Watch, Wait, and Wonder by 6Ru726Y

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									  Watch, Wait, and
Wonder: An Infant-led
Approach for Working
with Infants and Their
       Parents
            Nancy J. Cohen

Hincks-Dellcrest Centre & University of Toronto
COLLABORATORS:
  Mirek Lojkasek
  Elisabeth Muir
    GOALS
 Discuss the underpinnings of Watch, Wait,
  and Wonder in attachment theory
 Compare Watch, Wait, and Wonder to other
  current interventions
 Describe Watch, Wait, and Wonder technique
  and process
 Summarize research results on Watch, Wait,
  and Wonder
 Consider applications of Watch, Wait, and
  Wonder
On the surface, some infant
problems may not appear to be
relational.
However, they often reflect the
infant’s separation anxiety.
The difficulties do not reside
solely in mother or child but in the
relationship.
SYMPTOMS THAT BRING INFANTS
TO CLINICAL ATTENTION


Infant Symptoms
 Irritability and difficulty being soothed
 Excessive tantrums
 Sleeping problems
 Eating problems
 Clinginess
SYMPTOMS THAT BRING INFANTS
TO CLINICAL ATTENTION

Parent Symptoms
 Depression
 Anxiety
 Risk for or allegations of abuse
 Complaints of not feeling bonded or
  attached to infant
“A baby has none of the conventional
attributes of a psychiatric patient. He
can’t talk about his problem. He can’t
form a therapeutic alliance. He has no
capacity for insight. Such patients are
usually labelled ‘not suitable for
treatment’ in the language of psycho-
therapy.”
CONDITIONS FOR SECURE
ATTACHMENT

 Accurate perception of infant cues
 Sensitive responsivity to infant
 Display of affection
 Acceptance of infant’s behavior and
  feelings
 Physical and psychological accessibility
  when infant is distressed or when
  exploring
IMPLICATIONS OF
ATTACHMENT SECURITY

 Regulation of emotions and behavior
 Sense of self
 Curiosity and exploration
 Cognitive and language competence
 Capacity to relate to others
 Capacity to parent
Individual Differences in Infants
Contribute to the Relationship

Infants have different personalities or
 temperaments from early on
These traits evoke different responses (e.g.,
 some babies are soothed easily)
Some parents find it difficult to establish a
 “fit” with their infant.
The parents often have expectations of how
 their child should be. These expectations
 may be conscious or unconscious.
Even when the problem is
attributed to something else
(e.g., FAS; developmental
exceptionality) a
relationship focus can be of
benefit.
SECURE BABIES

Explore freely and seek contact with
the attachment figure as necessary.
INSECURE BABIES


AVOIDANT BABIES
Do not show attachment needs in order to avoid
rejection.
AMBIVALENT
 Preoccupied with the availability of an
 inconsistent caregiver and make repeated high
intensity demands to ensure at least some elicit
attention or are extremely clingy.
DISORGANIZED BABIES

Do not have an organized strategy
that elicits care when distressed.
INTERNAL WORKING MODEL

Internal working models of self in relation
to others are set down and unconsciously
guide and filter attention and processing
of experiences with regard to attachment.
In this way, they impact on the course of
future relationships.
An intervention consistent with attachment
theory needs to meet a number of criteria:

   Provides emotional and physical access to
  mother.
 Focuses directly on maternal sensitive
  responsiveness to the infant's behavior and
emotional signals.
 Places the mother in a non-intrusive stance.
 Provides a space in which the infant can work
  through relational struggles through play and
interaction with the mother.
 Provides a therapist who can function as a
  secure base for the dyad.
OTHER INTERVENTIONS:
Support


 Assist mothers to access community
  resources, such as housing, work,
  child care.
 Counselling the mother or teaching
  social skills.
 Therapist is resource.
OTHER INTERVENTIONS:
Developmental Guidance

 Provide information to the mother on
 infant abilities, developmental
 milestones and needs, and practical
 caretaking issues individually or in
 group format or informally during infant
 medical check-ups.
 Therapist is resource.
OTHER INTERVENTIONS:
Relational Guidance

 Help mothers increase knowledge of and
    experience with infant in the context of
    spontaneous interactions.
   Mothers helped to attend to their infants’
    idiosyncratic cues.
   Therapists provide feedback directly or by
    reviewing videotapes with the mother.
   Therapist may also model parenting
    behavior.
OTHER INTERVENTIONS:
Psychotherapy

   With help of therapist, the mother gains access to
    repressed early experiences, re-experiences feelings
    associated with them, and achieves insight into the
    relational difficulties with her infant.
   Infant included as a catalyst for change.
   Repetition of the mother’s past primary relationships
    in her relationship with the therapist
   Therapist interprets and helps mother make links
    between past and present.
   Therapist may guide mother to interact in a different
    way.
In spite of our current knowledge that
infants contribute to relationships, all
of these therapies focus on the
mother and assume that the work
needs to be done with her before the
infant can benefit. None of these
therapies have as their goal that the
infant should be able to use the time
therapeutically himself.
Although it is the infant who is
the greatest clinical concern, the
actual focus of treatment is
usually the mother. In our work,
we have focused on how best to
include the infant in infant-parent
dyadic therapy directly through
the infant’s activity.
“You be this way or else you will
cease to exist in my eyes.”

The mother can only see certain
behaviors. The dilemma for the
infant is that if he is himself he
loses his mother. If he loses his
mother he loses himself.
Ironically, if he keeps his mother
he also loses himself. The
outcome of this experience is
separation anxiety.
HOW DO WE INCLUDE THE
INFANT IN PSYCHOTHERAPY?

 Allow the infant to explore and show
  his curiosity about the environment.
  through sensorimotor activity and play.
 Use observation of the infant’s
  spontaneous gestures as a reflection of
  his innate potential.
 Use a medium in which infants can
  seek and establish relatedness.
WATCH, WAIT, AND WONDER
SESSIONS

  Infant-led activity
  Discussion
 SUGGESTED LIST OF TOYS FOR WATCH,
 WAIT, AND WONDER
New born baby anatomically correct dolls with bottles and          Stacking cups
diapers an blankets

Doll’s crib that is large enough for child to crawl into, or set   Blocks
up a space on the floor with a pillow and blanket defining a
bed
Bean chair                                                         Small cars including ambulance
Two telephones                                                     Medical kit with stethoscope
Mirror, (shatter-proof)                                            Sets of vinyl family dolls (black
                                                                   and white
Activity board                                                     Set of tame and wild animals –
                                                                   large solid variety
Soft ball                                                          Bowls and mixing spoons
Stacking rings                                                     Train set

Policeman helmet or some other official hat                        Heavy duty blue vinyl (Pool
                                                                   manufacturers)

Undermatting polypropylene for padding

NOT ALL OF THESE TOYS ARE REQUIRED. IN FACT, WWW CAN BE DONE WITH VERY
FEW TOYS IF NECESSARY
INSTRUCTIONS FOR WATCH,
WAIT, AND WONDER

   Get down on the floor with your baby.
   Follow your baby’s lead at all times.
   Do not initiate activities yourself.
   Be sure to respond when your baby initiates
    but do not take over his activities in any way.
   Allow your baby freedom to explore;
    whatever he wants to do is okay as long as it
    is safe.
   Remember to Watch, Wait and Wonder.
DISCUSSION

   What did you observe?

   What was your infant’s experience?

   What was the play about?

   What were your thoughts and
    feelings?
RESEARCH OUTCOMES:
KEY AREAS OF MEASUREMENT

   Symptom reduction

   Mother-infant relationship

   Infant competence

   Maternal distress and confidence
RESEARCH OUTCOMES
PRE- TO POST-TREATMENT

   Both treatment groups exhibited
    symptom reduction, improved quality of
    mother-infant interaction, and reduction
    in parenting stress.
   Greater gains were made from the
    beginning to the end of treatment in the
    WWW group in attachment, infant
    cognition and emotion regulation, and
    maternal depression and parenting
    efficacy.
 RESEARCH OUTCOMES
 POST-TREATMENT TO FOLLOW-UP

 Improvements that were observed at the end of
 treatment were maintained.
 In some respects, further improvements were observed
 six months after treatment ended in reduced infant
 symptom severity, maternal intrusiveness, and dyadic
 reciprocity and parenting stress.
 Changes emerged in WWW and PPT at a different pace.
 Dyads receiving PPT showed gains in infant cognitive
 development, attachment, and maternal depression at
 follow-up that had been observed in dyads receiving
 WWW at the end of treatment.
WHAT MIGHT ACCOUNT FOR
DIFFERENTIAL TREATMENT EFFECTS - 1


Watch, Wait, and Wonder maximizes the
requirements for forming a secure
attachment relationship by providing
psychological and physical accessibility
to the mother and enhancing her capacity
to respond to the infant reciprocally and
without intrusion.
WHAT MIGHT ACCOUNT FOR
DIFFERENTIAL TREATMENT EFFECTS - 2

 In PPT, the primary focus is on the
 mother’s representations and the
 transference relationship. The latter
 focus may delay changes as the mother
 needs to work through earlier
 relationships before new insights can
 influence the relationship with her own
 infant.
CONCLUSION

All roads lead to Rome but taking
some roads takes less time than
others.

								
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