Second Morning’s Workshop

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Image of Supporting the Caregivers: Leonardo’s “Virgin and Child with Ste. Anne”

In this morning’s workshop we again started with the image of Leonardo’s Virgin and Child with Ste. Anne to remind the participants of the symbolic representation of supporting the caregiver. Then we moved to Sarah’s videos of last evening in the Home. We wanted to follow up our yesterday’s workshop discussion in which we talked about how the caregiving relationship can grow the children’s brains. 

1. A, with V, the cook: The Papusa Maker

In this video, A, a little girl now 7-years old, is watching intently as the cook, V, makes papusas.  The video demonstrates the role models of caregivers in constructive adult activities provide the children. The children observe the caregivers in their roles and imagine themselves engaging in the same activity.

The video shows A imagining becoming a papusa maker. In her expressive face, you can see her longing to be doing what the cook is doing.  Even though there are computer games going on in the same room, A stands enthralled by the papusa maker for about 20 minutes. She is observing the whole sequence of activities involved in making the papusas. As she observes, she is building the capacity for sequencing the steps in an activity, a critically important capacity for development.  She is learning by watching, by imagining, by anticipating, and finally by practicing. V is very patient in letting A be there and get in the way a bit and letting her feel as if she is part of what is happening. This is a great gift. A is beginning to anticipate a little bit, pointing to a papusa that she thinks is nearly ready. Kevin, an older boy, shares her interest, and V allows him to turn a couple of papusas over, because he is older, which is completely right. A can look forward to being older, when she will be able to make papusas too.

Comments:

B, co-director of another children’s home: I will think of papusa making differently now.

Sarah- You can think of sequencing through your entire day – all the activities children observe and engage in that help them learn sequencing. It is especially important for children with learning delays because they need an enormous amount of practice. 

Alex: Most of the children in the Home have the potential for learning delays because their background of malnutrition, neglect, or abuse.

Sarah: Being able to sequence in your body is a precondition for abstract thinking and academic learning. 

2. C and the Stick:

We started the observation with two ideas. The first was the idea we referred to yesterday, when we talked about those momentos magicos that occur when a child acts provocatively, and the adult does not overreact, how those accumulate to help the child learn that his strong emotions are tolerable and he can control them. The second idea is that when a child has intense emotion in his mind and in his body, and the adult joins him in those intense feelings but does not get angry or lose control, the child has the experience of being in that emotional state with another, and he can stay in that state without losing control. This repeated experience helps the child grow that capacity. C is learning that he can be mischievous and still keep it within a certain limit. 

In this clip, C plays with a stick, teasing the CG, who does not get provoked. Finally, he taps her on the behind, and she runs after him up the stairs in a playful way. They end up playing hide and seek. After that, he is calm and they end up quietly playing with play dough. 

Comments:

B: So you are saying that a teenage boy will manage his emotional behavior better if he is met with intense matching emotion but not aggression. 

A: Yes, that is probably true, but I am also saying that the teenage boy who has had the experiences that C just had with a CG will be more likely to back away from a confrontation than a boy who has not had such experiences. B says that he might have taken away the stick. Sarah says that there are also times when you need to do that.  Sarah says that what we are talking about here is that there are opportunities to help a child learn to self regulate through meeting him at an intense level and contributing to the mutual regulation.

3. G with I:

In this video, G is responding to I’s multiple provocations by teasing her back with a wet washcloth.  The actions are playful, not mean.  Then there is a pile on of G by several little girls. G adds that L wanted to play with G, and when A came, L tried to pull her away, but G told L that she could not play unless she let A join – setting a limit – and L allowed her to join.

4. Girls playing rowdily:

In this video, the girls are yelling and running around in a rowdy play. We thought that these girls were learning the importance of appropriate physical touch and also learning how to feel their strong emotions without being afraid, but instead, being able to assert themselves.  One might imagine that these girls will suffer less from domestic violence in the future (of course one never knows really).

N, from another children’s home:

 In their home, they are in the office a lot and when the kids want to come in, they will allow them to come in and give them a hug but then send them out again, setting a boundary.

Sarah: These girls are expressing a lot of intense emotion, and from the way the CG’s respond to it, they know that the CG’s are OK with it and they have the sense of being good people.

5. Soccer:

The video is full of loud noise – children yelling – and running around. Here you have some of the same emotions but they are being dealt with in a more organized way. 

Questions or comments: 

B: Rough play is good for kids. We agreed, as long as it is regulated by the adult. 

Sarah: The building of strong relationships, the modeling, all this changes the child’s brain, according to research.

Stories of Two Children:

This is the story of two children, Georgie and Alice.  Whereas the general narratives of the stories are true to my experience, and some details of the stories have been drawn from cases I have seen, they are not accurate accounts of real people.

First Child – Georgie:

At almost 3-years old, Georgie was very quiet in pre-school but he had tantrums at home. The tantrums began when his younger brother, Kevin, was born, ten months ago. Georgie’s mother was concerned about him and came to see me about him. What bothered her most was that she thought Georgie didn’t love her. He was very attached to his father, but not to her. Kevin, on the other hand, was sweet and always wanted his mommy. She thought Georgie was sad and she blamed herself for his sadness, but she was also angry when he preferred his father, and she felt rejected by him. 

The mother told me that although she felt wonderful while she was carrying Kevin, she had been sick during her pregnancy with Georgie, and that she and her husband had been fighting a lot. Finally they separated before Georgie was born. Her husband returned to be with her at the birth, however. Soon after Georgie was born, he developed a high fever. At the hospital they diagnosed an infection, and he was very sick for weeks. The mother also developed a terrible skin rash that made any physical contact excruciatingly painful and so the father stayed in the hospital with Georgie while the mother was recovering. When Georgie came home from the hospital, the mother still could not pick him up because of her skin condition.

When I saw the family in a family meeting, Georgie came into the room with big eyes and looked curiously at me, but clung to his father. Mother came in carrying Kevin. Mother sat on the floor and began to nurse Kevin and talk affectionately to him, while Father asked Georgie what he would like to play with. Mother also asked Georgie if he would like to play with her, but Georgie took one look at her nursing Kevin, and walked over to his father. He and his father began a play with an airplane and Georgie started making circles in the air with the airplane. The circles got bigger and bigger, until they encircled Mother and his brother. Then he began to play with the farm animals. He took up a sheep and put it up to the trough, but the sheep was too short to reach the trough.  “This little sheep cannot drink,” Georgie said sadly. After the meeting, when I was talking to the parents, the mother said sadly and with some anger at the father, “You see, Georgie does not love me.  He only wants to be with his father. I don’t know what to do.” 

This is a perfect case for the technique of videotape intervention therapy developed by George Downing, my mentor in videotape analysis and therapy.

Questions and responses by participants:

1. What feelings about mother do you have when you hear this story?

a. She was not giving equal amount of time to each of her children. 

b. Because she wasn’t giving equal time to each to the children that is why G was rejecting her.

c. She blamed herself for not talking it out with the husband and deciding how to share time with the kids and didn’t realize how this would affect her.

d. Seems like the mother is immature, childish, because kids go through stages and sometimes prefer one parent to the other.

e. There was a lack of communication between the husband and wife because the husband should have been more supportive; he instead should have said something like, OK I will take care of G because K is more dependent on you for the time being.

f. Because the reaction seems extreme, I wonder what in her past triggers this reaction.

2. What made it hard for Georgie’s mother to love him right at the beginning?

a. She was sick during the pregnancy, and she had conflict with her husband.

b. Maybe this baby was too small to understand that his mother didn’t go to the hospital because she was unable to go, and also he didn’t understand why she didn’t pick him up.

c. R pointed out that the first months have super importance. For the CG’s at the Home, they have experienced this – there is a deeper relationship for the children who came as infants.  

3. What might the father have done to support the relationship between Georgie and his mother?

a. The father can help the mother see that Georgie really does want to be with her.

b. The father can discuss the childcare with the mother so that both relationships can be supported.

 

Second Child – Alice:

Alice was 2-years old when her mother died in a car accident. Although she loved her mother and this was a devastating loss, she had been taken care of from birth by her mother’s older half sister, who had no children of her own and loved her as if she were her own child. Alice had two older brothers, one of whom was mentally ill; her brothers had left the home and were lost to contact. When her mother died, Alice’s father took her away from her auntie and brought her home with him. There was no preparation for this change; her father told her that her mother was not coming back and that she was coming to live with him and that was all. Her auntie was heart broken. Her father also began to drink heavily, and when Alice was 3-years old, her father died of complications of alcoholism. At this time, however, instead of being given back to her auntie, Alice was taken by her grandmother, her father’s mother, who was a difficult and domineering woman and who seemed to want Alice to be close to her to help her deal with the loss of her son, her favorite child.

Alice’s grandmother disapproved of all Alice’s school friends and dressed her in strange clothes, not in fashion. When Alice grew into adolescence, she wanted Alice to get a scholarship to a fancy school, but Alice just wanted to be a regular kid. They had arguments, but Alice was afraid of her grandmother. Sometimes her grandmother said bad things about her mother; she had never really approved of her son marrying Alice’s mother. In school, Alice met Billy, who was a nice boy and good to her. They had to sneak around to see each other because Alice’s grandmother didn’t want her to have a boyfriend. One night Alice and Billy had unprotected sex and Alice became pregnant. Nine months later, Georgie was born.

1. How does the story of Alice change your feelings about Georgie and his mother?

a. S, co-director of children’s home: These are the stories we hear all the time here. When you hear the stories of the parents of our children, you find they are just as bad or even worse (as those of the children).

b. B: We are “cycle-breakers” here. We are trying to break the cycle; otherwise it goes on and on.

c. Sometimes the mothers that have had experiences like this think that when their child is born the child will suffer the same way they have, and they don’t know there can be better, they won’t try to give them something better, whereas they could look to God to find something better for their child.

d. L: That was L’s situation growing up without a father; he wants to be a good father.

e. The grandmother didn’t rise above this the way many people can do, for example with the help of the church.

f. G : Many times the thoughts the parents may have about not wanting the children to rise above them are subconscious. We help them to realize this. 

g. Alex: Sometimes the parents do not want the children to succeed because they are competitive with them. The thought that their child may have more than they have can make them feel bitter and hurt. Other times, the parents can feel that if their child has more than they do, the parent is losing the child even more. 

Let us return to G’s story about E and his mother from yesterday. How can the story of Alice and Georgie help us understand what might be going on in that family?

a. Yes, his mother did have many losses, though it is hard to talk about the details.

b. R says she at times has felt frustrated with E’s mother and when she says, “He is rejecting me!” R thinks, “It is because you have been rejecting him!” 

c. S: For us with the parents, it takes months and years to earn their trust and hear the stories of the parents of our children. They feel that they will not live up to our expectations. Just like the grandmother of Alice; Alice was never meeting her grandmother’s expectations. 

After Break:

Photos:

We looked at the photos Sarah had taken yesterday of the CG’s and children. What was remarkable was the emotional connection in each of the photos. There also were wonderful photos of children playing together. We have not yet talked about the way the relationships among the children also facilitates development. In one series of photos of two school age boys drying the dishes, there was an amazing amount of gazing back and forth between them. The connection they maintained with each other made it possible for them to do their chore in a good humor.

Sarah Coaching the Aide of an Autistic Boy:

The eye contact that you saw in the children drying the dishes is one of the first goals when you are working with a child who does not have it.  This 8-year old autistic boy does not have language, but he does have a warm attachment to the aide, and Sarah is helping her establish communication with him through body language and facial expression. For the child to develop well, they will have to make a connection their and eyes and body before they really work on language. This is hard because the child is in a school system that tries to train children behaviorally to gain language without attending to the relationship; in fact the practitioners of the behavioral method are taught to maintain a neutral face while giving the children tasks. In the video, Sarah says, “wonderful!” to the aide when the aide makes a successful connection with the boy. In this case, Sarah is the Ste Anne, the aide is Mary, and the child is baby Jesus.  They are trying to have a flow of communication – a connection made up of many tiny actions, a whole succession of movements. This is our foundation for learning everything. Once they have the connection, then they might change the play a little bit. The aide is introducing some new kinds of play. Now it is time for the boy to go in from recess and he is going to get upset about going in. Sarah encourages the aide to join him emotionally to show him that she appreciates his frustration.  She can show this by mirroring what he does with his body.  She has told him he has to go in, and he is starting to have a tantrum. She is imitating him in an empathic way. She breaks up the transition into little steps and also negotiates with him about how many more swings before he stops, for example. Then she gives words to what she imagines he is feeling – “I don’t want to go in!” etc. and she models her body after his.

Questions about it:

a. With their little boy (an autistic child at another home), it is hard for him to make transitions.  They didn’t think of giving him language for his words.

b. Singing or playing what they are asking him to do is helpful. That was also true of the little boy in Sarah’s case.

c. Sarah: The aide started out just by following the child’s lead, but then she moved to their taking turns in simple play. This has worked also with the boy in El Salvador, who is learning to ride a horse by having the experience put into a song. 

Las Mil Posibilidades:

Finally, we showed the draft of a wonderful book written by Andrea Malagon Meagher. This book, presented as a special project for the U Mass Boston Parent Infant Mental Health Certificate Course, is designed to communicate important information relevant to healthy development simultaneously to parent and to child. In essence, it is supporting the caregiver. The book includes sophisticated facts from contemporary developmental science, presented in simple words in colloquial Spanish. There are dual narratives – one to the parent and one to the child – on each page. In one of my favorite pages, the little girl dances for the baby in her mother’s womb; the parent narrative explains that even babies in the womb are able to listen and sense if the people around them are happy. There are also wonderful tips about singing the same song to the newborn at the time of central daily activities such as feeding and going to sleep to facilitate the baby’s emerging self-organization. The group was delighted by the charming language and illustrations and impressed by the knowledge imparted by the book.  We wished we had individual copies to distribute to the participants for more extensive study and feedback. We look forward to hearing more from Andrea about the progress of the book. Sarah and I wondered if the book could be divided into two books – perhaps one before the birth of Mariana’s baby brother and one after Diego’s birth.

It has been a busy but wonderful time in El Salvador We will follow up on the workshop with evaluations by the participants and make plans for another visit.

Read this blog in Spanish.

 

 

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