Sleeping like a baby?

Parent’s often worry will they get enough sleep when they have a new baby and baby’s often struggle to learn how to sleep.  Sometimes this can be linked to parent’s unrealistic ideas about their baby’s sleep needs, perhaps based on the idea that to “sleep like a baby” is to sleep a long and deep sleep! This does not recognise that a baby’s early sleep is often broken by the need for food and the need for doses of relationship to help a  baby grow a sense of security that there is someone there to support them while they are so vulnerable.  Many guidelines on sleep focus heavily on aspects of the physical environment such as the baby’s position, wrapping and other practical matters around feeding and night time routines.  What is often less emphasised is the importance of the emotional environment that surrounds a baby and an adult around sleep.
<jem and mags
An infant will need much support from the caregiver to learn how to settle to sleep.  Within the womb they experience inbuilt systems that support settling- rocking to sleep through the rhythm of parental movement, the whooshing sound of blood flow, and the pressure of the womb to contain them. Once born, the need then for wrapping, rocking/ patting and white noise, all in the context of a stress free environment will support the baby’s development of the ability to self sooth to sleep.  Research by Papousek and Hofacker ( 1995) and others has shown that early self regulatory competencies are closely associated with the development of the infant caregiver relationship and therefore should be at the centre of assessment and intervention where there are sleep disturbances in infants.  For an infant, the ability of the caregiver to contain their distress and anxiety so that it doesn’t pass into the infant, will mean that the infant can grow a sense of security that underpins being able to fall to sleep and stay asleep.  A parent who is unable to manage their distress in the presence of the infant will dys-regulate the infant and lead to heightened anxiety and often sleep disturbance in the infant if it becomes a repeated pattern. Supporting the parent in being able to calm and have this calm influence the infant in positive ways is often the early work of child and family services.

For adults sleep patterns, it is helpful to review habits around sleep- see http://www.cci.health.wa.gov.au/docs/Info-sleep%20hygiene.pdf for a quick check list.  Beyond good sleep hygiene practices, the need for the adult to feel safe and settled in relationships is significant to supporting sleep.  Like an infant, the bedroom should be a place where a person can feel able to rest and feel safe, which is why the bedroom should be kept as a place associated with rest or pleasure and not tension or any activity that might be associated with stress.  The old biblical concept “Don’t let the sun go down while you are still angry” (Ephesians 4:26) supports the notion of being able to rest easy in relationship with others, that will support a night of sleep that means one will wake refreshed for the new day.

wrecked after a big weekend
Mandy Seyfang

 

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Are we working in partnership?

When working as a health worker with vulnerable families, there is often organisational rhetoric  that we work in partnership across agencies in order to achieve the best outcomes for children and families. partnerships There exists differing opinion though as to what “partnership” actually looks like.  In reality often it means a referral to another agency with no ongoing relationship with that agency and little sharing of the work apart from initial basic client information.  This does not meet the definition of “partnership” as defined by Stern & Green in 2005 (‘Boundary workers and the management of frustration: a case study of two Healthy City partnerships’ in Health Promotion International, 20(3): 269–276).  They describe partnership as two or more organisations that ‘make a commitment to work together on something that concerns both, to develop a shared sense of purpose and agenda, and to generate joint action towards agreed targets’.  The Continuum of Joint Effort model developed by Success Works in 2002  highlights that there are various forms of relationships between agencies from networking through to cooperation, coordination, collaboration and finally partnership.  ( see http://www.vcoss.org.au/documents/VCOSS%20docs/HSPIC/00911_vcoss_partner_guide_1_WEB.pdf for details ). Partnership implies a sustained relationship, formal agreements, shared vision and goals, interdependence, detailed joint planning and role clarification.  In most health and community agencies there is little time dedicated to such endeavours. Questioning the quality of the relationship required to meet best outcomes for families is often neglected and the reality that true partnership is often required when working to support the most complex family units. In some situations, there may be less need for true partnership and coordination maybe all that is needed but workers require clarity around this and an understanding of where investment in relationship building across services will lead to better outcomes for families. In general, the higher the risk issues in families, the more need for partnership models for practice. Mandy Seyfang  

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Reading the signs

As a therapist, one of the key skills developed over the years is being able to quickly read and respond to signs of distress in the client. The hope is the client will experience an attuned sensitive response that help them feel seen, heard and supported.  This has the effect of containment as the person feels emotionally held and can help in preventing the spiralling of distress that may lead to overwhelming sensations of abandonment.

In most situations, the signs of distress are easily read and can often be felt in the therapist if they are well tuned into their client’s experience in the moment.
emotions
In situations where there has been past relational trauma, distress cues can be much more difficult to read and may be covered over with behaviour designed to deflect from the distress felt.  Cooper, Hoffman, Marvin, and Powell ( 2001) describe these signals as miscues – misleading or contradictory cue used to protect the child ( or later adult) from the pain of having a specific need exposed and/or unmet.

Addressing miscues is at the foundation of therapy work with traumatised adults and children with the hope that an experience of relationship with the therapist, where the underlying needs are met, will help shift towards healthier ways of connecting, particularly around distress.

The importance then of reading miscues and making sense of these and responding to the underlying distress signals is then paramount.  In conversation with parents, some of the cues that might indicate  underlying unmet needs include:

  • Incongruence- smiling when discussing distress
  • Disjointed sentences
  • Sudden move away from topic
  • Physical restlessness- wanting to finish, hurrying
  • Long pauses
  • Overchatty
  • Caregiving of therapist

Infants miscues can likewise hide underlying needs.  Examples might include:

  • Indiscriminate social behaviour
  • Falling over, getting stuck
  • Hitting self
  • Caregiving of adults
  • Giggles and high pitched squeals for no apparent reason
  • Controlling behaviour
  • baby in charge

As a reparative attachment figure (Adshead,1998), the therapist role is to pick up and make meaning of these cues and then act as an affective container (Bion, 1970) that might then be able to meet the unmet emotional needs of parents and children.  Ensuring we are able to read and respond to the signals that are different to the cues offered by others in distress situations, becomes critical in the work with these vulnerable families.  

Mandy Seyfang

 

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Conflict, Couples and Children

In work with families there is a tendency to become focused on one or maybe two individuals in the family system, typically the child or the mother or their relationship. There is recognition of the importance of engaging fathers where there is distress in the family or concerns regarding how children are progressing, but the detailed approaches to working with men around their children’s wellbeing are still being articulated in therapy circles. In the midst of this focus, there is still a hesitancy in exploring how the adult couple in a child’s life are travelling as a couple despite there being clear evidence that dysfunction in the couple relationship has BIG implications on a child’s wellbeing.
couple yelling at each other
Marshall and Watt (1999) established that marital conflict has been found to be the strongest risk factor for behavioural problems in children. They found it was significantly associated with externalising and internalising behaviours and social, attention and thought problems when children were assessed at the age of five. The more frequent and intense episodes of parental conflict were, the more likely it was that children exhibited problem behaviours. A focus on the couple dynamics around managing conflict then becomes important business for those wanting to support children’s wellbeing. It appears that how the couple manage conflict is at the heart of the health of the relationship -not unlike how children and parents manage distress in the attachment relationship. This is why it is often said to be important for couples to go beyond the “ honeymoon stage” of their relationship before making life commitments to each other as there needs to be time for conflict to become present in the relationship to highlight a couples capacity for an ongoing healthy relationship.

In terms of assessing the couple’s functioning a useful starting place is the use of the Marital Agendas Protocol developed by Notarius and Vanzetti, 1983, which asks couples to individually rate problem areas in their relationships and rank order the top three. Based on these rankings, couples are then asked to choose a top problem area and discuss the problem for 12-15 minutes, not unlike what naturally happens in a regular family session.  See http://digitalunion.osu.edu/r2/summer09/eskin/MAP.html for a video example of it in action. It is in conflict that the strength and capacity of the relationship is exposed, and the valuing of the other tested.

Malik and Lindahl ( 2000) then created the SCID- System for Coding Interactions in Dyads to assess the functioning of the couple in this conversation. Important elements that are coded are

  • Verbal aggression
  • Coerciveness
  • Attempts to control
  • Negativity and conflict
  • Withdrawal
  • Dysphoric affect
  • Problem solving communication
  • Support
  • Positive affect
  • Negative escalation
  • Cohesiveness
  • Pursuit/withdrawal
  • Conflict management style
  • Balance of power

Identifying struggles in a couple’s conflict management then needs to lead to supporting capacity building for each person individually and then ultimately within the dyad. William Doherty, Professor of Family Social Science and Director of  Minnesota Couples in the Brink Project outlines in detail in his recent article in The Therapist ( March/ April 2012) the benefits of working with each person individually to ensure there is commitment to addressing the difficulties before launching into couples therapy.

For many workers, there is a clear understanding around the impact of domestic violence on children. There is a need to further recognise the significance of more subtle yet powerful interactions around conflict in the dyad if there is to be support for healthy relations in the dyad and therefore best outcomes for children in their care.

Mandy Seyfang

 

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Shared reading and play -support for children’s development

Yesterday marked a celebration of the life of a remarkable young man who I had the privilege of teaching within the Occupational Therapy programme.  He died tragically from the effects of leukaemia at 26 years of age and left behind many people who loved him and held him in high regard.  He was academically brilliant but more than this, he was creative and sensitively relational in his endeavours.  I had the opportunity to briefly speak to his father about his most loved son and he spoke great wisdom about parenting children.  He said he had two thoughts for parents for building the capacities of children –

  1. Read to them and grow in them the love of books
  2. Turn off the TV and encourage creative play

There is much interest in the infant development field about the power of reading to a child and also of supporting play.  We know that the first three years of life are a period of incredible growth in all areas of a baby’s development. A newborn’s brain is about 25 percent of its approximate adult weight. But by age 3, it has grown dramatically by producing billions of cells and hundreds of trillions of connections, or synapses, between these cells.  The one thing we can clearly say from science of child development is that children require a responsive relational environment if they are to develop well and both supporting reading in infancy and play provide this.

baby and books

Spending time reading to babies and young children has many benefits. Lerner and Cievo ( 2004, p 2) summarise that “Talking, reading and singing all stimulate children’s understanding and use of language, and help them learn to become good communicators and eager readers” .  Likewise Trelease (2001) reports that “Reading aloud to children improves their reading, writing, speaking, listening — and best of all, their attitudes about reading”.  Through reading aloud and storytelling, children’s development in print and language exploration as well as in listening and responding are being developed.  “They learn that books contain pictures of familiar things; that they can make their own picture-like marks; that stories, rhymes, and songs are fun to repeat again and again; that they can talk about their own experiences and make up their own stories; and that trusted people affirm what they do, communicate, and say” (HighScope Educational Research Foundation, 2001, p. 5). In addition, reading to babies and toddlers requires adults to dedicate time and  focus to their child and offers the child a chance to be physically close to the parent whilst sharing an experience together. The parent will need to tune into the child’s responses to adjust their presentation of the content so shared reading also supports sensitive attunement and bonding which we know is critical to children’s wellbeing.
turn_off_your_tv_by_graphic_resistance-d3874ti

In terms of turning off the TV there is much evidence to recommend this as well.  Michael Goldstein, a language development researcher at Cornell University is undertaking research to demonstrate that social responses are fundamental to a child’s ability to fully learn language.

Babies divide up the world between things that respond to them and things that don’t,” Goldstein said. What he has discovered is that things that don’t, don’t teach. A recording does not follow a baby’s cues, which is why infant DVDs, such as Baby Einstein and Brainy Baby, have been found to be ineffective, he explained.

More disturbing though are the negative effects that TV can have on young children’s development.  In a recent study by Pagani et all (2013) that followed almost 2,000 Canadian children from birth, they found that an extra hour’s TV viewing at 2.5-years-old predicted worse performance later when they attended kindergarten. They found that the more TV a child viewed was linked to poorer vocabulary, math and motor skills at 5-years-old.

The need for children to have supported space for exploration and creativity with available parents (who are not preoccupied with their mobile phones or other distractions!) clearly does support children’s development. Magda Gerber writes that  “Infancy is a time of great dependence. Nevertheless babies should be allowed to do things for themselves from the very beginning.”  Child led or non directed play with responsive others giving feedback on gains made, is part of an infant learning agency and mastery. Learning how to include others into the play and to express ones thoughts and emotions in the play medium, builds capacity and supports development of children with few toys required to make this possible.

In the first few years of a child’s life, the investment of time in shared reading and free play, with the TV taking a back seat, will mean that children have the best opportunity to become the leaders and inspirational young people always hoped for in this world.

In memory of Nic Easton

Mandy Seyfang

 

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Christmas Chaos

“In each family a story is playing itself out, and each family’s story embodies its hope and despair” Auguste Napier

It is well known that there is a rise in mental illness presentations to health services at Christmas time. Much of this is understood to be linked unrealistic expectations and excessive self reflection with the comparison to the “perfect” Christmas image that the media portrays.
Christmas-presents
As families gather (or don’t gather) at this time of the year, there will be an emotional consequences that vary from joy to devastation.  Old family rituals, patterns and roles are often revisited and re-established with consequences on the wellbeing of the individual and family unit.  Historical triggers can open a flood gate of reminiscence that can lead to much delight or other more unacceptable feelings of sadness, shame, anger or fear.  What is clear is that the family system will be under stress at Christmas and dysfunctional ways of coping can emerge leading to internal and potentially external chaos on the day and the weeks that follow.

Virginia Satir one of the originators of family systems theory thought that up to 96% of families are dysfunctional. Her idea of a healthy family is one where “Feelings of worth can flourish only in an atmosphere where individual differences are appreciated, mistakes are tolerated, communication is open, and rules are flexible” and this is challenging on stress free days let alone on Christmas day!  She also recognised that “ what lingers from the parent’s individual past, unresolved or incomplete, often becomes a part of her irrational parenting” leading then to the next generation facing difficulties.  Adding to this, in our culture, Christmas day is associated with consumption of large amounts of alcohol- one of the ways families cope with being together, which can derail healthy thinking responses and fuel aggression and distress. The excitement of the day also can lead to children being completely hyper-aroused and having lots of difficulty containing themselves- leading the multiple meltdowns and emotional distress needing parental support that may be lacking in the midst of other agendas and pressures.

When talking with families, it is often helpful to ask them to reflect on their early memories of Christmas to learn more about how their family system worked or didn’t!  In response, what is often needed is “Presence” rather than “Presents” when thinking about this time and other stressful times of life.  We need to see the distress in others and “check in” to offer emotional and practical support as people work their way through the healing process that maybe needed from their Christmas’s past and present.

Mandy Seyfang

 

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Eyes really are a window to the soul

Poets have known for a long time and scientists are catching on that eyes are important for us to focus on if we are to identify clues to someone’s life and wellbeing. 
panda eyes
Andrew Iwach, MD, associate clinical professor of ophthalmology at the University of California San Francisco and executive director of the Glaucoma Center of San Francisco describes the eyes as “unique real estate…They’re the only place in the body where you can see a bare nerve, a bare artery, and a bare vein without doing any cutting.  And the disease processes we see occurring in the eye are probably occurring in the rest of the body.”

In a different field, Swedish scientists in Orebro University compared the eyes of 428 subjects with their personality traits to see if these structures in the iris reflected their characters. They focused on patterns in crypts – threads which radiate from the pupil – and contraction furrows – lines curving around the outer edge – which are formed when the pupils dilate. Their findings showed those with denselypacked crypts are more warmhearted, tender, trusting, and likely to sympathise with others. In comparison, those with more contraction furrows were more neurotic, impulsive and likely to give way to cravings.

the eye

In babies, eyes are incredibly important to observe – how they look and also how they are used and responded to.  Are they shiny and alert when baby is interacting and do they seek out faces and also do they blink to help regulate the baby’s arousal levels?
baby eyes

Professor A. Guedeney developed the Alarm Distress Baby Scale which can be used to help identify infants at risk of social withdrawal from a range of factors including distress in the parent infant bond.  (http://www.adbb.net/gb-echelle.html )  Key to this assessment are the infant’s eyes! The domains observed within the scale are facial expression; eye contact; general level of activity; self-stimulation gestures; vocalizations; briskness of response to stimulation; relationship to the observer, and attractiveness to the observer.  In terms of attractiveness, in 1949, Konrad Lorenz proposed the concept of baby schema (Kindchenschema), a set of facial and body features, that make a creature appear “cute” and activate (“release”) in others the motivation to care for it- and large eyes are a part of this!

In terms of the response from others to babies’ eyes, parents with trauma histories will frequently  report that their baby’s stare can be disconcerting, as if the baby can see inside them to their broken parts.  It is this that can lead to disruptions in eye contact, as the infant gaze is not met and taken in by the parent. Also parents who are sensitive to rejection may not be able to tolerate a baby’s break in gaze.  This too can lead to difficulties for infants in how they then use their eyes in response to others.

A focus on a baby’s eyes will lead to rich insights and conversations with parents and may assist in identifying those babies and parents who need more support at the start of life.

Mandy Seyfang

 

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