WITH PARENTS AND INFANTS
C.F. Zachariah BOUKYDIS
Brown University Medical School. Providence. R.L. U.S.A.
I have been working to develop a model for consultation on the parent- infant relationship which derives from client-centered/experiential theory and which integrates research on non-verbal communication between infants and their parents. This chapter will highlight some of the settings where this approach is relevant and discuss some of the principles of consultation.
Research on non-verbal communication between parents and infants has done much to elucidate the subtle patterns or sequences of interaction which occur. Observers of parent-infant interaction have called this exchange “the behavioral dialogue” (Bakeman & Brown. 1978): Both participants go through cycles of attention and inattention and modify their behavior over time to promote optimal levels of attention (Tronick, Als, & Brazelton, 1980; Condon & Sander, 1974; Stern, 1971, 1985). High attentiveness promotes social learning, cognitive development and self awareness (Thoman, 1975). Infants seem to enjoy having their actions responded to contingently and this kind of exchange leads to an early awareness of the relationship between self and other: as well as promoting the feeling of efficacy (Goldberg, 1977) at being able to initiate and sustain interpersonal discourse.
From the perspective of non-verbal communication and sensory awareness. the relationship is not only experienced on visual and verbal modes. but with all senses including taste. smell and touch. Thus, the “knowing” which develops for both infants and parent must be based on information integrated from these sensory modalities as well. The parent-infant relationship, based on all senses, can lead parents back to a more basic experience of self and may call forth early memories either as an explicit knowing level or an implicit “felt in the body” level. What is felt, is felt in the body, at a level below ordinary awareness: before the distinction between body and mind. This kind of awareness can be disruptive. It is here that a perspective developed from client-centered/experiential theory is important. We are interested in the relationship between the “observable” and the “felt” in the relationship.
The consultation context
Within the consultation context, we are asked to deal with a variety of parenting concerns where the difficulties arise from problems at management (feeding, sleeping, crying patterns), problems due to a mismatch of personalities between parent and infant, problems due to infant behavior or temperament. or problems due to parental perception of the infant and of their relationship. From the client-centered/experiential perspective, we would say that the relationship is structure bound: The natural self-correcting tendencies of parent and infant are not working and certain unproductive cycles of behavior are repeated.
The metaphorizing process
The core of consultation work leads from an understanding of the ‘metaphorizing process”. In the metaphorizing process, words, images, or body sensations have a particular interactive relationship with the preverbal felt sense. In the context of consultation on the parent-infant relationship, we extend from words, images, sensations to the “behaving of the partner” as potentially metaphorizing one’s preverbal felt experience. Therefore, the baby’s behavior can be a metaphor for parental experience and vice versa.
As we shall see, consulting with the parent-infant relationship involves emphasis on situations where parents can attend to their preverbal felt experience “in” the relationship, can engage in the metaphorizing process, and can evolve steps which eventually amount to changes of perception of the relationship, feeling of self efficacy as a parent, and changes in structures or patterns of interaction with their baby.
OPPORTUNITIES FOR CONSULTATION
As a psychologist working often in interdisciplinary settings, I have the opportunity to integrate the principles of client-centered/experiential practice both into ongoing work with parents and infants, and in developing new services. The most typical contexts for integrating principles into an existing service are: 1. Structured assessments where parents are observing a neurobehavioral, communicative, or temperamental assessment of their infant; 2. Standardized assessments of parent-infant interaction where parent and infant are either interacting freely or are engaged in a structured task; 3. Interactional play therapy where the focus is on parental problems at management /or dysfunctional patterns of interaction due to parental misperceptions, infant behavior, or both; 4. Training mental health clinicians on parent-infant consultations; 5. Consultations with self-help parenting groups; 6. Community workshops;
7. Media presentations.
PR1NCIPLES OF CONSULTATION FROM A
Respect for parent experiencing
Any form of consultation begins with respect for parent’s experiencing and their current articulation of their relationship with their infant. This means that consultation begins with what the parent defines as the problem, and that the ongoing task of consultation, if necessary, is to help a parent look at their behavior from a different “internally-evolved” perspective in order to expand their options for dealing with problems.
There are many instances in which we are trying to sort out where difficulties may arise from the infant, from the parent, or due to a mismatch in personalities. Rather than define where the “trouble is” from the outside of the relationship, consultation involves listening to the parent, helping them to touch their felt sense of the relationship, and devise new steps in relating to themselves and their infant out of this process.
In many Western countries, with greater separation of parents from extended family, many parents have less exposure to infants and infant care, are less sure of their capacity, and are more susceptible to influence - especially media (articles, magazines, parenting programs) on how to parent. Parents may have a high ratio of advice and a low ratio of opportunity to listen to themselves or find their own ground in relation to advice. Therefore, one major principle in consultation is to find ways to provide the opportunity for listening to parents and help them to hear themselves - strengthen their own voice distinct from the external voices on how to parent.
Enhancing parental self-ref1ection
From a client-centered/experiential perspective, one main principle is to find ways to enhance parental self reflection, to help parents listen to themselves to set up a productive dialogue with preconceptual being (Gendlin, 1962, 1964, 1969, 1981). The next section will describe a number of modes where this process may take place. It is common to encourage this kind of attentiveness during actual interaction with their baby, or while observing videotapes of interaction.
The basic overall process is to start with the felt experience of the interaction, feeling and clarifying feelings, focusing on the implicit felt experience, metaphorizing; and eventually to step out of the interaction, to conceptualize possible different strategies for relating.
Efforts to understand the infant’s process
Behavior can be seen in the context of its communicative intent, in relation to internal self-regulatory processes, and as an indicator of maturing developmental processes. Take for instance thumb sucking in a newborn. Viewed externally, the baby is eliciting the behavior of trying to get his or her thumb or fingers into the mouth. We might say that this behavior communicates a desire to suck, and take it at its face value. However, how does this behavior function for the baby? We can see thumb sucking as an attempt to self-soothe and from this effort, establish rhythmic sucking in order to gain homeostatic balance. Sucking is related to a better coordination of breathing, closer linking of breathing and heart rate patterns, more efficient metabolic use of oxygen, muscular relaxation and so on. The capacity to get thumb or fingers into the mouth and hold them there also reflect development changes in neural maturation and motor coordination.
Parents have an intuitive awareness of these different dimensions of behavior, but in the consultation process, the dimensions are articulated and made explicit in ongoing interaction. There are parallels which arise between the baby’s efforts to self-regulate, and the parent’s efforts to manage, to achieve an internal balance, and a homeostatic balance in the ongoing flow of the relationship. There even are instances where infant efforts to self regulate precede parental attempts to disconnect from a tense interaction and eventually lead to parental focusing or self reflection.
There are times when parents experience certain behavior, crying especially, as being “done to” them: “crying bothers me, he is bothering me, he is trying to bother me.” These are examples of structure boundness in the interaction. By having the opportunity to “get outside” problematic interactions with their baby, yet still feel, parents are able to differentiate and recover the question of what can be learned from this disruptive feeling. As indicated, one dimension which evolves from this process is what their baby is doing “for” themselves, somewhat separate from where this “effects” the parents.
The analogy of focusing, or self-reflection is important. By referring to the felt sense of the relationship. or interactive event, parents use this preverbal, implicit knowing as a guide for how to make concrete steps of change in the relationship. The consultant provides an outside partner for those who may just “fall into” the feelings, and helps them to develop the capacity to just touch, and learn from the felt sense -with a friendly questioning part of themselves outside feelings, the relational feelings which arise in the “between” or “non-separateness” between parent and infant.
In viewing communicative, self regulatory and developmental aspects of behaving, we are led to consider how these aspects of behavior relate to the infant’s developing sense of self. We can ask, given what we experience, what may he/she be feeling? - how does this behavior relate to self regulatory processes? - and how does this behavior confirm or violate expectations as to who this baby “should be”?
Another instance where focusing or self reflection is useful is where disruption in the relationship between parent and infant may be due to qualitative shifts in the development of the infant. These are periods such as the “biobehavioral shift” in 2-3 month old infants where there is a major reorganisation in physiological processes and where many infants who have been relatively predictable in daily patterns of waking, feeding, crying, etc. up until this point, become much less predictable and behaviorally labile. It is in periods of qualitative change, or rapid maturation of the infant where the relationship may be in disequilibrium. The experience of these periods may be disruptive to some parents, and they may take the changes personally as instances of their failure to parent adequately or where something personally disruptive is being done to them by their infant. In this context, focusing is internally self-righting for parents: They are able to change their “internal set” or fixed perceptions of the relationship and move to respond with a wider range of options or creative adaptations to the new behavior and capacities of their infant.
As indicated, in understanding the metaphorizing process, both infant and parent “behavior” (gestures, sounds, facial expressions, body movements and posture) and “state” (deep sleep through active alert, to crying) can be a metaphor for ongoing experiencing. In the effort to understand the experience congruent with an infant’s communicative acts and autonomic states, parents learn to listen to the explicit and the implicit signals. With a concerted effort in the consultation process to attend to, and actively reflect their infant’s acts/states, parents also become aware of their own feelings, and the underlying questions of who initiated what; from whom feelings arose; how much comes from self, how much comes from the infant and how much arises synergistically in “the between”. While in everyday interaction, parents may not be aware of the principle of behavioral reflection, there are instances such as violations of expectations where parents either notice a mismatch, or where their infant’s behaving or autonomic state is a metaphor for the parent’s own uncomfortable experience. For example, a parent in the “face-to-face paradigm” (Tronick, Als, & Brazelton, 1980) which is used for observing parent-infant face-to-face interaction, holds her face still and the infant shows wariness and an accelerated effort of gesturing, vocalizing and facial expressions. There has been a violation of expectations: the infant changes behavior, and the parent notices the change.
During consultation, attention to behavioral reflection occurs by observing interaction, and commenting on; or asking a parent how they feel during particular events, watching a videotape of interaction, or during exercises which highlight the question of what is reflection, and what is metaphorizing of parental experience.
Attending to non-separateness
So far I have said that there is a felt experience in interaction and behavior can relate to, or metaphorize felt experience. Parents sometimes attend to this felt experience with uncertainty as to - from whom feelings arose. At this time, attending inwardly, in one’s body to the felt sense is akin to attending to non-separateness. The emphasis on autonomic metaphorizing, and the importance of both infant behavior and state as a metaphor for parental experiencing relates to a bodily felt energy which seems to have arisen synergistically and not from parent or infant alone. This experience can sometimes be disruptive or can lead as we have seen to attributions that the infant’s behavior or state are causing parent’s uneasiness, or guilt that parent’s behavior or state are causing infant’s upset. With principles derived from experiential focusing and sometimes, structured excercises, parents are asked to change their interaction, set aside their usual modes of conceptualizing, attend to the felt sense in the body. and notice metaphors arising. Parental feelings and metaphors are reflected or possibly further steps of focusing occur. The changes which occur feel better in the body, and give new energy to working out active solutions in the relationship, enable new perspective to arise on “who is doing what”, change the structure boundness, and probably unfreeze the merging of personalities. For example, parental anger has the tendency to move outward and inward at the same time - “I am frustrated with my baby. I am frustrated with myself’ - “He (my baby) is just like me, he’s stuck just the way that I am.” With the inward attention of focusing, and observing interaction, it eventually becomes clearer who is doing what in complex interactions, and parents can see their infant’s personality and behavior in the context of the baby’s own self regulating and self expressing tendencies.
Recognizing structure boundness
Relationships between parents and infants are compelling and a lot happens which can be felt but which is either below normal awareness or disorganizing to parent’s usual conceptual modes. It is often difficult to step out of the relationship to notice certain patterns which cause disruption, increase tension, and block forward moving felt experience.
There are structure bound patterns which can be observed (for example, gaze aversion in the infant when too much is happening). And, there are other instances, not easily observable, where the recognition of structure boundness must happen through counseling attention to the felt experience of one of the participants in the interaction. A potential key to structure boundness happens when a parent feels “stuck” or says something particularly charged about their infant or about the interaction. This statement can begin a process where the parent is encouraged to attend to their felt sense and where the metaphorizing process is facilitated (Boukydis, 1985b).
Articulating implicit conflicts: Taking both sides
Babies are dependent beings. Many parents immerse themselves in caring for their babies and may lose touch with their own needs. They may have feelings which touch on their responsibility for their baby while also trying to care for themselves, but these feelings may be vague or threatening, in some situations, it may be helpful for the consultant to articulate a disparity or conflict in needs between parent and infant, as a beginning in metaphorizing the feelings implicit in the relationship. This process can lead to a connection between metaphor and that which was implicitly felt, and can release new energy toward resolution.
One strategy for articulating disparity or conflict is to ask a parent to alternately take their own voice, then the voice of their infant and undertake an exchange relating to the conflict. Then, the parent can be asked to step back and imagine being a mediator who has heard both sides, and is trying to develop a resolution which affirms and eventually answers both people’s needs.
Parents as collaborators in the process
Rather than interview to gather information, and then exclude parents from the diagnostic phase, the consultation model enables practitioners to engage parents as collaborators in all phases. There are two areas of theory which are relevant to this perspective: Contextual assessment (Fischer, 1978) and enhancing self reflection (or focusing: Gendlin, 1969, 1981). Contextual assessment emphasizes ways to create typical interactive events between parent, infant and consultant so that the weighing of perceptions as to what occurred, and what caused particular behavior can become the focus of the collaborative process. Alternative explanations, and unforseen influences on behavior are weighed. Then, the contextual influence, the influence of the family system, and informal network on the parent-infant relationship are explored as possible influences on current patterns.
As indicated earlier, enhancing self reflection or focusing emphasizes how to help parents refer to feelings in interaction, and enables parents to articulate the implicit meaning in complex interactive events.
Integrating developmental and experiential input
The main emphasis from this perspective is to develop a receptive mode to hear parent’s feelings and concerns about their child’s development. In structured assessments there can be direct input about development, but the main emphasis is on how a child performs, imagining what he or she may be showing, or learning, and thinking about how this related to other areas of development. As in consultation on parent-infant interaction, there is a basic effort to bear what parents are feeling while they are watching their child, to compare how typical this behavior is - and to anticipate the next steps in development.
Emphasizing strengths/attitudes of will to improve or change
Another principle involves respecting and commenting on things that are going well in parents’ relationship and in their ongoing interaction with their child. Parents are vulnerable to criticism and often find themselves in situations facing varied opinions about how they should relate to, or discipline their child. One of the important principles in client-centered/experiential practice is finding something to care about in each person as the basis for relating empathically to what they are feeling (Rogers, 1957, 1975). During consultation, one way that this respect can be engendered in the collaboration is by noticing and commenting upon what parents are doing well and respecting their efforts to grow and change. It is very moving when parent’s of premature infants talk about the incredible will their baby had in order to survive the hardships of the early days. Parents of all babies are enraptured at times when they see their baby’s efforts to accomplish a new skill. Attention to the felt sense of this will and this effort in their baby sometimes leads to an experience of will and effort experienced as non-separate - the “we-ness” has will and effort to explore, learn and grow. One parent said: “When I recover my sense of my baby’s will, I am not only moved by his courage, but I recover this capacity of will, to go on with courage in myself.” A return to memories of this will, this effort, are helpful when things are going badly in the relationship.
Using consultant’s own feelings in interaction with the infant
There are times when parents find it helpful to watch someone else interacting with their baby. They can attend to how they feel about the interaction, possibly imagine more clearly what their baby is feeling and imagine how they would have responded. This kind of interaction draws on the authentic feelings of the consultant, for instance reporting on their efforts to soothe a fussy baby, and helps build trust toward a collaborative relationship.
STRATEGIES FOR PROCESS CONSULTATION: INTEGRATING
CLIENT-CENTERED/EXPERIENTIAL PRINCIPLES WITH EXISTING PRACTICE
There are a number of strategies for consultation on the parent-infant relationship. Here is a list of strategies or modes of consultation from different areas of work on the parent-infant relationship.
focus while watching live interaction of self/others with own/other baby
parent attends to felt sense of interaction and gets listened to on how it feels
running commentary on what parent is/baby may be- feeling; state alternate possibilities
parents go back and forth between what they are/were feeling and what their baby may be feeling, then state other possibilities for what their baby may be feeling; then are listened to on this
focus/listen while watching videotape segment of parental event
parent watches videotape of parenting interaction and attends to felt sense; then is listened to on this
focus/listen while listening to audiotape ofbaby crying
parents listen to tape, attending to felt sense in their body, and are listened to on this
(Boukydis, 1985a, 1985b)
focus on baby personality- including of whom he/she reminds me
parents explicate their sense of their baby’s personality, and whom their baby reminds them of: how are they similar and different to those people?
listen to parents while they observe structured assessment
parents are listened to on their feelings about watching their child perform structured tasks in the assessment context
from what they observe behaviorally and feel viscerally, parents try to imagine what their baby is feeling or communicating and return this or reflect this to their baby
follow baby initiations, imitate or mirror; change give and take patterns
parents spend a period of time returning or following their baby’s initiations: they can imitate or mirror facial expressions, gestures: and can change give and take patterns so that the baby initiates and the baby responds (Field, 1978)
give verbal reflections to baby’s communicative acts
parent responds to/reflects baby’s sounds, expressions
coach parent in interaction live or on tape then listen/focusing
parents try changing patterns of responding, may watch this afterward on tape, then get listened to on how it felt
take imagined voice of baby or parent/done by parent/consultantwhile either parent or consultant is interacting with the baby, the other takes the imagined voice of the baby
accentuate body movement/posture/facial expressionsparent tries mimicking or accentuating baby’s body movement, posture, and facial expressions, and then gets listened to on what he/she thought was being communicated, and on how this felt
slow down/accelerate initiations, speech; use one modality voice/touch/ facial
parent is asked to change pace of interactions or use one modality, then is listened to on what happened, and how this felt
carrying forward infant initiatives; structure environment to facilitate infant exploration
without interfering, parent imagines what infant is doing in play and when necessary helps infant to follow through with his initiatives without doing things for her/him (Mahrer, 1978; Maher, Levinson &
Fine, 1976; Stollak, 1978)
ask parent what are you feeling: how does it feel when he/she does such and such
parent coaches consultant in interaction
parents using knowledge of their baby, and trying out new patterns make suggestions to consultant while consultant interacts with the baby
watch someone else relating to baby/compare similarities and differences
parent attends to feelings while watching someone else interact with baby, and then compares similarities and differences in how parent and other person interact and in how baby responds
ask where in your body do you experience bodily energy while interacting with baby?
parents attend to felt sense of interaction with baby and are asked how and where they feel during the interaction
examine baby with hand; different energy patterns
parents are asked to explore their baby with their hands and notice differences in energy patterns that they feel (Krieger, 1979)
how baby responds to different orientation in space; patterns of being held/soothed; response to different rhythms in play/caretaking; massage
parent tries out these activities, attends to felt sense, notices how baby responds, and is listened to on how it felt
listen to parent; feeling mainline; who is affecting who; influence of family climate, family patterns
parent is listened to on these perspectives; what does the relationship with your baby feel like; who is affecting who; who is in charge of the interaction; how do other relationships or the family climate effect your relationship with your baby?
negotiate with a preverbal being
parents articulate their needs, their baby’s needs, then are asked to take the outside stance of a mediator and make suggestions for how to solve differences so that both people’s needs can be met
Keeping in mind the principles outlined above, the main job of the consultant is to attend to parental feelings, return to the baseline of parental experiencing during and after structured exercises, and to empathise/imagine infant experience. Consulting on the parent-infant relationship has differences from verbal counseling or psychotherapy, but the parallels are also striking. As a counselor, one imagines the preverbal experience taking shape in their clients, focuses on their own ongoing experience, and attempts to hear and reflect both the explicit and implicit “edge” of feeling in the clients. A parent is often in a similar situation with his/her baby - without the benefit, or possible distraction, of the verbal mode. Empathy implies both an attention to preverbal experience (in the baby, in the between, in the parent), and an activity of exploration to elaborate or heighten an understanding of what the baby might be feeling. As indicated in this chapter, the use of principles derived from client-centered/experiential therapy are helpful in facilitating this process.
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