Keeping The Baby In Mind Infant Mental Health in Practice

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Keeping the Baby in Mind
Infant Mental Health in Practice

Edited by Jane Barlow and P. O. Svanberg

First published 2009 by Routledge
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Simultaneously published in the USA and Canada
by Routledge
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Copyright © 2009 Selection and editorial matter,
Jane Barlow & P. O. Svanberg; individual chapters, the contributors
All rights reserved. No part of this book may be reprinted or reproduced or
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British Library Cataloguing in Publication Data
A catalogue record for this book is available
from the British Library
Library of Congress Cataloging-in-Publication Data
Keeping the baby in mind : infant mental health in practice / edited by
Jane Barlow & P.O. Svanberg. – 1st ed.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-415-44297-8 (hardback) – ISBN 978-0-415-44298-5 (pbk.)
1. Infant psychiatry–Great Britain. 2. Infants–Mental health services–
Great Britain. I. Barlow, Jane, 1962– II. Svanberg, P. O., 1948–
[DNLM: 1. Infant. 2. Parent-Child Relations. 3. Early Intervention
(Education) 4. Family Health. 5. Parenting. WS 105.5.F2 K26 2009]
RJ502.5.K44 2009
618.92'89–dc22
2008028913
ISBN 0-203-88377-2 Master e-book ISBN

ISBN: 978-0-415-44297-8 (hbk)

ISBN: 978-0-415-44298-5 (pbk)
Contents

Contributors ix
Foreword xv
DILYS DAWS

1 Keeping the baby in mind 1

JANE BARLOW AND P. O. SVANBERG

PART I
Universal approaches

2 The power of touch – exploring infant massage 17

ANGELA UNDERDOWN

3 The Solihull Approach: an integrative model across agencies 29

HAZEL DOUGLAS AND MARY RHEESTON

4 Promoting development of the early parent–infant relationship

using the Neonatal Behavioural Assessment Scale 39
JOANNA HAWTHORNE

5 ‘First Steps in Parenting’: developing nurturing parenting skills

in mothers and fathers in pregnancy and the postnatal period 52
MEL PARR, IN COLLABORATION WITH CATHERINE JOYCE

6 The Family Partnership Model: understanding the processes

of prevention and early intervention 63
HILTON DAVIS

7 The importance of the parental couple in parent–infant

psychotherapy 77
PAUL BARROWS
vi Contents
PART II
Targeted approaches

8 Empowering parents through ‘Learning Together’:

the PEEP model 89
ALISON STREET

9 Promoting a secure attachment through early screening

and interventions: a partnership approach 100
P. O. SVANBERG

10 Perinatal home visiting: implementing the nurse–family

partnership in England 115
ANN ROWE

11 Working with parents from black and minority ethnic

backgrounds in Children’s Centres 128
LUCY MARKS, SANDY HADLEY, ANTONIA REAY, TAMARA GELMAN
AND ANNE MCKAY

PART III
Indicated approaches

12 Working with the hidden obstacles in parent–infant relating:

two parent–infant psychotherapy projects 141
TESSA BARADON, SUE GERHARDT AND JOANNA TUCKER

13 Mellow Babies: Mellow Parenting with parents of infants 155

CHRISTINE PUCKERING

14 Enhancing the relationship between mothers with severe

mental illness and their infants 164
SUSAN PAWLBY AND CHARLES FERNYHOUGH

15 ‘Parenting with support’: supporting parents with

learning difficulties to parent 173
BETH TARLETON
PART IV
Postscript

16 Developing infant-centred services: the way forward 185

P. O. SVANBERG AND JANE BARLOW

Index 199
Contributors

Tessa Baradon (MA Public Health) is a child and adolescent psychotherapist,

and a member of the Association for Child Psychotherapy and the Associa-
tion of Child Psychoanalysis. Tessa developed and manages the Parent Infant
Project at the Anna Freud Centre, integrating training in child psychotherapy
and psychoanalysis with a background in public health. She is a practising
child psychotherapist and supervisor, and writes and lectures on applied psy-
choanalysis and parent–infant psychotherapy.
Jane Barlow (DPhil, FFPH Hon) is Professor of Public Health in the Early Years
at the University of Warwick. Jane’s main research interest is in the field of
public mental health, in particular the effectiveness of early interventions
aimed at improving parenting practices and evaluating their role in the pri-
mary prevention of mental health problems and the reduction of inequalities
in health. Her programme of research focuses on interventions that are pro-
vided around infancy, and she is currently setting up the Warwick Infant and
Family Wellbeing Unit, which will provide training and research in innovative
evidence-based methods of supporting parenting during pregnancy and the
early years, for a wide range of early years and primary care practitioners. She
is a committee member of the Association of Infant Mental Health (UK), and
a member of an expert group making revisions to the Child Health Promotion
Programme (0–3 years).
Paul Barrows (PhD) is a consultant child and adult psychotherapist working for
the United Bristol Healthcare Trust. He was until recently editor of the World
Association for Infant Mental Health newsletter and editor of the Journal of
Child Psychotherapy. He is also the former chair of the UK Association for
Infant Mental Health.
Hilton Davis (BA, DipClinPsych, CPsychol, FBPsS, PhD) is Emeritus Pro-
fessor of Child Health Psychology, King’s College London, and recently
retired as Head of the Centre for Parent and Child Support, South London
and Maudsley NHS Foundation Trust. Hilton is particularly concerned with
the design and evaluation of services to support families and to prevent
psychosocial problems and has been developing a model of process (i.e. the
x Contributors
Family Partnership Model) to underpin and guide this work (see www.cpcs.
org.uk).
Hazel Douglas (BSc, MPsychol, MBA, AFBPS, MA, MPsych, PsychD Psycho-
analytical Psychotherapy) is a clinical psychologist and child psychotherapist,
and has always been interested in prevention and early intervention. She began
her clinical career working with adults but has subsequently slowly worked
her way down the age range. She is Strategic Lead for Solihull Child and Ado-
lescent Mental Health Service and leads on the development of the Solihull
Approach.
Charles Fernyhough (MA, PhD) is a developmental psychologist at Durham
University. He has been involved in the conduct of several longitudinal studies
of children’s socio-emotional development, and has recently been pursuing an
interest in developmental approaches to psychosis.
Tamara Gelman (MA, ClinPsych) is a clinical psychologist working in the
Tower Hamlets Primary Care Trust. She works across two Children’s Cen-
tres in Tower Hamlets, and focuses on the treatment of perinatal distress in
parents.
Sue Gerhardt (BA Hons, MA) is a psychoanalytic psychotherapist (UKCP Reg-
istered). After training in baby observation and studying child development,
she became passionate about early intervention and co-founded the Oxford
Parent Infant Project (OXPIP). She has worked part-time for OXPIP as a par-
ent/infant psychotherapist for ten years, and combines this with a private psy-
chotherapy practice, and lecturing and writing. She is the author of Why Love
Matters: How Affection Shapes a Baby’s Brain (2004).
Sandy Hadley (BA, BSc Hons, RMN, Certificate in Systemic Family Therapy,
DClinPsy) is a clinical psychologist working full-time for the Psychology and
Counselling Team, Tower Hamlets Primary Care Trust. She currently divides
her work between four GP surgeries and two Children’s Centres, treating adults
and parents with a range of psychological difficulties.
Joanna Hawthorne (PhD) is a psychologist and senior research associate at the
Centre for Family Research, University of Cambridge, and director and NBAS
trainer at the Brazelton Centre in Great Britain, c/o Addenbrookes Hospital,
Cambridge. Joanna trains health professionals and those who work with new-
borns nationally and internationally in the NBAS. She is on the committee of
the Association for Infant Mental Health (UK), and council member of the
Maternity and Newborn Forum, Royal Society of Medicine. Her research and
clinical work includes work with parents and babies in neonatal units, and
evaluating the use of the NBAS in early intervention.
Catherine Joyce (Fellow Chartered Institute of Personnel and Development,
Member of the European Coaching Institute, Master Practitioner Neuro Lin-
guistic Programming, Independent member of Parenting UK and WAVE) is
 Contributors xi
founder of BlueQuay Consulting and works as an organisation change con-
sultant and business coach with individuals, teams and work groups who are
undergoing major change. She has a wealth of experience in the private, public
and voluntary sectors, consulting at all levels. Catherine was Assistant Direc-
tor, Projects and Training PIPPIN (2000–2003), and Director, Projects and
Training (2003–2005).
Anne Mckay (MClinPsych, Masters in Consulting to Organisations, Dip Forensic
Psychotherapeutic Studies, DipEd) is a chartered clinical psychologist (BPS)
with the Children’s Centres Adult Psychology Team, Tower Hamlets Primary
Care Trust.
Lucy Marks (MClinPsych) is a consultant clinical psychologist, joint team leader
of the Primary Care Psychology and Counselling Service in Tower Hamlets,
and co-chair of Tower Hamlets Professional Executive Committee (PEC),
Tower Hamlets Primary Care Trust. Lucy has a special interest in primary
care mental health services and particularly services for parents of under-fives,
and set up and developed the Sure Start Children’s Centres Adult Psychology
Service. She is also interested in ensuring there is strong clinical leadership
in the process of commissioning health services, and she works alongside the
management team of Tower Hamlets Primary Care Trust in her capacity as co-
chair of PEC with this remit.
Mel Parr (PhD) is a chartered counselling psychologist and adult psychotherapist
(UKCP) who also has over fourteen years’ experience in the NHS in adult men-
tal health, and is an Honorary Fellow at the University of Hertfordshire. Mel
has over thirty years’ experience working with parents through the voluntary
sector and was the founding director of ‘Parents In Partnership–Parent Infant
Network’ (PIPPIN) (1993-2004). She is the named leading contributor to par-
ent and infant mental health for the UKCP Tenth Anniversary Lecture Series.
She currently works with Hertfordshire Partnership NHS Foundation Trust in
secondary/continuing care and is the clinical lead for perinatal mental health
for the Enhanced Primary Care Mental Health Service as part of the Depart-
ment of Health ‘Improving Access to Psychological Therapies’/Perinatal Men-
tal Health pilot. She trains and supervises nurses, midwives, health visitors,
social workers, psychologists and medical doctors. Mel is also a co-tutor on the
MSc in Family Health at the University of Hertfordshire, and an independent
consultant working on the development of a university qualification template
for training trainers of parenting practitioners to work with parents of children
aged 0-3 years with Parenting UK/National Academy Parenting Practitioners
‘Early Learning Partnership’. She is a committee member of the Association
of Infant Mental Health UK, WAVE Trust, and a member of the international
advisory board for the journal Attachment and Human Development.
Susan Pawlby (BSc, MA, PhD) is a chartered psychologist (British Psychological
Society) in the section of Perinatal Psychiatry, Institute of Psychiatry, King’s
xii Contributors
College London and Channi Kumar Mother and Baby Unit, Bethlem Royal
Hospital, South London and Maudsley NHS Trust. Susan is a developmental
psychologist with a specific research interest in infancy and the developing
relationship between a mother and her baby. Her research work has pioneered
the use of video feedback techniques in supporting the developing relationship
between mothers with severe mental illness and their infants during their ad-
mission to a specialist mother and baby unit.
Christine Puckering (BSc, MPhil, PhD) is a chartered clinical psychologist, a
chartered forensic psychologist, a full practitioner of the Neuropsychological
Division, and Consultant Clinical Psychologist and Research Fellow at the
Royal Hospital for Sick Children, Glasgow; Honorary Senior Research Fellow
at the University of Glasgow; and Honorary Lecturer in Forensic Psychology
at Glasgow Caledonian University. Christine is a clinical psychologist and re-
search fellow with a specific research interest in measuring and helping parents
to change their relationship with their child. She is co-author of the Mellow
Parenting programme and has developed and researched the core under-fives
programme and Mellow Babies which was developed to meet the needs of
under-one-year-olds and their parents. Mellow Parenting is now an indepen-
dent charity. In 2006, she chaired a short-life expert group on infant mental
health for the Scottish Executive which made policy and practice development
proposals for supporting all infants and protecting those who are particularly
vulnerable.
Antonia Reay (BA, MSc) is a chartered counselling psychologist at Tower Ham-
lets Primary Care Trust, Lincoln and Burdett Children’s Centre and Bromley
by Bow Children’s Centre. Antonia works in primary care and in Children’s
Centres with parents of young children, and is currently training as a cognitive
analytic therapy practitioner. She previously worked at Henderson Hospital
and with the Crisis Counselling Service at Holloway Prison.
Mary Rheeston coordinates the Solihull Approach and has been involved in de-
veloping their training, parenting group and resources. She is also a Solihull
Approach trainer, a health visitor, and an infant massage teacher.
Ann Rowe (BA, MMedSci, RGN, RHV) works independently and is currently
contracted to act as Implementation Lead for the Health Led Parenting Pro-
gramme for the Department of Children, Schools and Families. In this role she
has been responsible for the training and implementation of the Nurse Family
Partnership programme. During a career in nursing, health visiting and prac-
tice development roles, Ann has led a teenage parenting project, developed
and delivered learning programmes, designed and run change programmes and
acted as an external organisational consultant to a variety of organisations.
More recently Ann has worked as a research and development facilitator at the
University of Sheffield, and as a Nurse Advisor to the Department of Health in
the Long Term Conditions team.
 Contributors xiii
Alison Street (PhD) is an early years music specialist at Roehampton University.
Alison devised and compiled the musical materials and piloted the group work
with parents in the PEEP project from 1995 to 2000. Her doctoral research
(2006) explored the role of singing in mother–infant interactions and its influ-
ence on engagement patterns. As a trustee of PEEP, she contributes to training
and development, and lectures at Roehampton in music education.
P. O. Svanberg (BSc, MSc, Dip Psychotherapy, PhD, AFBPSs) is a chartered
clinical psychologist. He originally trained in Sweden and has lived and worked
in the northeast of England since 1979 following early work at Dingleton Hos-
pital in the Scottish Borders and in Yorkshire. He worked as an adult psycho-
therapist for many years and, following his doctorate in the late 1980s, became
very interested in adult attachment. Having trained in the Adult Attachment
Interview he became passionate about primary prevention and early interven-
tion, an area of interest he has pursued since 1997, resulting in the development
and evaluation of the Sunderland Infant Programme. He currently works at the
FNP and CHPP Implementation Team at the Department of Health.
Beth Tarleton (BSc, PGCE, MPhil) is a Research Fellow at the Norah Fry Re-
search Centre, University of Bristol. Beth has carried out research in a wide
variety of areas, including housing, short breaks, and most recently around the
support available to parents with learning difficulties, all of which relate to her
central interest in learning disability and empowerment. Beth currently coor-
dinates the Working Together with Parents Network which aims to improve
policy and practice in supporting parents with learning difficulties (www.right-
support.org.uk).
Joanna Tucker (BA Hons, MA, CQSW, UKCP) is a registered psychotherapist.
Joanna trained first as a social worker, and then as an adult psychotherapist
with the Jungian training of the West Midlands Institute of Psychotherapy. She
currently divides her time between private practice, working as a therapist and
trainer for the Oxford Parent Infant Project, and teaching infant observation.
Angela Underdown (MSc, HV, RGN, BEd Hons, PGCert in Applied Systemic
Theory) was previously Associate Professor of Early Childhood at the Univer-
sity of Warwick, and has recently taken up a post as Public Health Advisor to
the NSPCC. She originally trained as a health visitor and has a longstanding
interest in supporting infant mental health within family relationships. Angela
has been researching infant massage interventions in the UK and has recently
completed a Cochrane Systematic Review exploring the effects of infant mas-
sage on the mental and physical health of infants under 6 months of age.
Foreword
Dilys Daws

William Blake wrote, ‘He who would do good to another must do it in Minute
Particulars: general Good is the plea of the scoundrel, hypocrite, and flatterer, for
Art and Science cannot exist but in minutely organized particulars’ (Blake, 1804:
ch. 3, line 60). Harsh words for those of us optimistically engaged in grand gen-
eral policies aimed at reform and development, but perhaps there is some truth in
what he says when it comes to thinking about what to do for the good of babies.
This excellent book starts with an overview of recent developments within the
field of infant mental health, spanning the decades of research about infant attach-
ment and maternal sensitivity, and more recent theories about the importance of
helping parents to keep the baby’s mind, in mind. We now know that the transition
to parenthood is challenging for both men and women and that services to support
them during this period need to focus on the emotional preparation of parents for
parenthood, as couples negotiate their new relationships with their infant and each
other. All infant mental health provision needs to be underpinned by a universally
available service comprising practitioners with the necessary knowledge, skills
and capacity to build a trusting relationship. In the UK we are fortunate to have a
dedicated group of professionals (i.e. health visitors) who perform this function.
The knowledge for every new mother that a ‘someone’ exists, who has her and her
baby in mind, and whom she has a right to contact, can help many parents through
the often lonely and confused weeks of early infancy. A sensitive response by the
health visitor can help a seriously distressed mother to begin responding to her
baby. It is so simple when it exists and so unattainable when it does not. Many of
the chapters in this book describe interventions delivered by health visitors and
other professionals who are working in new and innovative ways to support par-
ents to provide the sort of parenting that recent research suggests to be important
if we are to help every infant to achieve their full potential. What all of these ways
of working have in common is a shared recognition of the importance of helping
parents to be sensitively attuned to the communications of their infant, and of
promoting the parent–infant relationship.
The core of the work being explored in this book is as such with parents and
their infants, and clinical anecdotes give us ‘minute particular’ glimpses of real
parents and babies. All of the interventions described have in common the crucial
role of the relationship between professionals and families, with professionals
xvi Foreword
first needing to understand parents, so that the parents can understand their baby.
When attachment between parents and their baby has faltered, this crucial rela-
tionship with the professional can symbolically provide an experience which can
be a model for a new beginning. Parenting takes time. The minute repeated details
of feeding, changing, playing and putting a baby to bed are the foundations of at-
tachment and family life. Professionals who do the valuable work of supporting
parents during this period need to be able to take the necessary time to reflect on
the experience of the families they are working with, and for their relationship to
model the type of reciprocal and containing relationship that will optimally exist
between the parent and their baby.
The recent UK government initiatives to combat social exclusion and reach out
into the community, particularly to young families at risk, provide the necessary
backdrop against which infant mental health can be promoted. What is of course
revealed by such initiatives is that those families who have been excluded, or who
have excluded themselves, often endure a considerable degree of deprivation and
disturbance, especially emotional distress. The professionals and volunteers who
work with these families may in turn be distressed by what they encounter and
need consistent and sensitive supervision that contains and helps them to under-
stand their own feelings and reactions. They also need, of course, support from
their organisations and a management hierarchy that appreciates the emotional
investment that they are making.
It is striking that many of the projects described in this book have grown in
similar ways in different parts of the country. Some have sprung up indepen-
dently, while others have cross-fertilised each other. New ideas are often created
spontaneously more than once when their time has come. I am proud that many
of the contributors are active members of AIMH-UK (i.e. the Association for In-
fant Mental Health – UK), which is affiliated to the World Association of Infant
Mental Health. I founded AIMH-UK in 1997 after visiting Australia to speak to
the Australian sister organisation - AAIMH. At the time I was impressed by the
way clinicians there got together with primary care workers to discuss clinical
work and research, and the provision of infant mental health services. On the long
plane journey back to the UK I thought, ‘We in the UK could do that’, and the
AIMH which emerged has been a fruitful place for all of us interested in infancy
to meet and share ideas, and may have contributed to at least some of the ideas and
programmes described in this book.
There has been a lack of a clear, conceptual framework in the UK concerning
the processes involved in helping families, particularly during the transition to
parenthood and the first few years of life. This coherently edited book adds to the
development of such a framework, as well as providing stimulating examples of
how it can be realised in practice. However, such a framework must not become
rigid. Parent–infant work is by its nature chaotic. As Picasso said, ‘If you know
exactly what you are going to do, what is the point of doing it?’ The parent–infant
worker needs to go into a visit with a family open to the emotions that will greet
him or her. In home visits this is often expressed in visible chaos with nowhere
apparent for the visitor to sit down. Alternatively, there may be conspicuous over-
 Foreword xvii
tidiness, as though the feelings stirred up by having a baby must be organised
out-of-sight. Whatever the setting, professionals need the skills to recognise and
support parents who may be struggling with the intense emotions that are evoked
at this time.
Why do we do this work? I can only answer for myself, having worked for
over thirty years as a child psychotherapist in the baby clinic of the James Wigg
General Practice in London and for many years in the Under Fives Service of the
Tavistock Clinic. There is the pleasure of helping families make a relationship
with their baby, and of getting in early and perhaps repairing something after gen-
erations of deprivation and despair. There is also the unexpectedness of the work,
of coming into contact with raw emotions, of making yourself vulnerable and ris-
ing to the occasion. Trying to contain the feelings of parents, who may never have
felt properly understood before, can sometimes lead to the humility of discovering
that their problems mirror those of our own. There is also the satisfaction of work-
ing with ‘ordinary’ families who have become temporarily stuck with the impact
of the ‘life and death emotions’ that new babies elicit. These families may need
only a little help in re-connecting with their capacities as parents. Professionals
working with parents during this period have the deep pleasure of seeing moth-
ers, fathers, and babies in the reciprocal interactions of a healthy relationship as
it grows and develops. I believe that there is an emotionally integrative effect for
the worker in going through such a process with parents and their baby, which is
deeply satisfying. So, while working this way is often painful it is also often very
enjoyable. It can bring out the creativity in workers, and also their playfulness.
New populations of patients also bring out new ways of working, and the human
propensity for risk-taking and innovation can lead to the development of new
projects and clinical approaches, as is so aptly illustrated in this timely book.

Reference
Blake, W. (1804). Jerusalem.