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| Key elements in teaching the practice of clinical infant mental health: Observations, genaralizations, theoretical & metapsychological concepts | Elisabeth Tuters, Canada | |
| Assessing withdrawal behaviour in infancy | Antoine Guedeney, France | |
| Children’s home environments and their development: A cross-cultural view | 1 | Robert Bradley, USA |
| Communicative musicality and amae | Hisako Watanabe, Japan | |
| Attachment, trauma and attachment disorders: From theory to therapy and prevention | Karl Heinz Brisch, Germany |
Saturday, July 3, 8.00 - 9.00 am
| Stress and depression during pregnancy: What should the infant clinician know? | 1 | Martin St Andre, Canada |
| Intuitive parenting - a hidden resource in severely troubled parent-infant relationships | Mechtild Papousek, Germany | |
| Parental intersubjectivity and neurobiological basis: The role of the mirror neurons system |
Massimo Ammaniti, Italy | |
| Cultural brokerage in infant-parent psychotherapy | Astrid Berg, South Africa | |
| Reflective Clinical Conversations Across the Sea: Technology offers new possibilities for reflective clinical conversations across cultures, time zones and oceans | Debbie Weatherston, USA; Catherine Maguire, Ireland |
1 With simultaneous translation English-German (Simultan Übersetzung Englisch-Deutsch)
Further information on master classes and speakers:
Massimo Ammaniti, MD, University of Rome, Italy
Parental intersubjectivity and neurobiological basis: the role of the mirror neurons system
Observations of early mother and father interactions with the child have shown that intersubjectivity is a primary motivational system, and parental competencies are important for the development of the child. A special contribution to the understanding of early intersubjective experiences has been given by the recent discovery of the mirror neurons system. On this basis the exploration of the mirror system has been performed in mothers during the first year of life of the baby in order to explore the neurobiological basis of maternal empathy. In the lecture fMRI images of the brain of the mothers will be presented in order to visualize the neural areas involved.
Astrid Berg, MD, University of Cape Town, South Africa
Cultural Brokerage in Infant-Parent Psychotherapy
The majority of health care interactions in primary health care settings take place in the presence of a third party, particularly in developing countries or in ‘minority’ areas in developed countries. This person, variously taking the form of a nurse, counselor or informally appointed ad hoc interpreter, is usually expected to serve a function which extends well beyond that of mere language interpreter in the context of a multilingual clinic. Most frequently this individual also serves as a “cultural broker” whose role is to provide the clinician with an interpretation of other aspects relevant to the setting and to what has been referred to as the “lifeworld.
The model developed in such a primary health care clinic in South Africa will be presented; infant-parent psychotherapy is not only possible but is strengthened through such collaboration.
Astrid Berg is a Psychiatrist, Child & Adolescent Psychiatrist as well as an Analyst. She is an Associate Professor at the University of Cape Town and a senior consultant in the Division of Child & Adolescent Psychiatry at the Red Cross Children’s Hospital in Cape Town where she heads the UCT Parent-Infant Mental Health Service.
Astrid has been involved in working in a community in Cape Town since 1995 where she is in charge of a weekly mother-baby mental health clinic. She has written about this work and presented it extensively internationally. Her particular interest is in inter-cultural communication.
Robert Bradley, PhD, Arizona State University, USA
Children’s Home Environments and Their Development: A Cross-Cultural View
The focus will be on social and physical components of children’s home environments and their relations with health, competence, and adaptive functioning. Consideration will be given to how these relations vary by culture and geography and how scholars have chosen to adapt measures so that they more accurately capture critical aspects of the environment for particular social groups.
Karl Heinz Brisch, MD, University of Munich, Germany
Attachment, trauma and attachment disorders: From Theory to Therapy and Prevention
Attachment disorders are a form of severe early psychopathology that emerges from early forms of violence of caregivers against the infant.
Based on attachment theory a diagnostic classification system of attachment disorders is presented. The presentation of clinical case studies (with video) demonstrates the differential use of the classification system of attachment disorders in infancy and childhood. The general and special guidelines of attachment based therapy are presented in the treatment of transgenerational trauma. The special treatment approach and the process of psychotherapy with various attachment disorders are demonstrated with audio-visual material.
To prevent attachment disorders, the attachment-based intervention programs SAFE and B.A.S.E. were developed in Germany. There major aims are to promote the infants’ development of secure attachment and to enhance parental sensitivity for infants’ needs, and to reduce aggression and anxiety, especially the transgenerational re-enactment of violence. SAFE starts early in pregnancy and guides parents in group meetings and individual trauma-oriented psychotherapy till the end of the first year of their infants. B.A.S.E. is a training for kindergarten and school-aged children that uses mother-infant observation in the classroom to promote sensitivity and to teach empathy. The evaluation shows that children are less aggressive, less anxious, but more attentive and prosocial after one year of B.A.S.E. training.
Learning objectives: Attachment, trauma, disorders, therapy, prevention
Ref: Brisch, K. H. (2002) Attachment Disorders. From Attachment Theory to Therapy. Guilford Press, New York.
Brisch, Karl Heinz, MD, is specialist for child and adolescent psychiatry and psycho-therapy, adult psychiatry and neurology, specialist in psychosomatic medicine, psychoanalysis and group psychoanalysis. He is head of the Department of Pediatric Psychosomatic Medicine and Psychotherapy at the Dr. von Hauner Children’s Hospital Ludwig-Maximilians-University, Munich/Germany. He is a lecturer at the university and also lecturer at the Psychoanalytic Institute in Stuttgart/Germany.
His main research topic is early child development with special impact on attachment processes and disorders. His publications are about attachment development of high-risk infants and clinical attachment research. He wrote a monograph about the application of attachment-based psychotherapy in the treatment of attachment disorders.
He is the president for Germany of the GAIMH (German Speaking Association for Infant Mental Health)
Brisch, Karl Heinz, M.D.
Dept. Pediatric Psychosomatic Medicine and Psychotherapy,
Dr. von Hauner Children's Hospital, Ludwig-Maximilians University Munich
Pettenkoferstr 10
80336 Munich,
GERMANY
Phone: +49 89 5160 3954
Fax: +49 89 5160 4730
Karl-Heinz.Brisch@med.uni-muenchen.de
Louise Emanuel, MPsychPsych, Tavistock Clinic, London, UK
Exploring ‘The Turning Point’: Transformative processes in clinical work with parents, infants and young children
Carlberg (1997) defines a turning point session as one ‘ where the therapist notices that something qualitatively new may be identified concerning the behaviour of the child or the child’s way of showing his/her inner world, or where something new enters the interplay between the child and the therapist.’
I aim to describe some detailed clinical material of interventions based on the Tavistock Clinic model of brief work with under fives, and to reflect on the ‘turning point’ or transformative moment in these interventions which suggest that a shift or change has taken place. I hope to consider technical and theoretical implications which arise from these explorations.
Elisabeth Fivaz-Depeursinge, PhD, University of Lausanne, Switzerland
The baby and the couple
Are young infants able to simultaneously play with both their parents and how do they respond as they witness an affectionate or a conflictual exchange between them? We will examine 9 month-olds in these situations by contrasting video observations and results on families with functional versus problematic coparenting and will discuss their clinical implications.
Antoine Guedeney, MD, Hôpital Bichat Claude Bernard, Paris, France
Assessing withdrawal behaviour in infancy
The description by Spitz of Anaclitic Depression in 1946 has vividly shown how an infant may be sensitive to sudden and major changes within the attachment relationship. This was made even more clear with the famous film by Bowlby and Robertson, 1968, John in the nursery. Sustained withdrawal behavior is now recognized as an important alarm signal in the behavioral repertoire of the infant, when faced with enduring parent infant dys-synchronization. This presentation will briefly describe the clinics and biology of sustained withdrawal behavior in infants and will emphasize the way it can be assessed, using the Alarm Distress baby scale (ADBB). Video clips will able the assistance to use the scale and to test the validity of the concept for clinical and research use.
Sybil Hart, PhD, Texas Tech University, USA
Infant Jealousy in the Transition from One Child to Two
The arrival of a sibling is a turning point in a child’s life, and for some it poses serious challenges to healthy adjustment and family functioning. This presentation taps findings from the new area of research on experimentally-induced jealousy to help identify abnormality in the child’s expression of jealousy, and the types of events that give rise to its display. In closing, we touch on clinical implications for the early diagnosis of psychopathology, and potential avenues toward prevention and treatment during this difficult period of transition.
Miri Keren, MD, Geha Mental Health Center, Israel
Evidence-based argument for a Family axis on the next DC 0-3: clinical implications for assessment, treatment and brain research in infant psychopathology
Based on the results of a resent study we have conducted with clinic-referred and non clinic referred infants on the family and dyadic relational patterns in the context of infant psychopathology, we will argue for adding a family axis on the next diagnostic classification in infant mental health, and we will illustrate through a clinical vignette the clinical implications of our results for assessment as well as for treating infant psychopathology. We will end with thoughts on potential research directions in studying the brain processes involved in triadic, and not only dyadic, interactions between infant and parents.
Robert McCall, PhD, University of Pittsburgh, & Christina J. Groark
The Science, Practice, and Policy of Improving Orphanages: Should We? Could We? How?
We first tackle the controversial policy issue of whether a country should attempt to improve orphanages at all or devote all resources to developing alternative family care for children without permanent parents. Research is then reviewed on various strategies to improve orphanages and the benefits in children’s development that they have produced. Finally, we describe the practical procedures we have used to work with orphanages in several countries to implement comprehensive institution-wide changes in decades-old traditional structural organization and staffing patterns
Joy Osofsky, PhD, Lousiana State University Health Sciences Center, USA
Promoting Recovery and Resilience in Infants and Young Children following Disasters
Infants and young children are especially vulnerable during and following disasters because their specific needs are not usually recognized and they are dependent on parents and other adult caregivers to ensure their well-being. With the inevitable disruptions and displacement caused by disasters, it is crucial that young children be able to maintain consistent, familiar relationships to minimize attachment related traumas. This presentation will focus on the needs of infants and young children during and following disasters with emphasis on recovery and resilience and present data from interventions and services following Hurricane Katrina.
Mechthild Papoušek, MD, University of Munich, Germany
Intuitive parenting – a hidden resource in severely troubled parent-infant relationships
The notion of ‘intuitive parenting’ refers to an implicit communicative competence in parents and other caregivers elicited by and attuned to an infant’s affective signalling and feedback cues. Parent-infant communication has long been recognized as a genuine reciprocal reward system residing in complementary biologically anchored motives and capacities in both infant and parent. As such parent-infant communication plays vital adaptive roles in almost every developmental domain, and, at the same time, offers intrinsic resources of strengths and mutual pleasure. The author summarizes recent findings from different strands of developmental and clinical research related to: forms and functions of intuitive parenting observable in infant-directed speech and other vocal, facial and tactile behavior; neurobiological processes (related to oxytocin and mirror neuron networks a.o.) that seem to validate the assumption of a biologically anchored program; epigenetic considerations related to the program’s enactment; adaptive regulatory functions of intuitive parenting in various developmental domains; regulation of intuitive parenting through the infant’s power to elicit, co-regulate, shape or inhibit the parent’s intuitive behaviour; and intervening innerpsychic/psychodynamic processes that may disguise, inhibit, distort, or block the parent’s intuitive engagement with the infant in cases of obvious insensitive caregiving, interactional failures, neglect or abuse. The final section outlines how this knowledge can be applied in communication-focused strengths-based approaches to parent-infant counselling and psychotherapy emphasing the therapeutic potentials of videomicroanalytic feedback. Even in the midst of adversity intuitive parenting is expected to exist as a primary basic resource. It is up to the therapist to bring these genuine resources to life and to do so not by rational instruction but by freeing the parent’s intuitive competence from its innerpsychic barriers.
Campbell Paul, MD, University of Melbourne, Australia
Infant Directed Infant-Parent Psychotherapy: one model for developing a therapeutic relationship with the baby and his parents
Babies and toddlers with a wide range of problems are referred to a paediatric hospital based infant mental health service. One of the commonest presenting symptoms experienced by the baby is a difficulty in feeding and the feeding relationship. Perturbations in the infant parent attachment relationship are intensified when the baby has a medical illness. This presentation will consider ways in which the therapist may engage directly with the baby as a way of better understanding the baby’s emotional experience. Communicating directly with the baby as a responsive and autonomous individual can lead to ongoing transformation in the relationship between the baby and her parents, and consequently a reduction in the baby's symptoms.
Heidi Simoni, PhD, Marie Meierhofer Institut für das Kind, Zürich, Schweiz, Switzerland
Im Übergang in die Kinderwelt
Frühe Kontakte unter Kindern aus entwicklungspsychologischer Perspektive
Systematische Beobachtungen illustrieren, dass Kinder durch andere Kinder bereits in den ersten beiden Lebensjahren in beträchtlichem Mass sozial-emotional-kognitiv herausgefordert sind. Damit der Übergang in die Kinderwelt gelingt und kleine Kinder ihre Kompetenzen im Austausch mit andern Kinder tatsächlich erweitern können, sind sie auf eine adäquate Ermöglichung und Begleitung früher Kind-Kind-Kontakte angewiesen. Entwicklungspsychologische Erkenntnisse und Überlegungen können dazu einen wichtigen Beitrag leisten.
In der Veranstaltung sollen die Reichhaltigkeit und die Bedeutung früher Kind-Kind-Interaktionen anhand von videografierten Beobachtungen aus einer entwicklungspsychologischen Perspektive ausgelotet werden. Als Basis dient eine eigene empirische Untersuchung zum frühen Erwerb sozialer Kompetenz, in der Kinder vom 9. bis zum 25. Lebensmonat im Abstand von zwei Monaten während 30 Minuten im freien Spiel gefilmt wurden. Für die Analyse des beobachtbaren Verhaltens werden entwicklungsabhängige Möglichkeiten, entwicklungsadäquate Motive und anstehende Entwicklungsschritte der Kinder reflektiert. Diese Überlegungen werden in empirische Erkenntnisse über die frühe Entwicklung prosozialer Verhaltensweisen sowie über Inhalte, Formen und Verlauf früher Konflikte eingebettet.
Martin St. André, MDD, University of Montréal, Canada
Stress and depression during pregnancy: What should the infant clinician know?
Objectives:
1) Review the clinical presentation of antenatal depression;
2) Review the obstetrical, neonatal and infant neurodevelopmental risks associated with untreated antenatal depression;
3) Review the maternal, neonatal and infant neurodevelopmental effects of antidepressants, which are increasingly used during pregnancy.
Dr Martin St-André is associate clinical professor of psychiatry, CHU Sainte-Justine and Université de Montréal (Canada); he is president of WAIMH-Quebec (Association québécoise pour la santé mentale des nourrissons).
Mark Tomlinson, PhD., University of Stellenbosh, South Africa
Infants in a rapidly changing world: the next 50 years
We are living in an increasingly complex and mobile world (air travel, migration -forced and otherwise); where threats to the environment are becoming critical; where technology is changing rapidly; a world where homes have four television sets, a laptop for each family member; where five month old infants are being sent for computer classes, and a world where five year olds have personal mobile phones. How do we imagine the world our infants will be living in 50 years from now? This lecture will attempt a crystal ball approach in imagining the world of our grand and great grandinfants.
Elisabeth Tuters, PhD, HincksDellcrest Children’s Mental Health Centre, Toronto, Canada
Key Elements in Teaching the Practice of Clinical Infant Mental Health: Observations, Genaralizations, Theoretical & Metapsychological Concepts
By examining the data derived from teaching a group of well trained mental health professionals, the essential elements to the practice of Clinical Infant Mental Health will be identified through understanding the experience(transference/countertransference)of the teachers, the students and the clinician (teacher) working with a directly observed clinical case from assessment & formulation through to the end of treatment. DVD segments from the case will be shown.
Hisako Watanabe, MD, PhD, Keio University, Japan
Communicative Musicality and Amae
Parent-infant psychotherapy provides a unique window into hidden family conflicts transmitted transgenerationally. Through videotaped Japanese cases I will show how the concept of Amae (Doi) and Communicative Musicality (Trevarthen & Malloch ) help us create a secure context whereby we can help parents to resolve their traumas.
Debbie Weatherston, Michigan Association for Infant Mental Health, USA; Catherine Maguire, Ireland
Reflective Clinical Conversations Across the Sea: Technology offers new possibilities for reflective clinical conversations across cultures, time zones and oceans
Technology offers new possibilities for reflective clinical conversations across cultures, time zones and oceans.
This master class will illustrate the use of technology to nurture and sustain consultation relationships that promote the expansion of infant mental health.
Charles Zeanah, MD, Tulane University, New Olreans, USA
Attachment Disorders in Early Childhood: What Do We Know and Where Do We Go?
This class will review research on attachment disorders in early childhood, highlighting research advances in the past 10 years regarding phenomenology, course, correlates and response to intervention. In addition, we will discuss potential areas of future research that can contribute to illuminating predisposing, precipitating and perpetuating factors associated with these disorders. These data will be used to consider implications for practice and policy.
