Tag Archives: Infant Parent Mental Health Course

Preschool, Day Care: Attachment and Separation


I have promised to discuss interventions for childhood constipation and soiling, but I received a great comment that I would like to address first.

A reader of the blog commented:

As the director of a Montessori school in Colorado, I have a few questions:
1) What are your thoughts about early child care and its effects on attachment? I am aware of Belsky’s study and the NIHCD studies. Do you believe that early child care (before 3) undermines security of attachment? Do you believe this is irrespective of the type or quality of care? Is there other research on this issue that you would recommend?

2) I know there have been a lot of studies (some even specific to child care) which show that infants/young children separated from their parents show abnormally high cortisol levels and lower growth hormone levels. Given these studies, do you have a recommendation as to an optimal way to transition a young child into a child care setting (to minimize their distress)? Is there an optimal way for children to separate from their parents each day (we have tried many things over the years- parents walking their child into the school, children leaving their parents in a car line- a teacher comes out to get the child, etc)? If a child appeared to be highly stressed (how would you quantify this?), what would you recommend? Is there any research as to how specific practices might increase or decrease a child’s experience of separation?

In response to this important comment, I contacted recent graduates of the Infant Parent Mental Health course in Boston and Napa, of which I am on the faculty – https://www.umb.edu/academics/cla/psychology/professional_development/infant-parent-mental-health. I value the knowledge and expertise of this group of clinicians and wanted to start a discussion about the issues of childcare, security of attachment, and separation from parents. I will also request comments from another group of valued colleagues – preschool teachers.

My first response came from an IPMH graduate who also has extensive experience directing and administrating early child care programs, Alayne Stieglitz. Here is her thoughtful response:

When I read these questions I thought of Ed Tronick on the first day of the IPMH Program introducing us to the caregiving practices of several cultures around the world: The village in the Andes where infants are bundled in blankets and strapped upside down on their mothers backs for the first year of their lives and the tribal group in Africa where children have an average of seven caregivers before their first birthday. These are not what we would consider ” best practices” but the children there are reaching their developmental milestones, forming healthy, robust attachments, and thriving in their societies. He said, “Different patterns of care taking and parenting may violate norms we hold as vital, yet children are still developing and learning. Those differences work for their culture. The point is to raise a child who can be competent and successful in the culture they live in.”

In this day and age, the culture that an increasing number of families are living in includes childcare. Single parent households and households where both parents work in order to provide what’s needed for their family do not have the option of whether or not to put their children in someone else’s care. There are many choices; in home care by a relative, in home care by a nanny, small family day care, and center based care. I think the question to ask is not, “Which type of care is best?” But, “Which type of care will be best for my child and my family?” And, of course, “Which is the highest quality of care that I can afford?” This last question limits the options for many families. Continue reading

Caring for Caregivers in Infant Mental Health Course


First Weekend of the UMass Boston Infant Parent Mental Health Course

This course is essentially related to the focus of this blog – caring for the caregivers. The course was where I developed my ideas more fully and also my clinical skills. 

Our first weekend of the course was exciting, as I have come to expect from my previous experience at the first two courses. We started on Thursday afternoon with an introduction to the program. Berry Brazelton paid an extended visit to the Thursday afternoon class, and in his relaxed and gracious manner and in his wisdom, he offered the program an extraordinary inauguration. 

On Friday morning, Ed Tronick initiated the theoretical framework of the program by presenting his developmental model of match, mismatch, and repair, and its implication for Attachment Theory.  Marilyn Davillier then offered us a paradigmatic case, “Pretend You Feeded Me!” a moving videotape of a young child and her grandmother trying to find each other and create a family together against a background of profound loss, trauma, and insecurity. We thought we would return to this case again and again in our attempts to use new knowledge to understand tragic human dilemmas. After the case, Ed returned us to a focus on theory, laying out the theoretical framework of the infant parent course and explaining his core developmental model of the dyadic expansion of consciousness. Ed illustrated the salient points of the lecture with powerful videotapes of the still face paradigm. The remarkable sensitivity of infants to their mother’s non-verbal communications was demonstrated in these tapes, in which when their mothers suddenly became unresponsive in their presence, the babies made multiple bids for attention (calling out to their mothers, putting up their hands, pointing,) while also self regulating themselves in this stressful situation. Finally, as the 2-minute time period progressed, some babies seemed to give up, even lost postural control and slumped in their infant chairs. The repair of the rupture caused by the still face was again a unique creation in each mother-infant pair. Making use of familiar patterns of behavior that had meaning for the two of them in particular, mother and child rebuilt a sense of connection, a “being together”, but one imagines that, after the still face experience, the ways the two have of being together can never be exactly the same again.

On Saturday, I (Alex) began the program with a presentation of my sandwich model of therapeutic action. I call it a clinician’s attempt to integrate infant research and psychoanalytic theory. As mentioned earlier in the blog, … , the top bread in the sandwich represents the very very big (the wide scope of nonlinearl theories describing how all open systems change). The meat or veggie in the sandwich represents the interactive processes taking place in the time frame in which language and other symbols are made; it tells the story.  And the lower slice of bread represents the microprocess, in a time frame measured in seconds and split seconds. This micro level is what I refer to the music and the dance of therapeutic (and developmental) process, and it is rarely taken into account in clinical case descriptions. And yet nestled within it are micro versions of patterns that are more evident at higher temporal levels in the form of gross actions and language.  I illustrated the model with the case of a dyadic treatment of a young child and his mother. In this case demonstration, the coming together of meanings from multiple domains and time frames – language, actions, coordinated vocal rhythms –with the shared intention of creating a new meaning, was a modest attempt of illustrating the multiple simultaneous meaning making processes constantly at work in human beings as they try to move forward in their lives. 

We had a FIGS group lunch in which I got to know some of the remarkable fellows in greater depth. Out of our seven international fellows, a Peruvian and a Chilien, were included in my group. Our conversation ranged from our individual journeys to the program and to infant mental health, to projects we are passionate about. I talked about the reunification law in El Salvador, because I had the feeling that these people would comprehend the impact of the law.

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A team member, Susana, is featured in her agency newsletter.

Village Staffer Shares New Expertise Locally and Internationally

Just over a year ago, The Village’s Co-Founder and Chief Operating Officer, Irma Seilicovich, approached therapist Susana Fragano, ASW, with a unique opportunity: a chance to participate in an innovative, yearlong postgraduate certificate program featuring a multidisciplinary approach to infant-parent mental health. The program also happened to be housed at the University of Massachusetts. Without hesitation, Susana, who works with parents of children from birth to 18 years and supervises our MSW student interns, made the commitment to spend one weekend a month in Boston. We’re glad she did!

The course attracts professionals from around the country and is led by some of the most respected pioneers in the field of child development. Students gain firsthand experience with the latest research on how to train parents and caregivers to build strong and healthy attachments to the children in their lives—identified as the linchpin in helping children thrive. Susana not only mastered skills that are now enhancing The Village’s services but, as one of the few bilingual clinical social workers in the program, she was invited to accompany faculty member Dr. Alexandra Harrison on her field work to an orphanage in El Salvador. There, Susana co-facilitated workshops for caregivers on building relationships with severely traumatized children, who must contend not only with issues of abandonment but with the effects of poverty and war. In addition to providing much-needed services, Susana returned with new insights that will be invaluable in working with the many Salvadoran families The Village serves.

Read this blog in Spanish.