Brighton and Hove Psychotherapy

01273 921 355

by Leave a Comment

Post Natal Depression in Mothers & Fathers

In this blog, I want to write about post-natal depression, revisiting and summarising a classic paper by Lawrence Blum, an American Psychiatrist and Psychotherapist. The paper was written originally in relation to post natal depression in mothers, however, because it essentially explores the conflicts aroused in becoming a parent and caregiver, particularly in relation to our own experiences of caregiving.  I think it applies also to fathers and to same sex couples and heterosexual couples where the caring of the infant is more equally shared.

Blum’s paper, titled the, “Psychodynamics of Postpartum depression”, is available on the web.

The paper draws a distinction between baby blues which he defines as the hormonal induced depression resulting from pregnancy and childbirth, and post-natal depression, which has typical features of depression, – ‘sadness, crying, insomnia, or excessive sleep, low mood, low energy, loss of appetite, agitation and self-critical thinking.’ 

He describes the external factors that can contribute, such as prior anxieties and depressions, low external support, difficult relationships, difficulty conceiving, stressful life events, etc. He summarises the studies at the time into the results of different therapies and concludes that supportive counselling, CBT and Psychodynamic Psychotherapy were all superior to the control and that the Psychodynamic therapy had the biggest impact on depression, as defined by the DSM 111. 

The focus is then on the possible  ‘psychodynamics’ of the depression and these are what I shall briefly outline here as these are what can really be usefully explored and alleviated by Psychotherapy. Three principle emotional conflicts are outlined; Dependency conflicts, Anger conflicts and Parent conflicts. 

Dependency Conflicts

In order to care for a baby, there is a need to be utterly depended upon, this is tiring and emotional and benefits from support. If there is a conflict about receiving support, a self-denial of the caregivers own needs, they can seek to repress their own essential vulnerability and needs and get  depressed.

Often people manage this part by becoming carers and end up in caring roles, such as therapists (a good a reason as any why therapists need their own therapy!) This counter-dependent strategy can work until it doesn’t. Someone who seems to be managing everything well, suddenly finds the balance has tipped too far. A baby can stir up the caregivers previously unconscious or sleeping wishes to be cared for, hidden by a display of  independence.

Anger Conflicts

A conflict with feelings of anger, which can feel counter to the role of caregiver. Parents can feel they don’t have a right to be angry, feel guilty about it or frightened of it, yet may have experiences and histories, which have left them feeling angry. Anger can be felt towards the baby, either as a projection of past hurts, or for the very real things it has done to the parents lives; tuned them upside down, deprived them of sleep, money, jobs, sex, etc, while carrying on with its incessant demands obliviously. The danger apart from depression in all of this, is that these feelings are denied and controlled and ‘loss of control can follow from over control as internal pressure builds up”, and has to be released, either threatening the relationship with the baby or more commonly being displaced onto partners.

Feeling the anger, tolerating it, and judiciously putting it into words, easy for the clinician to say, is the difficult and essential task for the person who is looking after the baby.

Parenthood conflicts

Caring for baby can stir up unresolved and unprocessed feelings about the caregivers own experiences of being cared for, whether a mum or a dad by a mum or a dad. Although a negative experience of being cared for can positively inform the ways in which the caregiver feels they don’t want to be, it doesn’t necessarily translate into clear ideas of how or what to be. In addition the caregiver, giving the baby what it didn’t receive, can be gratifying but  can also stir up the wounds of what they, the caregiver, didn’t receive. 

I would like to finish with Donald Winnicott,’s, (a British paediatrician and Psychotherapist), funny but true reasons why a mother, (or father or caregiver), hates their baby, with the intention in which they were written, to provide relief from the day to day conflicts, that can be felt in the rewarding, important but by no means easy job of nurturing an infant:-

  1. The baby is not her own (mental) conception. 
  2. The baby is not the one of childhood play, father’s child, brother’s child, etc. 
  3. The baby is not magically produced. 
  4. The baby is a danger to her body in pregnancy and at birth. 
  5. The baby is an interference with her private life, a challenge to preoccupation. 
  6. To a greater or lesser extent a mother feels that her own mother demands a baby, so that her baby is produced to placate her mother. 
  7. The baby hurts her nipples even by suckling, which is at first a chewing activity. 
  8. He is ruthless, treats her as scum, an unpaid servant, a slave. 
  9. She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself. 
  10. He tries to hurt her, periodically bites her, all in love. 
  11. He shows disillusionment about her. 
  12. His excited love is cupboard love, so that having got what he wants he throws her away like orange peel. 
  13. The baby at first must dominate, he must be protected from coincidences, life must unfold at the baby’s rate and all this needs his mother’s continuous and detailed study. For instance, she must not be anxious when holding him, etc. 
  14. At first he does not know at all what she does or what she sacrifices for him. Especially he cannot allow for her hate. 
  15. He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt.
  16. After an awful morning with him she goes out, and he smiles at a stranger, who says: ‘Isn’t he sweet!’ 
  17. If she fails him at the start she knows he will pay her out for ever.
  18. He excites her but frustrates—she mustn’t eat him or trade in sex with him. 

Winnicott, D.W. (1949). Hate in the Counter-Transference. Int. J. Psycho-Anal., 30:69-74. 

 

Paul Salvage is Psychodynamic Psychotherapist trained to work with adolescents from 16-25 and adults across a wide range of specialisms including depression, anxiety, family issues, self awareness and relationship difficulties. He currently works with individuals in our private practice in Hove.

 

Further reading by Paul Salvage –

The Therapeutic Relationship and the Unconsious

A Nation Divided

Adolescence: the trials and tribulations

Facebooktwitter

by Leave a Comment

Curiosity: how can children’s behaviour help us understand what they need from us?

“Watch your plants and see what they’re telling you” (Ollie Walker, Hosta grower, Gardeners’ World, BBC2, 14.6.19).

Ollie Walker has fallen in love with the diversity of Hostas and delights in watching them grow.  This is some dedicated watching: the nursery he works at stock over 800 varieties.  Noticing small changes in thousands of plants, he knows exactly which nutrients are needed for the healthiest growth.

Many babies are fortunate enough to be watched with arguably much greater devotion than this.  For starters, the care-giver: cared-for ratio is much better – 1:1 attention at least.  The sense of wonder surrounding a new-born breeds connectedness which begins relationship. It gives the baby an experience of felt safety, of being held psychologically as well as physically. This is just as well.  We now know that early attachment relationships are a foundation for all forms of later development.  As Winnicott said, “there is no such thing as a baby.” [i]  Infants cannot exist independent of someone to look after them.

An attuned care-giver is open to a baby’s non-verbal communication -her cry, gaze, gesture, smell, touch or muscle tone – and finds meaning there. “Good enough” parents provide consistent, appropriate care and interaction enough of the time. Inevitable mis-attunements are further food for curiosity, opportunities for adjustment and repair which strengthen attachment and resilience. Toddlers and children of all ages, continue to require the mind of a benignly curious adult to scaffold development.  Behaviour is a window to a child’s inner world of thoughts, feelings and body states.

All children, at one time or other, behave in ways which cannot be dealt with easily or quickly and might be perplexing, concerning, maddening or all three.  Those children growing up in environments where their needs are not sufficiently met or where they are unsafe will be more likely to do this.  We may find that even our best intentions and the most tried and tested behaviour management strategies are not effective.  This is often because they have not evolved from a relational understanding of the child’s needs and what is being communicated through the behaviour.

Staying curious can be hard if there is pressure from friends or family to quickly stamp out unwanted behaviour. Or we may be driven by a need to make something better and hurry to provide instruction, fix a problem or eradicate pain without first considering what the matter might be.  These can also be the behaviours which trigger our own vulnerabilities.

In addition to highlighting aspects of our own internal make-up, intense emotional experiences inside of us can be an effective clue as to what children themselves are feeling.  This is central to Wilfred Bion’s development of Melanie Klein’s theory of Projective Identification.[ii]  Bion proposed that not only can unwanted feelings be projected into another person, who then feels those feelings, but that this process serves the purpose of communication.  For example, a looked after child who sabotages her own birthday meal after a lovely family day out may cause a foster carer to feel rejected and resentful.  This could be thought about as the child (unconsciously) letting her carer know about both early experiences of rejection and how hard it is to believe in her own capacity or deservedness to sustain states of joy in the present.

For children with experience of trauma, challenging behaviour and Projective Identification may be the only means they have of telling the emotional story of what has happened to them.  It can seem counter-intuitive, but we need to welcome this and, alongside setting appropriate boundaries, seek to find meaning in it.

Symbolism in the child’s play and other activity can be very revealing about a child’s inner world and language itself can be thought about beyond its literal meaning.  For example, a child who repeatedly says she is hungry, when we know she has recently eaten, may be letting us know she is hungry for connection, as opposed to food.

It is the wondering process here which is as or more important than the resulting care itself.  Through close observation and knowledge of the child and attention to his/her own emotional response to what is happening, a care-giver takes in the communication of discomfort, frustration, distress, fear and so on, reflects on it, digests it, and feeds it back in a more manageable form, often through words, as well as through tone/ gaze/ affect/ posture/ actions.  Correspondingly, the child feels accepted, held and understood and receives a message that his/her care-giver is able and willing to be alongside and help manage emotional pain.

This is what Bion called “containment”, the parent as “container” the child as “contained” – in my view, one of the greatest gifts we can give to the younger generation. Through repeated experiences of this kind, children develop their own capacity to think about and process feelings.

In addition to patience, true curiosity requires flexible thinking, open to the myriad nuances of human behaviour.  The same actions can have different meanings for different children or even for the same child, such as a troubled 7 year-old boy who would regularly take himself into the corner during a PE lesson and sit with his head in his lap.  Over time, staff learned that he would do this both when he was hyper-aroused (worked up) and needed space away from others to calm down and when he was hypo-aroused (switched off) and in need of company and livening up.

In psychotherapy with children (and in therapeutic parenting work) we are often dealing with issues which have felt too difficult to think about and make sense of.  The therapist’s task is to engage, observe, listen to, accept, be curious about and sit alongside a child, gently helping to make thinkable the unthinkable.  This takes time.  Emotional defences are there for a reason and require sensitive handling.

Holding steadfast to curiosity is one of our soundest investments with children.  If we can start to wonder about a child’s behaviour, we stand a much greater chance of coming up with an effective way to meet his/ her needs.  As Gerda Hanko (Educational Psychotherapist) and others have said: “Don’t just do something, stand there!”

Michael Reeves is a Psychotherapist working with children and young people aged 4-18 and/or their parents/carers. He is available as a clinical supervisor for training or practising therapists and counsellors, whose work is primarily focused on children/ families/ parents. He is available at our Lewes Practice.

 

Further reading by Michael Reeves –

Acceptance – What does it have to do with managing children’s difficult behaviour?

 

Resources – 

[i] Winnicott, D.W. (1960). The Theory of the Parent-Infant Relationship. Int. J. Psycho-Anal., 41:585-595.

[ii] Bion, W.R. (1962b). Learning from Experience. London: Heinemann

Facebooktwitter

by Leave a Comment

“Ghosts in the Nursery” – The Power of Family Scripts

 

 

As much as we might fight it, our own experiences of being parented, create within us blueprints or ‘internal working models’ of what it is to be a parent. These models only become fully activated when we become parents ourselves, and often take us by surprise. For instance, we may find ourselves ‘turning into’ our parents in ways we hadn’t intended. Similarly, memories from our past can be unexpectedly invoked in us when our own children reach the same age. 

Selma Fraiberg (1987) emotively referred to this phenomenon as “ghosts in the nursery” – the idea that without conscious effort to alter entrenched family patterns, family life can essentially become a ‘rehearsal’ for the next generation. More commonly, we refer to this phenomenon as the enactment of ‘family scripts’. John Byng-Hall (1985) proposed three ways in which these family scripts may manifest – 

  1. REPLICATIVE SCRIPTS: 

These scripts are a direct replication of the parenting that we received ourselves. They can include replication of positive scripts (e.g. family rituals, ways of nurturing children, ways of enforcing boundaries, certain sayings, etc.). They can also include replicating negative (unresolved) scripts, which may be consciously replicated (e.g. “smacking never did me any harm”) or unconsciously replicated (e.g. needing to hide one’s sad or angry feelings from a parent can make it harder for these children to later recognise or respond to these feelings in their own children).

  1. CORRECTIVE SCRIPTS:

These family scripts are a conscious decision to offer our children a different experience of being parented to what we received ourselves. The danger for this type of script, however, is that because they are driven from an emotional response to our past, there is a risk that we will go too far the other way (e.g. feeling hard done by as an older child, so favouring our own eldest child).

  1. IMPROVISED SCRIPTS: 

These family scripts relate to the ability to flexibly and creatively amalgamate what we most value from our own experiences of being parented, with what we now value and learn from new relationships, education, culture, etc. We generally consider that the most resilient and healthy families adopt this form of script. 

Difficulties can arise when damaging or unhealthy replicative family scripts cannot be consciously thought about by parents. In extreme cases, these can negatively impact upon a parent’s relationship with their child and therefore, their child’s subsequent emotional well-being. For the most part, however, activation of family scripts is normal, inevitable, and actually helps children to become embedded within the familial and social context to which they belong. Indeed, almost all the parents that I meet in my work (myself included), offer a fascinating mix of all three of the above scripts to their children.

References:

Byng-Hall, J. (1985). The family script: A useful bridge between theory and practice. Journal of Family Therapy, 7, 301-305

Fraiberg, S., Adelson, E. & Shapiro, V. (1980). Ghosts in the nursery: A psychoanalytic approach to the problem of impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14, 3.

 

Dr Laura Tinkl is a Senior Chartered Clinical Psychologist, professionally accredited by both the Health and Social Care Professions Council (HCPC) and The British Psychological Society (BPS). Appointments can be made in the Lewes Practice.

 

Further reading by Dr Laura Tinkl –

When praise becomes harmful to children

The role of ‘attunement’ in relationships with babies and young children

What is ‘Blocked Care’ as it applies to parenting?

 

Facebooktwitter

by Leave a Comment

Family Therapy for Beginners

Professor Richard Layard, one time ‘Happiness Tsar’, wrote, ‘in every study, family relationships, (and our close private life) are more important than any other single factor in affecting our happiness’.

It’s hard to grow and feel safe and content in the world if our family stories are causing us distress and discomfort. This is especially true for children, and young people when their family is their world. When they are struggling with emotional and behavioural problems or maybe unexplained physical ailments a ‘systemic’ approach can be revealing.

Systemic therapy is relational, that means looking at the spaces in between people and their relationships with others, as opposed to looking inside individuals. Systemic therapists are interested in the ‘systems’ that people belong to, such as our families, school, work places, peers and friendships. Exploring the context of tension, distress and unhappiness can help us illuminate the possible causes.

For example we may find stories of divorce and separation, estrangement, sibling rivalry, family illness and disability, bullying, academic struggles, financial problems, loss and bereavement, or drug and alcohol use Family therapy is about having conversations that can be difficult, exposing, controversial, and upsetting.

But also about reconnecting, understanding, sharing and being surprised. Feeling heard, understood, loved and believed. Explaining your side of a story, hearing family stories that help you understand current struggles and appreciating other people’s point of view. Feeling proud and united, relieved and supported and wondering together how you can move on.

Any therapy involves taking a risk; family therapy provides an invitation to be brave and accept that families may be worried, sad or confused about someone they love. Or maybe family relationships are feeling tense and strained, or they are missing someone who played an important role in your lives.

Established, repaired and revisited relationships give families a rich resource for healing.  Family Therapy sessions usually last 90 minutes, and as many family members who are available are welcome.  Work would begin by exploring why it had been decided now was the time for family talking and noting individual and family goals to help focus the work. Some family members may be initially reluctant to attend, its important for them to be aware that just be attending they are showing their support. They do not have to contribute verbally if they do not want to – this could be agreed at the beginning of the session. By just turning up they are able to listen to other expressing their views and will usually join in when they feel comfortable and safe within the process.

A genogram or family tree is usually constructed looking at the current family structure and remembering older generations. This provides a map of the family and a cultural context for the current problems. It generates stories, sometimes forgotten, about how positive and negative patterns and traits may have been inherited by the family in the room. This can be a revealing and emotional, with younger people hearing about relations that may have died before they were born and older ones remembering stories that help build to a clearer understanding of the family’s identity. A time-line constructing a chronology of family births and deaths and other family events is also useful. Again, this begins reveals its own narrative, which can help a family begin to plot the life story of a problem.

Family Therapy is always driven by the goals of the family and continual feedback allows the therapist to ensure that the family are having the conversations they want and need to have. Sometimes it may feel useful for family members to meet individually, in couples or sibling groups as part of the therapy.

It is not necessary to meet weekly; sometimes families find one or two sessions are enough to feel they are able to move forward. In my experience family therapy can be a powerful process with the family leaving more connected with and appreciative of each other.

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Facebooktwitter

by Leave a Comment

Acceptance: What does it have to do with managing children’s difficult behaviour?

The Paradoxical Theory of Change[i]  states that we can only change aspects of ourselves when we first become what we are.  Likewise, in order to support children’s development, we also need first to see them for who they really are and accept where they are at.

This can be a difficult thing to do.  To begin with, we need to be present with children for long enough and with sufficient attunement to really get to know who they are and how they are doing.  This is perhaps one of the greatest challenges for many parents today, with the pressures of work and the distractions of technology.  I once passed a young boy walking with his Mum who was on her phone.  “Mum, you’re not listening” said the boy, tugging at her sleeve. “I am listening” she said, not looking up.  “But you’re not hearing me” the boy replied.

Quantity of time together is important, but quality of contact is what matters most.  Setting aside a block of time for a planned activity at home or a trip out will usually be very well received.  In addition, briefer periods are valuable windows of opportunity for everyday re-connection through child-directed play, shared tasks and focused listening.

Really being present with a child can be challenging for other reasons.  When we look and listen we can be alerted to traits and behaviours  which we may find irritating or displeasing.  This can leave us feeling that we have failed as practitioners or parents and, at desperate times, that perhaps we made a monumental error ever choosing to take on a role of responsibility with children.  We may feel disempowered, at a loss as to how to help and so we look the other way as the task seems too big. Challenging child behaviours may also reflect vulnerabilities in our own character that we would rather not acknowledge.

For children who have experienced complex developmental trauma (repeated adverse experiences over time), there can be an additional avoidance, in society at large and even in adults providing care and support.  These insecurely attached children usually develop their own defensive patterns of behaviour.  These can be aimed at either deflecting adult attention by presenting as pseudo-independent or drawing adults in to collude with their own negative self-view through becoming critical, rejecting or punitive towards them.  Adults and systems taking up these scripts struggle to see beyond the child’s surface behaviours and may unconsciously be finding a way not to witness and sit with the child’s emotional pain, the enormous elephant of loss in the room.  This protects individuals and services from the powerless anguish of imagining the horror and injustice of what life might have been like for a child during periods of abuse or neglect.

Once present and engaged with children, our next task is acceptance. In Dan Hughes’ P.A.C.E. approach to parenting[ii], the ‘A’ – Acceptance, is the fore-runner to Curiosity.  This is not about condoning or encouraging negative behaviours.  It is about being real and seeing the whole child for who he or she is.  By accepting what is happening for a child, we are joining him/her and building a bridge, making it possible to develop understanding and then convey empathy.

This kind of acceptance is about taking an integrated view of human beings, steering clear of both idealisation and demonising.  We accept that all of us have different parts which includes parts that we might think of as positive and negative.  We go on existing, despite our apparent contradictions.  Vulnerable children often need help with this as they split the world into either good or bad and fear that we will reject them if their less favourable parts are visible or made conscious. We can model integration for children by talking about different parts of ourselves – our cake-loving part, our grumpy part, our forgiving part.[iii]

True acceptance is not about putting up with behaviour and it is more welcoming than tolerance, more than bearing and giving permission to another’s way of being.  It is about setting judgement aside as much as we are able, and privileging connection and relationship.  It says “I am going to be with you no matter what you do and I am going to stay open and engaged to you, whatever you try to do to push me away”.

Acceptance is therefore unconditional.  Even in their darkest, wildest and most hurtful moments we accept children and stay open and engaged.  Without this, connection is lost and curiosity, understanding and empathy become marooned. This can feel like a radical, even reckless, position to take, but it is essential for building emotional resilience and enabling relational repair, both in the home and the therapy room.

Michael Reeves is a Psychotherapist working with children and young people aged 4-18 and/or their parents/carers. He is available as a clinical supervisor for training or practising therapists and counsellors, whose work is primarily focused on children/ families/ parents. He is available at our Lewes Practice.

 

Resources – 

[i] Beisser, Arnold (1970) The Paradoxical Theory of Change  https://www.gestalt.org/arnie.htm

[ii] Golding, Kim (2017)  Everyday Parenting with Security and Love.  Jessica Kingsley.

[iii] Bomber, Louise (2007)  Inside I’m Hurting.  Worth Publishing.

Facebooktwitter

Copyright © 2020 – Brighton And Hove Psychotherapy – Privacy Policy
6 The Drive, Hove , East Sussex, BN3 3JA.