Used by permission of YCS (Youth Consultation Service)
Permission given by
Gerard Costa, Ph.D.—Director
YCS Institute for Infant and Preschool Mental Health

Please do not make copies of this document
without first receiving permission from YCS

For additional information on YCS and their training programs in Infant Mental Health,
please visit their web site at: www.ycs.org

Editorial comments by the Foundation are shown in brackets

What is Infant Mental Health?

Infant Mental Health offers ways of conceptualizing early disruptions in the attachment process, and of organizing interventions which include developmental/parental guidance, systems' advocacy, supportive counseling, and a unique kind of treatment—infant-parent (dyadic) psychotherapy—where the presence of the infant in the work is essential.

Infant Mental Health is an interdisciplinary field concerned with the optimal physical, social, emotional, and cognitive development of the human infant within the context of his family. The infant is principally viewed within a primary caregiving relationship—usually with his mother—and this pair or dyad is the focus of assessment and intervention.

Why it is important to receive training in Infant Mental Health?

Infants' capacities for relationship are often underestimated. A guiding principle in Infant Mental Health is that the infant comes to the world with remarkable capacities to establish and regulate human relationships. Infants are surprisingly competent and are far from the “blank slate” they were once thought to be. Infants are able to visually track faces soon after birth, and, within two weeks after birth, the infant shows differential responsiveness to his own mother's breast milk, his own name, and his mother's voice. Moreover, infants possess an amazing repertoire of social and emotional capacities, including gestures, facial expressions, gaze, and head turning patterns—all designed to give the caregiver information about the infant's well being, but which also enable the trained specialist to discern how well the infant and dyad are doing. Infants actively behave in such a way that modifies and regulates the behavior of the caregiver: they can signal when distressed, quiet themselves, and display differentiated cries, including a “fake” [abstracted or conceptual] cry that develops at 4-6 weeks as a clear bid for attention. Infants seek emotional responsiveness from their caregivers and become disturbed when such displays are not present.

Theorists and researchers in the area of early attachment assert that human infants are endowed with predispositions toward relationships—attachment promoting behaviors or APB's—but these predispositions may go awry when the environment is inadequate or unresponsive. These capacities can also be compromised by genetic problems, prematurity, maternal illness, environmental toxins and intrauterine assault, such as in utero drug exposure, poor prenatal care and nutritional deficiencies. Although the infant's contribution to his relationship with his caregiver is great, it cannot be separated from the context of the caregiver. The infant-caregiver relationship will suffer, then, when infants fail to display behaviors or characteristics which elicit and reinforce caregiving—as in the case of some premature, drug-exposed infants or handicapped infants—or when the caregiver cannot modify his/her expectations or is not emotionally responsive or available.

Zero to three is a critical period of development.

The period of life from birth to three years is a critical period of development for the formation of what we call “character” or “personality.” Before there is thought and language, there is emotion, and, from the earliest moments, infants have rich emotional and psychological lives. Infants are active contributors to their relationships, and on the basis of these relationships, they form “representational models” [akin to Bowlby's Inner Working Models of attachment or simply IWMs] about themselves and the world.

From birth, infants begin to develop an understanding about themselves, their caregivers, and the world, based upon their experiences in their earliest relationships; this understanding becomes stored as mental representations or “working models” of relationships and serve to guide future behavior in interpersonal situations [which includes mentalizing behavior]. Infants' earliest experiences with caregivers begin to determine the answers to such questions as “Am I loved or unloved?”, “Do my feelings and actions get felt with and responded to?”, and “Are others to be trusted or mistrusted?”. [These types of questions are designed to ascertain and assess implicit mental states in self and other.] For this reason, emotionally attuned and responsive early experiences with caregivers are essential for infants to come to know the world and themselves as fundamentally good [and mentally knowable]. Moreover, recent research indicates that such experiences become “biologized;” that is, actual changes take place in the physical and chemical structures in the brain, so that the infant's experience of early caregiving—as well as the failures of the early environment to provide adequate care—can have an enormous and relatively permanent impact. At birth, the final “wiring” of the brain awaits experience; and the infant's earliest attachment organizes the nature and quality of these experiences and the “wiring” that occurs. Infancy is clearly a critical period for development in all domains.

Social and emotional development within the context of the earliest relationship forms the basis for all development along multiple lines—cognition [especially conceptual cognition], language, gross motor, fine motor, self-help, and social functioning [such as mentalization, which includes empathy]. When the infant is not met by a warm, attuned, and available caregiver, the capacity for social relatedness and development along these multiple lines can go awry. From this perspective, then, it becomes clear why it is essential to provide early intervention to the infant-caregiver dyad to promote the attachment relationship. If intervention is delayed until emotional and behavioral problems become obvious [i.e., Bowlby's “forty thieves” study], such efforts will require a greater expenditure of resources and are less likely to be effective.

Importance of the caregiver's own childhood experiences.

Clearly, the caregiver plays a profound role as a partner in the infant's emotional development. The single most important factor in the infant's and child's emotional well-being is the caregiver's emotional well-being. The nature of the infant-caregiver relationship is in large part determined by the nature of the parent's own childhood experiences and psychological history [underscoring the intergenerational nature of attachment relationships and behavior]. Pregnancy and childbirth are powerful and often unconscious reminders to the parent of childhood issues that may help or hinder the parent in responding to, caring for, and loving the infant. Parents whose early lives were characterized by unmet needs, by separations and abandonment, or by inconsistent and unattuned caregiving, may revisit these issues within the context of their relationships with their own children [in essence, revisiting the “small T” relational traumas of their own childhoods]. Parenting is a relationship, not a skill - and when parents are under stress they behave more on the basis of their [implicit] character than their [explicit] knowledge. While aspects of parenting clearly can be learned, parents whose own psychological health is compromised will be less able to use such learning.

Selma Fraiberg, the social worker and child psychoanalyst at the University of Michigan in Ann Arbor in the 1970s, is credited with beginning the field of Infant Mental Health, and developing the early approaches to infant-parent psychotherapy. Ms. Fraiberg often noted that the work of the Infant Mental Health specialist was to help find ways to “mother the mother” so she can be a “mother to her baby.” She coined the term “Ghosts in the Nursery” to refer to the specter of a hurtful parental past that can often “haunt” the infant-parent relationship. Parents whose lives have been hurtful can often think and feel malice towards their baby [i.e., project adult beliefs and desires onto their baby, a baby incapable of such beliefs or desires] and then treat their baby “as if” they are a hurtful figure from the parental past. The phenomenon whereby the baby is treated as if he/she is someone else (again, the parent projects qualities onto the baby that belong to others in the parent's life) is referred to as “baby as transference object”. This likely accounts for a large proportion of the tragic number of child maltreatment and infanticide cases. [According to attachment researcher Alicia Lieberman, such cases are on the rise.]

Despite the importance of development during this period and the costs of early derailment of the infant-caregiver relationship, there is a paucity of programs providing services to infants, toddlers, and their parents. There are even fewer training opportunities for professionals in the field of Infant Mental Health, with an absence of such an emphasis in most graduate programs in clinical psychology and related fields. Although there are a few notable exceptions, most Infant Mental Health practitioners develop their expertise in a piece-meal fashion through informal, mentorship relationships and rarely receive both theoretical and applied training in a single, comprehensive program.

The Institute for Training in Infant and Preschool Mental Health, is an effort to create this kind of training program. This kind of program differs from many others in that it makes Infant Mental Health training available to psychologists early in their careers (at the graduate level) which is an important time for the formation of one's professional identity. The integration of such training into existing graduate programs in psychology will ensure the creation of a cadre of Infant Mental Health professionals prepared to intervene during this critical period.

What is Preschool Mental Health?

The child's capacity to use imagination in play and thought, to communicate in gesture and word, to experience and express the full drama of human emotions and begin to develop ways to regulate very strong feelings, to handle excitement and arousal, to learn how to seek comfort and be self-comforting, to feel safe and secure enough to explore and be curious about themselves, others and the world, to engage in increasingly interpersonal activities, to form loving and reciprocal relationships - all these grow out of adequate infant mental health and constitute elements of preschool mental health.

Development continues along multiple lines during the preschool years (3-5), with growth in play, cognition, emotion and communication linked to the nature of the child's relationships. Emotional and developmental progress and their connection to the child's relational world are the areas for assessment and intervention in preschool mental health. [And, unfortunately, many of the standardized tests currently in use in the preschool arena are not capable of properly assessing dimensions such as emotional and relational development.]

Training programs must prepare students for clinical assessment, intervention and consultation in problems of development and relationships during the preschool years. While the importance of early identification of developmental disorders during the first three years of life will be emphasized, the emergence of language and symbolic play during the preschool years require special clinical skills. The nature of the child's progress or difficulties in development and the nature of the caregiving relationships must be understood so that intervention strategies can be developed.

Accordingly, the Institute is developing a training program in the field of preschool mental health. Ways to provide therapeutic intervention, foremost including parental and developmental guidance will be examined. In particular, work with children who are developing serious emotional problems, both internalizing and externalizing disorders, will be studied. Assessment of emotional development, social relatedness, use of language and play, and impact of trauma and inadequate care will be examined. Among the strategies of intervention we hope to develop within our students is the ability to provide “developmental help” to children, and to assist parents and caregivers in providing a supportive, attuned and clarifying relationship with infants and young children. Infants and preschool-aged children need adults who can “feel with them” their full range of feelings, and help them contain, experience and express these feelings in ways [especially conceptual and imaginative ways] that make the world feel safe.
 

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