The Developmental Science of Early Childhood by Claudia M. Gold

Author:Claudia M. Gold
Language: eng
Format: epub
Publisher: W. W. Norton & Company

Part II

Clinical Applications of the Infant Mental Health Paradigm

7

How the Science of Early Childhood Informs the Therapeutic Relationship

Part I focuses on the infant mental health principles that guide our listening in the clinical setting:

primary maternal preoccupation, the holding environment, and the good-enough mother

facilitating mentalization in parents

the child’s contribution to the relationship

the mutual regulation model of parent-child interactions

the neurosequential model of therapeutics

using relationships to change the brain

Part II focuses on clinical applications of these principles, beginning with an explicit look at the clinician-parent-child relationship as informed by an infant mental health paradigm.

THE RELATIONSHIP AS THE PATIENT. Because a caregiver’s ability to hold a child in mind facilitates healthy development at the level of gene expression and brain structure, our central task as clinicians is to hold the caregivers in mind, to listen to them in such a way as to help them find meaning in their child’s behavior. We hold the parents in mind to support their efforts to hold their child in mind.

Or, going back to Winnicott, just as the parent provides a holding environment for the child, the clinician offers a holding environment for the parent-child relationship. The presence of the clinician with the parent promotes the presence of the parent in a way that facilitates healthy development of the child. When the relationship begins to heal, parent and child move from mutual dysregulation to mutual regulation.

The science of early childhood offers us a frame for treatment. Commonly today when we speak of “behavior problems” or utilize DSM diagnoses to guide treatment, the problem is seen as located squarely in the child. What Part I has shown is that we can understand the child’s experience, or make sense of the behavior, only if we examine the relational context. This understanding, in turn, offers a guide to treatment.

For clinicians working with children of any age, although parent and child may not be together in the room, the relational nature of the problem is central to making sense of the behavior, whether the child is five months, five years, or fifteen years old. In their book Working With Parents Makes Therapy Work (2005), Kerry Kelly Novick and Jack Novick outline a model for including parents in therapeutic work, even with adolescents. The child being held in mind by the parent facilitates healthy development in the child. For this to happen, the parents must be an integral part of the treatment.

Psychoanalyst Selma Fraiberg is in a sense the mother of the discipline of infant mental health. Fraiberg and colleagues’ groundbreaking 1975 paper, “Ghosts in the Nursery,” describes the first infant mental health program, in which a staff of experienced psychologists and social workers went into the homes of mothers who had been abused. By forming a close connection in a supportive and understanding way while these mothers were interacting with their children in their own homes, the staff were able to significantly improve the parenting capacities of these traumatized mothers. The most important part of this intervention turned out to be the relationship between the therapist and the mother.

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