about being an inadequate parent. She may seem unresponsive or even rejecting professional offers for intervention. The rejection of professionals may be an effort toward self-protection from confronting the feeling that others are more skilled and responsive than she at engaging her child. A parent may be unable to tolerate watching a relationship blooming between her child and a practitioner while she yearns for warmth and intimacy with her own child. Attention to the parents’ internal experience is often put aside because the parent’s protective shield can be avoidant and abrasive. If we look through that armor and speak to the internal experience, many children will be able to benefit from the services they need so desperately.
Embrace complexity
Experience has taught us that although a referral might come to us about a baby with low muscle tone, once we get to know the family, this baby’s motor system is just the tip of the iceberg. The baby may also have dampened social sending power and the mother may be feeling blue caring for this child. The father, who has made the most of his ADHD in his career, may have been laid off from his job and at his wits end at home. A critical grandmother may have moved in, ostensibly to help out with the baby are share housing costs. And the household may be assaulted by the noise from a neighbor’s remodel that has turned into a major construction site.
If we only attend to the baby’s low muscle tone, very little will change for the child or the family. Our goal is to understand all aspects of family life including the identified child-related issues. When we work within our own discipline with an interdisciplinary mind, we are in a good position to ask the right questions and to get families the appropriate referrals and the help they need.
Stay attuned to our own emotional responses
Babies and parents are not always articulate about how they feel. But they can, and do, make us feel how they feel. When we learn to use those feelings to inform our work, we become more effective. We are more able to reflect and less inclined to react.
We intervene in the real-life moments associated with heightened feelings. These unedited moments are challenging for practitioners as they trigger our own internal feelings and reactions. The task for practitioners is to learn to keep a third eye on our emotional responses and to use them as helpful sources of information in our interventions.
↔ ↔ Stay tuned for Section 4:
Implementation of principles of infant mental health across disciplines
Barbara Kalmanson, Ph.D. is a Licensed Psychologist and Special Educator in private practice in the San Francisco Bay Area. She is a National Fellow of Zero-to-Three, Senior Faculty for the Interdisciplinary Council for Developmental and Learning Disorders (ICDL) and Senior Faculty of the Profectum Foundation.
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