Monthly Archives: October 2011

Supporting Caregivers Overseas and in the Pacific Northwest


I am just returning from an exciting and enjoyable visit to Portland, Oregon, where I was privileged to be this year’s Herbert M Woodcock Lecturer.  As the Woodcock lecturer, I had the opportunity to present to the Oregon Psychoanalytic Society Thursday night, give Grand Rounds at OHSU on Friday, meet with the child psychiatry fellows afterwards, and then give the Woodcock Lecture Saturday, which is open to the community.  Throughout, my hosts were gracious, welcoming, and intellectually engaged.  An additional benefit was to learn that Dr. Woodcock, for whom the lectureship is named, was first a pediatrician and then a child psychiatrist devoted to bringing psychoanalytic principles and practices to clinicians of many disciplines treating children with psychological problems.  I felt identified with Dr. Woodcock in that I did a pediatric internship and also as my blog readers know have for many years been committed as a psychoanalyst to working with child clinicians and caregivers on the “front line”.  

I was delighted to participate in a discussion of one of the child fellow’s videotaped sessions of a child therapy. The two sequences of videotape were lively and fascinating.  The experience was also inspiring, because the second tape showed the therapist and child viewing the first tape together, and in the second tape the child was able to reflect on his behavior in the first tape and put into words some of his out of control reactions.  This reminded me of the work of my colleague and videotape analysis mentor, Dr. George Downing, and his “videotape intervention therapy” work (G Downing,  Discussion: Emotion, body, and parent-infant interaction, Emotional Development, J Nadel & D Muir, Eds., 429-449).

In my lectures I presented my “sandwich model” of therapeutic action, in which I attempt to put together a developmental model with my psychoanalytic theory in an effort to understand how people grow and change.  My intention was to use contemporary science – videotape technology and developmental theory – to inform my psychoanalytic thinking. The sandwich model is a way of organizing clinical data according to the different time scales in which psychotherapeutic events occur.  It is a multi-layered framework in which the two slices of bread in the sandwich represent a contemporary developmental model based on nonlinear systems theory and derived from infant research and applies to data that are very, very big (all living systems) and very, very small (events that occur in seconds and split seconds), and the meat of the sandwich represents the psychoanalytic theory and applies to data in the form of language and symbols.  I think of it as putting together the words (psychoanalytic), the music and the dance (micro-process), and the “big picture”.  I illustrated this model with video-clips from child analytic and therapy cases.  The case presentations included micro-analytic – second by second – analysis of the vocal and action turns of the child and me in sequences of videotape.  The analysis demonstrated the rhythms in the interaction, the most interesting of which are the ones with a high degree of coordination. The meanings of these moments of high coordination depend on the context – in one instance indicating a struggle for control, and in others an effort to hold an emerging new meaning “in the air”, while the child and I continued to work on it.  

The audience in the lectures seemed very engaged and contributed intelligent and thoughtful questions and comments in the Q and A.  For example, there were many questions about the technique and impact of videotape. There were important questions about the family context of the cases and about the impact of learning disabilities on the dynamic conflicts in the case. There was affirmation for one of my long-time favorite ideas (supported and elaborated by G. Kliman’s Reflective Network Functioning, of treating children in the classroom.  Many participants inquired about the first infant parent mental health certificate program  I taught in, in Napa, California, and also the new program in Boston, both of which I raved about.  I was impressed with the curiosity and open-mindedness of the group and felt encouraged in my ongoing efforts to bring together developmental and psychoanalytic thinking into one package, or “sandwich”, and make it accessible to the community of child mental health clinicians. 




Do Babies Remember Trauma? The Psychology and Neurobiology of Early Trauma

Many if not most children in institutionalized care in developing countries have experienced trauma. 


Last weekend I traveled to New York City, where I participated in a conference on trauma in infancy, “Do Babies Remember Trauma? The Psychology and Neurobiology of Early Trauma” sponsored by The Margaret Mahler Foundation and The Columbia Center for Psychoanalytic Training and Research.   My colleagues, Susan Coates and Susan Vaughan and I co-directed the conference, and my friend, Maria Sauzier (“10 points for how to handle sexual abuse allegations” in this blog) and I discussed papers in the conference.  It was a powerful conference.  The subjects that were addressed included medical trauma, trauma in the home, and trauma on the street – experienced by infants – how it occurs, what are the effects on the mind and the body, and how to treat it.  The main speakers were Susan Coates and Lenore Terr – both of whom gave detailed case presentations of children traumatized before the age of 1-year old – and Sunny Anand and Ted Gaensbauer, who talked about the neurobiology of pain and trauma in infancy.  A 22-year old young woman, Mia, whom Dr. Terr treated for severe trauma suffered in the home of her biological parents before the age of 1-year, also spoke at the conference, with her adoptive mother. 

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