When Minds Meet: PAUSING, CONNECTING, RELATING. Some thoughts on Mother-Infant Psychotherapy. AAIMHI-APN Joint Conference, 2007 Dr Ian Harrison VMO Psychiatrist - Karitane

Pausing … Before we begin

Know the Value of Mother- Infant Work. There is nothing more valuable for the community’s future.

Know Yourself What do babies do to you?

An Ink Blot

Know what you believe about babies. Know what babies “do” to you. How do you react to different babies? What is your automatic thinking about babies, your own baby “prejudices”? What you think about mothers and babies sets the stage for how you connect with mothers and babies.

Let mothers start where they wish with their new babies. Begin with a Positive Partnership.

Let mothers start where they wish with their babies. Mothers need to be given an opportunity to do things how they want. It is rarely helpful to prescribe at the outset. Try to exhibit confidence in the mother’s choices.

Connecting …

Hear The Story of the Baby. Assume that most mothers have some trauma that will effect their relationship with their baby.

Every mother and baby have a unique story. Help to ventilate the story of the baby. We listen to the mother so that she can “listen” to the baby. Selma Fraiberg – “Hear the mother’s ‘cry’ and she will then be able to ‘hear’ the cry of her baby”.

Try to meet the new mother’s dependency needs. Model a secure attachment relationship

Be willing to accept and meet the new mother’s dependency. Healthy mothers, like healthy babies, will wish to become “dependant” on you as their therapist/caseworker. Accepting the mother’s dependency in turn helps the mother to accept the dependency of the baby.

Model a secure attachment. We try to be a “secure object” for the mother so she will know unconsciously what to do with her baby. We try to be as available as possible for the new mother. Schedule regular sessions. Regularity is more important than frequency. This avoids the well baby being brought along as a “ticket” for the mother to see you.

Try to see mothers and babies together. This makes any therapy far more effective.

As a general principle always try to see the mother with the infant. This is especially true if the infant is difficult or unsettled.  If you can’t stand the infant for a brief period of time, how can the mother be expected to cope?  There are enormous opportunities to model attachment behaviours when the infant is unsettled.

Relating…

Promote a wider supportive network. Everyone can help in some way.

Transference is your friend. Take advantage of it. Mothers project all sorts of feelings onto their therapists

Monitor how you are feeling Your feelings are often not your own! Try to monitor how you feel (counter-transference) and feed it back as a trial interpretation. “I guess it seems that a lot of the time it doesn’t matter what you do. It just doesn’t work.” or “I guess you are feeling at times that you know nothing about looking after a baby.” These interpretations can be enormously relieving for the mother and very helpful.

Help Parents To Reflect On Their Baby’s Emotional Experience. Many caregivers lack this ability at first. It is crucial to relating.

Keep a Solutions Focus. Maintain a solutions “tool box”.

The Solutions Focus Make use of what is already there. Always seize on what the caregiver is doing right. – Look for previous skills. Strengths. – Avoid focus on deficits. Avoid the blame game. – Look for the exceptions. When does the solution already happen?

The Solutions Focus (2) How would you know if the solution had arrived? The “magic question”.

Reframe “Negative” Behaviour to Promote Attachment. Help the infant’s attachment behaviours to become the solution not the problem. Language is important. Identify key metaphors. War vs Gardening – “battles, winners, losers, campaigns battle- grounds, retreats, casualties, combat, fighting, retreat, strategy, tactics etc – Growth, nurturing, pruning shaping, arranging, paths, borders, shoots, dormancy and flowering

Use Positive Suggestion. Use your leverage as an attachment figure.

The use of positive suggestion. i.e. you simply speak as if this will definitely happen, that they will do these things.  This is a form of ‘waking suggestion’.  Related to hypnotic techniques.  You can “see” them being a sensitive mother.

The use of positive suggestion  We Draw a new “dotted picture” of the client which the client later fills in.  You draw the picture of their future (positive) behaviour and interaction.  The client fills it in later with their behaviour.  A case example.

Don’t give up. The mother’s and baby’s development is an ongoing process.

.…..A Cycle…. Connect Relate Pause

THE END