WHAT IS INFANT MENTAL HEALTH?

Selma Fraiberg and her colleagues in Michigan coined the phrase infant mental health in the late 1960s.It is de?ned as the social,emo-
tional,and cognitive well-being ofa baby who is under three years of age,within the context ofa caregiving relationship (Fraiberg,1980).
Fraiberg understood that early deprivation affected both development and behavior in infancy and reminded us that an infantis capacity for
love and for learning begins in those early years. She had been trained in a psychodynamic approach to mental health treatment for adults
and children,which she adapted for work with parents and young children from birth to three.
Fraiberg was attuned to the power and importance ofrelationships and understood that how a parent cares for a very young child has a
significant impact on the emotional health ofthat child. She also understood that parental history and past relationship experiences
in?uence the development ofrelationships between parents and young children. Fraiberg referred to this new knowledge and understanding
about infants and parents as ia treasure that should be returned tobabies and their families as a gift from sciencei(1980,p.3).She
spent the remainder ofher career returning that gift through training and a carefully crafted approach called infant mental health service
(Weatherston,2000).
Four questions are ofgreat signi?cance to the scope ofinfant mental health practice and to the training needs ofinfant mental health
specialists: What about the baby? What about the parents who care forthe baby? What about their early developing relationship and the context for early care? What about the practitioner? These questions shape the framework for infant mental health practice and training (Weatherston,2001).

Returning the Treasure to Babies

Imagine that you are an infant mental health practitioner and that
you are sitting in a familyis kitchen. The young mother,her infant,and her toddler
were referred to you by a nurse practitioner who had some concerns about the babyis
care and development following the babyis discharge from the newborn intensive care
unit. It is about 2 P.M. Dishes are piled high in the sink; food from several meals sits
on the counter. It is hot. The windows are shut tight,and although the sun is shining,
the shades are drawn as if to protect against the intrusion of daylight. The baby,three
months old,cries in the back room. The information that you were given tells you that
the baby was premature and had been separated from her motheris care for three weeks
before hospital discharge. The twenty-two-month-old toddler,a boy,brings you toys
and indicates with a grunt that he wants to climb up on your lapoyou,the stranger.
His face is smudged with traces of chocolate. He is pale and unsmiling. There are sig-
ni?cant developmental questions about both small children. Their mother,a single
parent,twenty-four years old,is alone in caring for her children and isolated from fam-
ily or friends. She seems agitated and surprised that you have come,although you
spoke to her yesterday on the phone. She,too,is unsmiling,unable to pay attention
to the toddler or to hear the babyis continuing cries. She lights a cigarette,pours a cup
of coffee for herself and asks you,iSo . . . why are you here?

This vignette marks the beginning ofan infant mental health intervention in which the focus is on early development and relationships
between a parent and her two young children.The scene is a familiar
one in the world ofinfant mental health,challenging and complex.
What is it that you,in the role ofan infant mental health practitioner,
will do? What core beliefs, skills,and strategies will guide you to work
effectively from an infant mental health perspective? Finally,what
training experiences will you need to have in order to offer this family
meaningful service support? The intent ofthis chapter is to introduce
the reader to the practice ofinfant mental health and the experiences
that contribute to the growth and awakening ofan infant mental health therapist.

 

The delivery of mental health services to infants,toddlers,preschoolers,and their families involves a complex interweaving ofskills that
straddle disciplines and test boundaries.Provision ofsuch services is a testament to the strength ofpractitioners who struggle to balance the
necessary knowledge base,application strategies,and self-awareness required by the work.It is a fragile dance,with the practitioner often
initiating a conversation that a caregiver does not want to have, testing and retesting boundaries as the work unfolds,and maintaining a steady,
yet ever adapting,view ofindividual children and families.The practitioner must provide constancy in an ever changing world while
remaining open to new possibilities in her own work and in the lives ofthe families served.The dance requires the clinician to adjust her
tempo across timeosometimes it is a slow dreamy waltz,at other times a spinning,whirling motion accompanying the child and family on
their precious journey ofdeveloping and becoming.
In order to be effective,the infant and preschool mental health practitioner must exhibit a wide range ofpersonality characteristicso
some deep within,others at the surfaceoall ready to be called up at the appropriate moment.These characteristics include a sense of
humor that allows the clinician to share joy with a family and to lighten dark moments. She must be able to laugh with a family,to
laugh with her colleagues,and to laugh at herself.She must be patient, not only with herselfand her expectations ofher own work but in her
expectations offamilies. She must be able to sit quietly and listen but not be afraid ofproviding advice when asked.A practitioner must also
be enthusiastic and passionate about her workothe dance is different,then,than when a family encounters indifference and apathy.
Compassion must come as second nature but not overwhelm the work. Showing understanding,interest,and concern is crucial,but so
as the ability to step back from the work and to maintain direction without being sidelined by overwhelming need.A practitioner must have boundaries but be able to work in boundary-less fashiono cutting across disciplines,making decisions that are appropriate in her
work with one family but not with another family.High-quality supervision is essential to this work.The good supervisor holds the clini-
cian so that continuing progress is possible and acts as the depository for the self-doubt that inevitably arises when doing this complex work.
Infant and preschool mental health is an ever changing,evolving ?eld.This handbook is designed to help the clinician in the journey
ofprofessional growth as she works to help young children and families realize their potentials.The handbook is intended to help train-
ing programs,agencies,and clinicians determine what skills and clinical experiences are needed to do the wide range ofwork that
makes up this ?eld and decide how to develop those skills and structure the clinical experiences.
The book is divided into five parts.Part One focuses on broad training areas in which a clinician interested in infant and preschool
mental health practice must develop skills.Weatherstonis chapter provides a wonderful overview ofcurrent and historical issues related to
training and service delivery,along with key concepts in infant mental health. Other chapters in Part One focus on developing observa-
tion skills,designing assessment training,developing diagnostic skills with very young children,providing dyadic therapy,providing (and
receiving) re?ective supervision,and developing self-awareness and sociocultural perspective.Finally,the chapter by Delahooke examines
retraining from the perspective ofthe practitioner who struggles with putting together key training elements,without the bene?t ofa com
prehensive training program.This chapter is particularly pertinent, as many practicing clinicians who decide to retrain to work with birth
to ?ve-year-olds are not able to move to another city and enroll in a comprehensive training program.
Part Two addresses specialized areas ofpractice,including the evaluation and decision-making process for reuni?cation and adoption,
play therapy with preschoolers,and intensive day treatment for very young,traumatized children in residential care.The last two chapters
in Part Two focus on the delivery ofinfant and preschool mental health services outside the traditional mental health arena.Jones
Harden and Lythcott look at issues in providing services in homes, schools,day-care centers,and social service agencies.Harris addresses
strategies for delivering services in rural and remote areas.

Part Three explores training systems and the use oftechnology for training,supervision,and consultation.Included are chapters exam-
ining the development oftraining and practice standards within California,the Wayne State University Graduate Certi?cate Program in
TM Michigan,and the development ofthe DIR Certificate program.

Wajda-Johnston and her colleagues have put together a wonderful examination ofthe struggles they have encountered and the success
they have had in developing technology for remote supervision and training.

Part Four includes several innovative models ofservice delivery and training that rely on collaboration between disciplines and an inte-
grative approach to services to create system change. Finally,Part Five is a thought-provoking examination ofprograms in Illinois and New York that transform training and practice through the infusion of rejective process and the creation ofiripplesiacross systems.

As infant and preschool mental health practitioners continue to develop and expand the scope oftheir practices,they will ?nd many
ofthe chapters in this handbook particularly important to their professional development.The authors are trainers and service providers
who are involved with the leading edge ofinfant and preschool mental health services across the United States.I hope that this book will
be useful as a training guide for developing clinicians,a resource for current practitioners,and an inspiration to programs looking to
expand their boundaries on behalfofvery young children and their families.