FAMILY AND CHILD

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Psych 441-01C

Spring 2022, Week 4 Prof. Peggy Vaughan Class Discussion of Leiberman et al. Reading: Angels in the Nursery Focus on Two Case Vignettes and Caregiver-Child Interventions W hy Intervene? Early Development and Early Family-Child Interventions

February 22 � Note: These slides review some concepts linked to

early parent-child intervention, and recap the intergenerational model from earlier slides. They focus on the context of intergenerational transmission. They also refer to some points from the the Lieberman and colleagues article reading.

� We will brief ly review and discuss intergenerational transmission before we discuss the specific cases in small groups.

� Discussion questions can be found on the last three slides (and on the handout).

Prevention (from week 1) � Science shows that providing stable, responsive,

nurturing relationships in the earliest years of life can prevent or even reverse the damaging effects of early life stress, with lifelong benefits for learning, behavior, and health.

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Psychosocial Development as a Context Erikson's Earliest Stage of Psychosocial Development: Trust Versus Mistrust, Stage 1

� Erik & Joan Erikson proposed eight stages of psychosocial development. At each stage, the developmental task is to resolve a particular issue. � In the first stage (birth to about 1 year), the infant must

resolve the issue of trust versus mistrust. � According to Erik & Joan Erikson, securely attached

children, those who receive early caregiving that is loving and responsive, develop a basic trust that the world is predictable and reliable.

� Autonomy and Initiative are the healthy child outcomes of the toddler and preschool stages in Eriksons’ theory.

Erik Erikson (1902-1994) Joan Erikson (1902-1997)

Challenges of Parenting: How do caregivers read an infant’s or young child’s cues? � Observe behavior and “read” basic emotions.

� Observe infant’s and child’s overall responses to caregiving and sensory experiences. � Facial and bodily expressions: reactions and signals � Verbal and auditory cues � Activity and language during play: Identifying emotions from

facial cues and child’s language and behaviors. � Reactions in varying environments: joy, distress, fear etc.

� Read emotions in order to attune to infant and child needs; respond and provide sensitive care. � Emotional expression and give and take.

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Role of Parental and Family History � Some parents face more serious caregiving challenges.

Question � How is this detailed and represented in the Lieberman

Padrón, et al. article?

Impacts of Family History Intergenerational Transmission

� Parents may remember and even reenact scenes from the past with their own small children

� Varying levels of remembered events, as well as unremembered events

� Inf licting pain or ignoring infant or child could be an avoidance of one’s own pain

� Ghosts in the Nursery (Fraiberg et al,1975): These are “present” when there has been maltreatment or neglect

� Harmful inf luences: may disrupt development and infant-parent relationships

� Angels in the Nursery (Lieberman, et al,2005): present when there was caring and responsive parenting. Heroes as well.

� Benevolent inf luences: may guide the course of development and healthy infant-parent relationships

Intergenerational Influences Overall Points

§ Angels and ghosts as “siblings” existing together at times (heroes as well) § Protective versus harmful/malevolent influences § Exist in a dynamic tension

§ Healthy adaptation may win over parental intrapsychic conf licts or preoccupations

§ Lieberman et al: Uncovering of the angels more important than “exorcising” the ghosts

§ Placing trauma in context; integration of the inf luences

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Why Intervene? (from Week 1) � Support from neuroscience research

� Providing supportive and positive conditions for early childhood development is more effective and less costly than attempting to address the consequences of early adversity later.

� Effective policies and programs… � identify and support children and families who are most

at risk for early intervention � reduce or avoid the need for more costly and less

effective remediation and support programs down the road

Intervention: Methods of Treatment

� Infant mental health model � Psychoanalysis/Psychodynamic parent-child therapy � Social work � Developmental psychology � Teaching and supporting � Consultation with specialists with a consideration of

culture

� Key to all early mental health treatment and interventions is the importance of supervision, both clinical and developmental.

Supporting children and caregivers when challenges exist and a child’s needs are not being fully met.

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Intervention:Questions to Ask � Why intervene? � When intervene? � What about trust and family privacy? � How do we assess potential for change? � What approaches and models work best? � How do we address culture and beliefs? How

important is the visitor or therapist to match family (for language and culture)? Role of gender?

� Why is multidisciplinary model or approach critical? � How do we best define infant mental health?

Selma Fraiberg’s Significance � Fraiberg’s (1975) study of infants at developmental risk

focused on parent-infant relationships. � Parents were included in the treatment process to help

them become more attuned to their infant/young child. � In her collaborative work Fraiberg and her team:

� highlighted the intergenerational issues (intergenerational transmission) that shaped the parental capacity for empathic nurturance between parent and child.

� integrated insights from the fields of social work, psychoanalysis, and developmental and ego psychology in her research and practice.

Parent Child Relationships � Fraiberg suggested that ghosts from the childhood of

many parents are allowed to invade their children’s nurseries when parents “identify with an aggressor” rather than the young and fragile child. � linked to a form of repression � provides motive and energy for repetition.

� Some ghosts and patterns are easily sent away or banished as parents want something better for their child. � These parents are and capable of recognizing the ghosts

and the patterns.

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Angels in the Nursery Lieberman, A., Padron, E., Van Horn, P. & Harris, W.W. (2005). � Lieberman et al. emphasized angels as a response to

Fraiberg’s ideas about ghosts and related pathology. � Angels - focus on positive memories and healing

� Care-receiving experiences are intense and involve shared affect between parent and child in which the child feels nearly perfectly understood, accepted, and loved.

� Care provides the child with a core sense of security and self-worth. Positive memories can also be drawn upon when the child becomes a parent to break or change the cycle of neglect and maltreatment.

Seeking the Angels

“Uncovering angels as growth-promoting forces in the lives of traumatized parents is as vital to the work of psychotherapy as is the interpretation and exorcizing of ghosts.” Lieberman, A., Padron, E., Van Horn, P. & Harris, W.W. (2005, pp. 511-512).

Studies of Trauma (Lieberman et al.,2005) � Children and their parents traumatized by exposure to

various forms of interpersonal violence, display a broad range of parental responses.

� These range from anger at the traumatized child to an exquisite attunement to the child’s suffering and determination to restore the child’s emotional health.

� A similar range of parental responses has been reported in nonclinical settings such as when traumatized children are brought to the attention of the authorities such as via law enforcement.

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Angels: Parent-Child Therapy � Lieberman and others worked with ethnically and

socioeconomically diverse children ages birth to six and their parents. � Children/parents had witnessed or experienced trauma or

maltreatment

� Their clinical studies with these children and parents identified parenting difficulties � Lieberman and colleagues’ work involved clinical interviews

and the use of the Adult Attachment Interview (Main, M., 1986; 1996). This interview refers to the parents’ recall of their own early attachment experiences.

Adult Attachment Interview (AAI) � A semi-structured interview measure developed by

Mary B. Main that probes alternately for descriptions of the past relationship with parents, specific supportive or contradictory memories, and descriptions of current relationships with parents.

� An individual's current state of mind regarding childhood experiences with caregivers is inferred from a semi-structured interview (Hesse, 1999; Main & Goldwyn, 1998).

Therapeutic Vignettes � The two following vignettes from the article focus on

how parent-infant/parent-child therapy can in gradual and subtle ways lead to changes, understandings, and insights. These two case are meant to offer brief examples illustrating how parents can be supportive and attentive to children during interactions.

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Lieberman Case 1 Questions � Mrs. Arenas, her 4-year-old daughter Nancy, and the

Therapist � Note the issue/problem that the family is facing � Describe the child and her behaviors – as observed by

the therapist. � What is the mother’s behavior toward the therapist? � What are the therapists’ strategies? What leads the

mother to open up and to share more of her past? � How do the “angels” play a role?

Lieberman Case 2 Questions � Mr. Robertson, 4-year-old Martin, Mrs. Robertson, and the

therapist. � What is going on in the family? What are the issues and

concerns? For example, what had Mr. Robertson shared during the family assessment?

� What example was shared about Martin’s reaction when Mr. Robertson (his dad) arrives home early one day?

� Describe Martin’s behavior during the parent-child sessions and what his father learns.

� What memories does Mr. Robertson share and are these memories helpful to his parenting and the parent-child relationship?

A Few Overarching Questions 1.What do ghosts and angels represent in Lieberman's work and how do these relate to the intergenerational model? Does the more psychodynamic focus of therapy fit well with parent-child intervention?

2.What is the role of the therapist in each case? Why and when is it necessary to intervene in the parent-infant/parent-child relationship?

3. Does it make sense to work and work with parents to change their patterns of care while also trying to protect children?

4. How can providers and therapists assess parents’ and families’ needs and strengths and their potential for change? How can an effective intervention support parents and caregivers so that they can see their angels and their strengths?