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From “Fraiberg in Paris” to Attachment Theory Applied to Community Health Care Centers for Family and Toddlers

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From “Fraiberg in Paris” to Attachment Theory Applied to Community Health Care Centers for Family and Toddlers The Signal Vol. 15, No. 3 Newsletter of the World Association for Infant Mental Health October 2007 Twelve Years Later: From “Fraiberg in Paris” to Attachment Theory applied to community health care centers for family and toddlers By 1. THINKING ABOUT it is worth the effort, and that the cost Nicole Guédeney, M.D., Ph.D. and THE SIGNIFICANCE to him or her will not be too high. Antoine Guédeney, M.D. OF THE REFERRED The insecurely attached parent PARENTs’ help- therefore entails two risks while meeting the mental health clinician for SEEKING BEHAVIORS the first time: the difficulty to make a Bowlby (1988) emphasized the We wish to present here the relational “engagement”, and to explore universal meaning of the process of painful affects, with a serious risk main changes attachment help-seeking and the well known research has brought into of rupture or breaking-off (Bowlby, equivalence between proximity-seeking 1977). In these cases, a conflict our clinical practice with and care eliciting. Seeking help shows parents of infants and between the parent’s attachment and the parent’s attachment Internal care-giving systems may arise and will toddlers. Our context of Working Models (IWMs) which govern work is community mental be expressed through ambivalent help his or her expectations in the context. seeking behaviors towards the clinician. health care centers in Paris: In child mental health, parents are the Infancy Units provide entering a care seeking process on Systematic exploration of parents’ free services to families with behalf of their child (Fraiberg, 1980), help-seeking behaviors, and attitudes children under 5, in their although most of them would never towards help is therefore a source allocated local districts. have applied for it or even entertained of valuable information about the Infant psychiatrists are in the idea for themselves. They are conflict between their willingness to charge of the assessment seeking help for their child: whatever help their child and their own fear and the treatment planning, is said or whatever shows up should of receiving help: Have they already as well as the direct be considered also as an indicator for had experience, direct or indirect, of clinical work with parents their care-giving IWMs. Seeking help obtaining help from professionals like and infants. Our general will activate for each parent a complex us? (“The Bureaucratic Transference” approach comes from the picture of procedural, semantic, and as Seligman & Pawl wrote, 1984) field of developmental episodic memories. Who was involved? How did it go? psychopathology. What did they think? Have they had In child mental health as opposed experience with other professionals? to adult mental health, the working We then explore whether in general, Contents alliance has to be achieved with the help-seeking is viewed by them as parents as well as with the child. The a legitimate or illegitimate behavior 8 Smell, Taste and Flavor first session is very often decisive (Bowlby, 1988). What do their family, in terms of the continuation of the social and individual cultures have to 11 By the Red Cedar evaluation (and eventually of the say? How do they construct their own treatment). Parents need to feel from personal general theory? Have there 12 President’s Perspective the very beginning that they will want been changes linked to life events, or to come again or at least that they will encounters, in the private sphere or 12 Editor’s Perspective feel they can do so, without running among professionals? What specific any risk or feeling threatened. We can memories do they have of asking for 15 Literature Monitor help the parent only if he or she has help? Any negative experience reported sufficient trust in the fact that this is by the parents about help seeking possible, that he or she can trust us, that WAIMH Central Office: Michigan State University, Kellogg Center, Garden Level, MSU, East Lansing, MI 48824-1022 Tel: 517-432-3793 Fax: 517-432-3694 WAIMH Finland Office: University of Tampere, Medical Faculty, Finn-Medi 1, 33014 Univeristy of Tampere, Finland Tel: +358-50-462 7379, Fax: +358-35517710 with professionals as generalized is such as at the beginning of the meeting considered as a “warning” signal: the and at its impending termination. Also, parent is probably not secure.. The are there “unexpected” attitudes, such Editorial Staff explicit utterances of the parent about as the parent giving a boring wealth the process of help seeking by itself of factual details about the child, or are particularly relevant (Braconnier the parents threatening to leave the Editor: et al, 2006): “The parent runs down child alone in the waiting room or in Miri Keren the process”, ”The parent has come the consultation room if he/she does but only because he/she was asked not obey them. Are there clues as Production Editor: to do it”, “He/she expresses fear of to what the parent views as the most dependency if he/she begins to work important thing, such as fulfilling their Minna Sorsa with us”, “For the parent, asking for own expectations as he/she imagines Tina Houghton help means vulnerability or weakness”, them, or rather meeting their child’s “he / she expresses mistrust about the needs? The observed contrast between Editorial Board: professional’s willingness or ability to the parent’s apparent willingness to help and to protect or comfort”. collaborate with and to please the Susan Berger professional while not comforting the Salvador Celia 2. PARENTS MEETING child’s distress is often an indicator Peter de Chateau of a “Parentified” child (Liotti, 2004). Mauricio Cortina A PROFESSIONAL Generally speaking, our attention is Graziella Fava-Vizziello IN CHILD MENTAL drawn as much by what we see as by HEALTH FOR THE what we do not, but should, see; as Emily Fenichel FIRST TIME much by what we are told as by the Elizabeth Fivaz-Depeursinge way it is told (Crowell, 2003). Peter Fonagy Cynthia Garcia-Coll This context, –meeting a professional Bernard Golse within the context of care eliciting, -is a paradigm of an attachment-activating 3. ASSESSING THE Antoine Guedeney situation: a distressed or vulnerable INFANT IN THE LIGHT David Lonie subject, who is unable to cope on his OF ATTACHMENT Tuula Tamminen or her own, encounters a professional, Michael Trout i.e. a person “who is stronger, wiser AND CAREGIVING - Elizabeth Tuters and willing to help” (Bowlby, 1988). RELATED ISSUES Hisako Watanabe This leads us to the unique meaning of this first meeting for the parents’ own a. When evaluating the infant, one attachment system (Crowell, 2003). has first to explore whether there is President’s Perspective: Once again, we can help the parent only any attachment-related problem. Are Tuula Tamminen if he or she has sufficient trust in the the child’s symptoms directly linked to fact that this is possible, that he or she a threat concerning accessibility to the can trust us, that it is worth the effort, attachment figure (Kobak & Esposito, From the Red Cedar: and that the cost to him or her will not 2004)? Hiram E. Fitzgerald be too high. Research has widened our palette of The reactions of parents to this observation, with a new semiology that The Signal is a quarterly publica- context provide valuable indicators makes it possible to re-visit numerous tion of the World Association for on any insecurity in the parents from symptoms, in particular out-of-control Infant Mental Health. Address cor- the outset, without more detailed anger (tantrums), provocation and respondence to Miri Keren. information being required on their auto-aggressiveness, vicious circles history of attachment. This new type of in behavioral disorders, oppositional semiology includes the following: The disorders, dysregulation of negative All opinions expressed in The concrete manifestations of the parental emotions, difficulty on the part of Signal are those of the authors, not perception of help seeking often start to parents to set limits and cope with necessarily those of WAIMH’s. appear before the first encounter, such assertive behaviors (Lyons-Ruth as during the phone call for scheduling & Spielman, 2004). We also pay a Permission to reprint materi- the appointment, technical difficulties special attention to the history of the als from The Signal is granted, to get to the clinic, criticisms about the infant’s attachment. We look for any provided appropriate citation for quality of reception by staff (Brisch, early separation or loss and conditions source is noted. Suggested format: 2002) and so on. We pay special in which they occur or for repeated attention to the parent’s reactions at affective ruptures with attachment The Signal, 2007 Vol 15, No.3, times of “reunions and separations”, figures (Boris, Fueyo & Zeanah, 1997) WAIMH. The Signal October 007 b. The assessment of the infant’s contradictory demands). The caregiving past (Slade, 1999). Current parental attachment quality is one of function is also assessed according to attitudes towards attachment-relevant the cornerstones of our clinical the presence or absence of the other issues are systematically noticed: evaluation (Boris et al., 1997, parent, when the child is present or not, “How important is attachment for Lieberman & Zeanah, 1999, Brisch, according to the emotional register of the parents?, How important are 2002, Crowell, 2003). the child (negative or positive emotion) relationships? How important are (Kobak & Mandelbaum, 2003). This negative emotions (anger, sadness, The parameters of the security base systematic assessment of attachment fear)? phenomenon and its developmental and caregiving-related issues at the history are systematically explored: individual, dyad, family and contextual We also pay attention to behavioral or before 6 months, the patterns and levels makes it possible to identify emotional indices (we call them “infra behaviors of the pre-attachment period; possible focuses for an attachment- verbal indices”) each time there is an around 8 to 10 months, the balance informed intervention (Belsky, 1999).
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