Course-correcting infant trauma through therapy

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Is infant psychotherapy that metaphorical stitch in time or yet another symptom of over-parenting? BabyYumYum looks at the evidence and speaks to the experts on the need for early intervention.

Life begins with the very act of bonding. And here, at this union, begins the story of a growing and living entity and the bonds they will later form with the outside world. In the last 10 years, research has provided overwhelming evidence for the critical period of 1000 days between conception until the child’s second birthday.

Whatever advantage or disadvantage they get in the first 1000 days determines their physical trajectory over the course of their life. And, equally, the research provides overwhelming evidence that any relational trauma a child might experience through abuse or neglect may impact on the development of their brain. Whether the impending arrival of a child is met with anxiety or longing, whatever emotional trauma or calm the mother experiences during her pregnancy is transferred to the child through the complicated transport system of the blood to the growing baby.

“Any significant and constant stress, trauma and negative experiences of a mother while pregnant can result in the baby’s brain stem being overstimulated by cortisol, a stress hormone,” says Lisa Kallmeyer, a counselling psychologist working in private practice in Norwood, Johannesburg. “So, when babies are born, instead of the natural instinct of ‘who can I attach to?’ they are born saying ‘where is the danger?’”

At the end of the 1000 days, the child starts to individuate and see themselves as separate from the mother or caregiver. “Before this, the parent-child relationship and the resultant pattern of interaction that ensues results in the baby developing an ‘internal working model’ of relationships,” says Kallmeyer, drawing on the theory of attachment of psychologist and researcher, John Bowlby.

“Trauma has an impact on the mother’s mind which is likely to compromise her ability to be thoughtful and attuned to her baby.”

“This is essentially a long-term cognitive template and is used throughout life to mediate and evaluate relationships and interactions. The baby, now a grown person, uses the knowledge of the past – the experience of being a baby in a reciprocal relationship with the parent – in responding to the present and the future. This relationship forms the basis for all future relationships, thoughts and feelings in life.”

From the onset of life into the light

In the womb, there is constant temperature as well as constant comforting sounds of mother’s heartbeat. There is no hunger nor are there cramps when they relieve themselves. They kick or cough, and the mother’s body responds. Coming from the nested place that is the womb into the noise of the outer world can be overwhelming and scary for babies, as their senses are flooded. For a first-time mother especially, it can be overwhelming to deal with her baby’s needs.

“Baby comes with its own history; parents come with their own fantasy, especially if they had a journey of struggling to fall pregnant,” says Kathy Krishnan, an educational psychologist in a private practice in Norwood. Knowing the profound impact of the first 1000 days on the way we navigate through life, Krishnan has a committed interest in supporting and developing this awareness in all spheres of society.

Drawing on the work of researcher and child psychoanalyst Selma Fraiberg’s Ghosts in the Nursery, Krishnan explains the legacy of the parents’ own emotional history that enters into their parenting circle as the dormant ghost that may prevent parents from fully developing a deep attachment with their child. If there are unresolved issues in their own experience of being parented, they will be vulnerable to how these may enact in their own experience with their baby.

Krishnan illustrates: “Baby expresses discomfort at his soiled nappy and mommy does not respond. Baby screams to get attention, but that same scream may register in the mother as anger because of her own ghosts and past traumas with anger. When parents say ‘I am sorry I didn’t hear you; I am here now’, baby learns that their needs will be met. It is not possible, nor wise, for a mother to respond one hundred per cent of the time. An over-attentive mother can also limit a child’s ability to learn to self-regulate. But if she responds adequately, baby will build a bond of trust.”

“Attachment is essentially the result of the infant’s innate temperament and the nature of the caregiving experience,” says Kallmeyer. “It is not just about proximity to the caregiver; it is about how attuned the caregiver is and about rupture and interactive repair.” This does not mean that parents have to strive for perfect responses every time, but as long as they respond often enough and try to repair the ruptures through empathy and soothing, an attachment is formed.

Our own ghosts

Just as we genetically pass on eye colour or pass down certain habits and traits in the family, attachment tends to follow an intergenerational pattern.

“Mommy’s message may be, ‘you need to learn to self-soothe, you need to be a big girl now,’ because her own ghost tells her that her own needs were not met,” says Krishnan. “If your parents did not step up when you needed support, how will you know when to step up support for your child? You draw from your own experience of being parented and if your experience of being parented has potholes, then those potholes get activated more profoundly in your experience of being a parent yourself if they have been unresolved. So, you are in a frozen position.”

“On the other hand, we may see mothers who overcompensate for their own past traumas and become ‘helicopter parents’.” If parents do not give their babies opportunities to learn how to self-regulate within in a trusting relationship, they may never learn how to handle frustrations.

When distress starts to dominate 

Trauma is like the unwanted squatter camp in the mind, taking up precious mental real estate. By forcing itself into the thoughts of the mother, it takes away from the mother’s capacity to make sense of her own thoughts and emotions, as well as her child’s feelings and desires. Baby’s cries may be dismissed because “that is what babies do”, rather than trying to pinpoint the source of discomfort.

Mentalisation is the process of making sense of one’s own feelings, desires and mental state – and the capacity to mentalise is compromised by trauma. “Traumas can vary from difficult pregnancies, traumatic labour, premature birth to any severe health-related concerns, previous miscarriages and so on,” says Kallmeyer. “Irrespective of the type of trauma, it has an impact on the mother’s mind and is likely to compromise her ability to be thoughtful and attuned to her baby, which affects her ability to mentalise about her baby. This, in turn, can affect the attachment and attunement between mother and baby.”

“Babies are very sensitive to the emotional states of their parents and caregivers and will pick up on their distress,” says Krishnan. “If that distress stays dominant in their relationship, then the children may become dysregulated, more difficult and withdrawn and have symptoms like struggling to thrive and struggling to reach their full potential. This will be enacted in difficulty eating and sleeping. Their basic needs become more challenging because that is their only way of communicating the distress that they are experiencing in their relationship with their parent.”

Another consequence may be that their brains realise that their needs are not being met and their communication is not heard, so that part of their brain begins to atrophy and shut down.

The consequences of dysregulated infant scaffolds into other problems in life. “Baby grows to be the child that finds change very confusing and difficult to manage on their own strength and then might appear to be a child with a difficult temperament in how they embrace change in different spaces. This could then impact on their learning or social interaction, on their emotional development and their capacity to appropriately lean on parents and appropriately manage on their own.”

Does your baby really need therapy?

In a decade where perfection in parenting is almost synonymous with micromanaging your infant’s schedule between mother-infant classes – where baby can socialise with other infants, to flashcards on a wall behind the nappy changing station – has infant psychotherapy become yet another fad?

“We live in a relational world, where interacting with others in an appropriate and effective way is of paramount importance,” says Kallmeyer. “When there are significant attachment problems early on in life that are not repaired, this opens up the possibility to many problems.”

However, it is not just baby that needs therapy. “Parent-infant psychotherapy (PIP) works within the realm of the relationship between parent and infant,” says Kallmeyer. “As the infant is entirely dependent on their parent or primary caregiver, PIP draws both the caregiver and infant into the therapy to course-correct a maladaptive internal working model and repair the attachment between the parent and child and moderate a traumatic past.”

The growing understanding of how an infant’s mind works means we may need “translators” who can interpret those cries as evidence of the language of infants, especially where the caregiver may still be experiencing the effects of her own trauma.

“Books can provide rich information but it can be a challenge to internalise that information unless that information can be related to or understood,” says Krishnan. “Repeated positive experiences enable parents to rewire their own experiences of being parented and sometimes parents need help to see what those ghosts or intrusions are through a professional eye because it is so complicated that they struggle to see it on their own strength.”

“Much of our work as psychotherapists is psycho-education,” says Krishnan. “We help parents understand that there is a function to the cries and distress of their babies. We try to explain what can be expected of an infant of that age, for example, that a newborn may not be able to self-soothe but as they grow, they will learn to do so.”

“As a therapist, I would consider the system between the caregivers and the baby. If I am changing the internal working of the machine, I need to know where the machine joins to the bigger machine and what adjustments need to be made for the two systems to work. I will observe, for example, the mother suckling her child and perhaps point out that she did not look at her baby, or later, that she looked at her baby but did not seem to be enjoying the interaction. We try to find out how the mother responds to her baby and to construct meaning from that interaction without being persecutory. We equip the mother with practices that may help her understand and connect with her baby.

“Parents may not find it easy to read what their children are communicating and this may be based on their own journey of being parented. As psychotherapists, we try to identify the ghosts and past stories of trauma that may be compromising their enjoyment of each other.”

If we can address these vulnerabilities in the first 1000 days of life, there is a better chance that the child reaches their greatest potential. Moreover, we can prevent the cycle of trauma from passing to future generations as part of their family’s emotional and psychological legacy.

Who should consider therapy?

Parent-infant psychotherapy can help repair traumas caused by any of the following:

  • Where parents have a history of infertility, miscarriages or stillbirths
  • Adoption
  • Struggling to breastfeed and bond with baby
  • Traumatic births
  • Postnatal depression
  • Any stressor or trauma that compromises a relationship from forming or that impacts other relationships.

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