Infant Mental Health Awareness Week

We are delighted to share some of our members' work this week, as part of Infant Mental Health Awareness Week, organised by the Parent-Infant Foundation. As the theme this year is '20:20 Vision Seeing the world through babies' eyes', we have focused on work with infants which has observation as a key element, exploring its different uses. We will be adding new pieces during the week.

Child Psychotherapist and Infant Observation Teacher – Amanda Mintowt-Czyz discusses Infant observation for Infant Mental Health Awareness Week.

What is a baby feeling, experiencing and learning in the earliest stages of their development? What processes are taking place in the growth of their mind, relationships with others and their capacity to communicate? Is it possible to gain some understanding of an infant’s world, to see through their eyes? Child psychotherapists would say that the process of infant observation is a way in which we can begin to come close to aspects of the baby’s inner life. They can do this by paying close attention to the detail of the baby’s behaviour, their developing relationships and interaction with the world around them.

Infant observation is an essential component of a child psychotherapist’s training. The student follows the development of a baby in their family, visiting weekly for the first two years of life. Over that time they maintain a clear observational role, learn gradually to notice more detail and come to be open to registering what is seen and felt. This can be anything from the smallest changes in gaze, facial expression or vocal tone. It includes the way the baby interacts with their caregivers, siblings and others, playing and exploring the world as well as their development of skills such as language and walking.

Through this careful and sustained attention, and a process of study and reflection within a seminar group, the student can explore potential meanings and themes from what they have seen. The student may, for example, gain some insight into the infant’s emotional states: strong feelings of anxiety, fear or frustration, as well as feelings of safety, integration and love from their caregivers. Anything may provide insight: from the way a baby feeds, what toy or book they reach for or how they react when a new person walks into the room. Over time these perceptions can add up to a picture of a baby’s growth, in its many aspects.

Having this close up experience of learning about a baby’s development is central for child psychotherapists in understanding ordinary childhood development and processes. They draw on this knowledge and it contributes to their in-depth understanding of the mental health difficulties that other children and young people experience. Their observational skills, finely tuned as a student, are also essential as they seek to help them.

To find out more about ACP accredited pre-clinical courses, which include infant observation, see our website: here

Child and Adolescent Psychotherapist, Jenifer Wakelyn tells us about the development of a new intervention for babies and young children based on observation – Watch Me Play!

Watch Me Play! is a way of supporting vulnerable babies and young children and their caregivers. Initially developed in a mental health service for children in care, this approach has been found helpful in a wide range of family contexts and as a first-line intervention before a longer-term intervention or assessment can be offered. Watch Me Play! can be adapted to work with families using phone and video links during the pandemic, as well as with families who are not in travelling distance of services or practitioners.

The approach promotes child-led play, individual attention from caregivers, and talking with children about their play. Caregivers are encouraged to provide children with age-appropriate toys and their undivided attention in a quiet environment for regular short times two or more times a week. Caregivers are also encouraged to talk with the child about their play, and to reflect with another involved adult or a professional on their observations of the child’s play and how it felt to be with the child as they played. It is aimed specifically at supporting parents with babies from the first weeks of life to children under 5 - but some families tell us it can be helpful with older children aged 6 -8.

The approach is relatively simple to implement but potentially multi-faceted in its impact. Letting the child take the lead, as long as what they choose to do is safe, allows adults to learn from the child’s play.  Receiving their caregiver’s undivided attention helps children to focus in their play and communicate. The repetition inherent in play can help to allow new thoughts and feelings to be gradually assimilated. Closely watching a baby or child's play helps parents or carers to share in their interests and explorations and helps the baby or child to settle and bond. Observing the child’s play and how it feels to be with the child while he or she plays can also help to inform further support for the child or the family. 

What parents/carers say:

‘There’s not a lot of instructions but there’s a lot to gain.’

‘Gives an awareness of the child’s perspective.’

'My child is calmer and I feel more confident.’

‘Not intervening can lead to a story being told by a child through play.'

'I can go home and do it today.’

In a series of training workshops in Watch Me Play! across the UK involving 114 practitioners and adoptive parents, 95% of respondents rated the approach as useful for their current work and felt confident to try the approach. Social workers highlighted the value of sharing play-based observations for a better understanding of the child’s strengths and needs.

In 2019 and 2020 funding for the programme has been provided by the Tavistock Clinic Foundation. The manual has been disseminated across the UK and Europe, Australia, and Japan and translations are underway into Estonian, Italian, Japanese and Russian. In 2020 the Japanese government awarded a three-year research grant to the Waseda University Research Institute for Children’s Social Care to roll out and evaluate Watch Me Play! with foster carers and in children’s homes.

The manual can be freely downloaded from the webpage in the Tavistock Website here. Anyone can use the manual. Families and practitioners are invited to download it for printing or storage and to forward to friends or colleagues it may be helpful for.

Training in Watch Me Play! can be helpful for practitioners supporting families and is provided by the Tavistock centre and by ITSIEY (see below)  Jenifer Wakelyn is happy to hear from organisations who would like to put on trainings for their staff - please contact her directly at jwakelyn@tavi-port.nhs.uk. Jenifer Wakelyn is leading a half-day online training on Watch Me Play! 

See the Why Play Matter leaflets here.

Wakelyn, J. (2020) - Therapeutic Approaches with Babies and Young Children in Care: Observation and Attention. Abingdon, Karnac/Routledge.

 

Dr Jenifer Wakelyn, is Deputy Manager and Lead Child and Adolescent Psychotherapist in First Step, Tavistock and Portman NHS Foundation Trust, and Programme lead for WATCH ME PLAY!

Yesterday, Dr Jenifer Wakelyn, one of our members who has developed Watch Me Play! described this intervention as part of Infant Mental Health Awareness Week. Jenifer has also written a book exploring more broadly observation based therapeutic approaches for babies and young children in care, which has recently been published.

Therapeutic Approaches with Babies and Young Children in Care is about the value of observation and close attention for babies and young children who may be vulnerable to psychological and attachment difficulties. There are case studies which explore the potential for observation-based therapeutic approaches to support caregivers, social workers and professional networks. A third theme in the book is the roots of observation-based interventions in psychoanalytic infant observation and the contribution of these ways of working to professional training and continuing development.

Using case examples, Jenifer Wakelyn illustrates observational ways of working that can be practiced by professionals and family members to help children express themselves and feel understood. The interventions focus on the early stages of life in care and on the ‘golden thread’ of relationships with caregivers. The book explores contemporary neuroscience and child development research alongside psychoanalytic theory to explore the role of attention in helping children to develop the internal continuity that sustains the personality and protects against the fragmenting impact of trauma.

Therapeutic Approaches with Babies and Young Children in Care is written for social workers, teachers, medical staff and other professionals whose work brings them in contact with the youngest children in care; it will also be relevant for commissioners, managers and trainers as well as mental health clinicians who are starting to work with children in care. It will provide a valuable insight into the lives of infants and young children in the care system and the applications of psychoanalytic infant observation.

Jenifer Wakelyn is a Child and Adolescent Psychotherapist, Under-Fives Lead and Deputy Manager, First Step at the Tavistock and Portman NHS Foundation Trust and programme lead for Watch Me Play! This manualised approach has been disseminated across the UK and Europe, Australia and Japan. She teaches and supervises in the clinical training in child psychotherapy at the Tavistock Centre.

What others thought!

The experience of reading this book will be therapeutic for many professionals who may feel daunted and overwhelmed by trying to help children whose lives have been severely disrupted and who have lost trust that they will ever be genuinely ‘seen’ - from the preface by Dilys Daws.

In this profoundly important book Jenifer Wakelyn and her colleagues sensitively and skilfully offer acute insights into the lived experiences of babies and young children in care and their caregivers. The book conveys deeply empathic, compassionate and hopeful understandings of trauma and what is needed to recover from it. In so doing it makes a vital contribution to practitioners’ abilities to access, and better understand, the internal worlds of the children and families they work with and provides invaluable guidance to support them in developing and delivering attentive and attuned professional engagement - Gillian Ruch, Professor of Social Work, University of Sussex and Co-editor, Journal of Social Work Practice.

The achievement of Wakelyn’s book is in its focus on the baby and young child and to help others to achieve such a focus… The examples given show how even the briefest of interventions can help young children under stress, and how flexible the method can be in a range of situations including assessments" - Jenny Kenrick, former Consultant Child and Adolescent Psychotherapist at the Tavistock Centre, writing in Infant Observation.

Parent Infant Work by a Child Psychotherapist – Juliette Flower

Child and adolescent psychotherapists support families and young people in a wide variety of ways and with focus according to children’s age and development.

For Infant Mental Health Awareness week we spoke to ACP member Juliette Flower who works in the Parent Infant Relationship Service (PAIRS) in Lambeth Early Action Partnership (LEAP), a place-based Early Intervention programme supported by the National Lottery Community Fund to improve outcomes for pregnant women and children aged 0-3 years and their families in four Lambeth wards. LEAP funds, continuously improves, and evaluates over 20 services addressing children’s diet and nutrition, social and emotional development, and communication and language development.

The PAIRs team helps parents to spend quality time together with their baby/child and to further improve their relationship. Juliette explained: ‘The main focus of the PAIRS team is Parent-Infant Psychotherapy, where the relationship between mother/father and infant is the patient, and the work is in understanding the dynamics in the mother/father-baby relationship.’ Alongside this work, the team run group sessions including; Together Time and Circle of Security, as well as offering training, supervision and consultation to other professionals working with families with babies and young infants.

Juliette explained many of the mothers she works with are struggling in their own ways with common themes of motherhood. ‘Is what I can provide good enough? Will I damage my baby if I leave them to cry?’ There can be difficulties in the transition to motherhood, a feeling of loss of identity, re-living the trauma of a difficult birth, anxieties about separation, how to manage the frequently exhausting demands of a new baby, small infant, a toddler who is constantly on the go. Past experiences and relationships with the parents’ own parents are ever present, coming to the fore with the birth of a baby, often stirring up difficult and painful memories of the care that was received. Hopefully, thinking and talking together can relieve some of their anxieties, enabling a space for thinking about the emotional experience of their babies and infants, supporting the infant’s mental health and development for the future.

During lockdown, the team have continued to offer parent- infant psychotherapy sessions by video link.  Juliette commented: ‘In normal circumstances I would be meeting the mothers and their babies in one of the local Lambeth Children's Centres. All our work happens in the community: in homes, Children's Centres, GP practices. This has enabled us to make good links with other professionals who support families within LEAP, such as midwives, health visitors, social workers and Better Start workers. These colleagues have extensive knowledge of the local community, the families that visit the centres, their needs and the difficulties they might be facing.’

In relation to lockdown, Juliette commented that as a team, they are always concerned to highlight the emotional experience of the baby who doesn't have a voice, whose anxieties may go unnoticed. They are mindful about the experience of a baby during this time of virtual relations and heightened parental anxiety.  She notes that many of the parents they work with, predominantly mothers, have significant mental health difficulties. Some parents are struggling with already high levels of anxiety and depression which the lockdown has exacerbated.  She commented that ‘Our work at this time has been very much about containing parental anxieties so that they can continue to look after the emotional needs of their infants.’

To see more about how Child and Adolescent Psychotherapists work, and how they are trained, please visit our website.