Month: October 2019

  • Preschool: The celebration of wonder and connection to home

    Preschool: The celebration of wonder and connection to home

    The Michigan Association of Infant Mental Health sponsored this series of developmental articles to help us all reflect on the journey of parents and children from pregnancy through early childhood. This article explores the emerging preschooler and the wonderful, tumultuous transformation that the parent-child dyad experiences. On the shoulders of giants, this article attempts to build upon the writings on pregnancy, infancy, and toddlerhood presented over the past year by Michael Trout, Julie Ribaudo and Kathleen Baltman. Moving from the inner relationship in pregnancy through the beginnings of the attachment relationship and on through the emergence of the ME of toddlerhood, we are called to pause and remember the roots of our work, the space of the beginnings, the landscape of the children and families we serve.

    Look at the world through the eyes of a preschooler — full of the delights of imagination, friendship, and stories. This is a time of transition for children and parents, centered on the balance of exploration and holding, independence and connection.

    The primary caregiver continues to be vital in the preschool period, although the growing focus of social exploration can challenge this tenet.

    As the preschooler tries on new roles, new relationships, and new opinions, there can be a misperception that the attachment figure is optional or secondary.

    Marvin & Britner (2008) write about the need for attachment to remain “the holding environment to do the work of exploration and sociability” as the preschooler naturally feels drawn into the world beyond their front door. The parent-child relationship is the vital space of scaffolding, quiet attending, restoration, and repair in response to the brave trips into the big, exciting world. Shifting to more of a base camp mentality, the attachment relationship is vital for the child to recharge, share the stories of successes and failures, and be a laboratory for learning and developing more strategies needed for climbing up the mountain of the preschool classroom. Erna Furman, in her article Early Aspects of Mothering: Why it’s so hard to be left, writes of the role of this safe haven in preschool. “He (the preschooler) may need her (his mother’s) help with his own conflicted feelings and worries about his new venture, or he may need her assurance that she can tolerate his absence and can even share his enjoyment of new relationships and independent activities” (1982).

    Attachment in the Preschool Period 

    How the preschool child uses the attachment figure changes dramatically during this developmental period. While attachment “requires renegotiation at every developmental stage” (Moss et al., 2004), the milestones unique to this period exert a strong influence on how the interactions in the dyad are maintained and expanded. Preschoolers become increasingly aware of self and their own effect on others. Through experiments, the young preschooler begins to notice how he can affect their caregiver’s reactions, or even alter situations. In their foundational book, Touchpoints Three to Six, Drs. T. Berry Brazelton and Joshua Sparrow write about these “aha!” moments for young children. Like ripples in a pond, the child notices that their intentional (or unintentional!) expression of feelings, needs, and desires can change how the parent responds. At first accidental, these exciting and intense interactions teach a child that they have some control in their relationships and surroundings. Over time, and with practice, children learn to use various modes of communication to effect change.

    John Bowlby explains these changes in the attachment relationship as the movement into a “goal-corrected partnership” (Bowlby, 1953).  Part of the child’s work of exploration is the realization of and curiosity about the fact that their parents have their own independent thoughts, feelings, desires and plans. Within a secure relationship, the young child is able to experience the discordance of differing agendas. With a good measure of increasing impulse control, coupled with an increase in empathy and a growing understanding of cause and effect, the preschooler begins engaging in negotiations with the primary caregiver, jointly creating strategies and new attachment schemas.  (Marvin, 1977).

    Bowlby’s Internal Working Model (IWM) helps illuminate this crucial, early life transition. A blueprint for relationships, the child’s IWM is a compilation of their experience of deserving care, how efficacious they are in eliciting help, and the type of help that is available for them during times of distress. A child’s positive IWM, the memory of parental safety and care, is a source of internal strength when away from their attachment figure. During these moments, the preschooler uses her growing developmental skills of metallization, memory, and symbolism through her IWM to manage the challenges and stressors of exploration. Doug Davies, LMSW, PhD., in his book Child Development (2005), discusses this emerging representational competence, which he describes as the creation of mental schemas of interactions, feelings, thoughts, and sensory experiences. On the surface, preschoolers with “good enough” IWMs appear self-reliant, not needing their attachment figure for regulation. However, looking more deeply you will see that they are actually leaning on caregiving memories to modulate their emotions. Through a growing sense of time, the ability to use routine and rituals as time markers and, most important, these reliable IWM  schemas, preschoolers and older children reassure themselves that they are being “held in mind” by their caregiver who will return, and restore the child’s emotional balance.

    Developing Friendships

    While out in the world, the preschooler uses their IWM’s “implicit and explicit rules for social behavior and interaction” (Marvin & Britner, 2008) as a base to do the work of friendships, a key developmental milestone. Whether in the preschool classroom or in the community, preschoolers enter interactions with new caregivers or peers with the memories and expectations of their primary attachment relationship, and, when that relationship has been secure, view themselves as deserving of care, and capable of eliciting connection and support. In addition, they use the internalization of their family’s values and beliefs to guide how they treat others. The security of their IWM provides the foundation for their self-control and emotional regulation, which directly affects the ease in which they engage with others.

    Awareness of peers, interest in their perspectives, and building friendships are central developmental goals for this period. A preschooler becomes curious and their attention shifts to being alongside and then with another child as they play. The increased ability to keep another’s perspective in mind, and the joy and success in meaningful peer relationships is self-motivating.

    A preschooler and older child’s attachment styles affect their social competence, peer relationships, and future school success.

    Language and play skills can especially affect a child’s success or challenges in peer relationships. An older preschooler begins to use language as a way to enter play or interaction with another child, negotiate play content, or work together to develop co-constructive plans. A less adept child who struggles with fluent, coherent language may have difficulty making and interacting with friends. Since same-aged children are less likely to work harder to understand the less capable preschooler, this difficulty in communication can lead to rejection by peers, creating an additive negative effect on language and subsequent social skills. Again, the attachment relationship has a central role in helping a preschooler integrate, understand, and problem solve new perspectives, interactions and activities.

    Play

    Play becomes an amazing tool in negotiating these new relationships and experiences, taking on an array of functions: a way of communicating, joining with others, expanding developmental skills and processing an expanding view of the universe. Believing that play can be a window into the child’s mind, Piaget urged all professionals to look more deeply into the meaning behind all levels of play in young children. Play can become a space for children to express, question, and understand an array of emotions and experiences. “Symbolism (in play) provides the child with the live, dynamic, individual language indispensable for the expression of his subjective feelings for which collective language alone is inadequate” (Piaget, 1999). The child can explore anxieties and confusion through bending reality through their highly creative fantasy life.

    “In play, a child is always above his average age, above his daily behavior; in play, it is as though he were a head taller than himself” (Vygotsky, 1978).

    From this area of strength, the child has the ability to face intense experiences and feelings. Doug Davies states that, “Play allows the child to comment on and try to understand reality through a make-believe medium that is under the child’s control and therefore more easily manipulated than the actual world” (2011).

    Pretend play can become the safe framework for making difficult concepts more tolerable for the young fragile self.

    While in a play episode, children can reenact trauma memories or reminders, which can sometimes be eerily close to reality, such as a foster child locking animals in jail. Other times, the metaphor of a play episode may be vague and obscured, requiring more repetition, elaboration, and time for full understanding.

    Billy was a 4-year old whose father left the family without much notice when Billy was a toddler. His mother believed he was better off without him and was confident she was “enough” for him. Billy was highly emotional, had difficulty with peers, and resisted separation from his mother. In play, Billy quickly moved through various animals, people, and events, from story to story, at times without apparent cohesion. As his mother continued to witness his narrative in play, she began to see his theme: Billy was replaying times he had spent with his mother and father together. She discussed her surprise about his ability to recall these very early memories. As we allowed his play to continue, his mother was able (with the writer’s support) to begin voicing his memories, “I remember when we all did X…” As she retold the stories of the play themes, Billy’s play became more cohesive. Mother became braver and began speaking more directly of his father, her own denied sadness regarding his absence, and her wish that he was present. Billy’s story changed to a theme of loss, horses searching for a leader. With the writer’s encouragement, the mother became her own horse and took the lead. As the horses calmed in the story, Billy’s play changed to themes that are more typical, without repetitive trauma or intense meanings. He no longer repeated the themes of loss or aching nostalgia. Nearing the end of treatment the mother said to the writer, “From the beginning you wondered if he was missing his Dad and I thought for sure he wasn’t, being quite adamant about this subject. I did not believe he could remember him, let alone miss him. I see now he did.”

    Many scholars have created theories for understanding how children use play in all developmental domains. In the area of social-emotional growth, Mildred Parten expanded on Jean Piaget’s foundational work recognizing the sophistication within the play of the very young child to create a model of social stages of play. Parten’s stages consist of solitary play — playing alone though around others; parallel play — playing alongside others; associative play — playing separately but where there is an exchange of items and interactions; and cooperative play — playing with others, involving negotiation and co-creation of play themes and metaphor. Her structure looks at how the child uses play to move gradually into direct relationship with others, especially peers. Awareness of these stages and theories, and how a child moves in and out of mastery of these concepts, can help adults understand many areas of development, and in turn learn how to support and encourage development. (For an overview of different play theories see Bulgarelli, D. & Bianquin, N. (2017).

    The beauty of play is that it is very resilient and can communicate the inner world of the young child, but it too is susceptible to stress. Unfortunately, “(if) the play frame is not strong enough to contain frightening feelings and a child breaks off the play” (Davies, 2011), the child may regress to a lower level to developmental play. The child may lose the ability to use symbolic play, or pretend play, and fall back into sensorimotor type play — the use of objects in a functional, movement-focused manner.  With awareness and knowledge of play development, a sensitive adult can see this regression as a sign of dysregulation. Fortunately, with emotional scaffolding from a responsive, attuned caregiver, the child may be able to return to the overwhelming emotions and use dyadic play to understand and master intense feelings.

    Development and Regulation   

    Development itself can be a victim of the passage of time, even for a preschooler. Since developmental gains build on previous mastery, lags or challenges in specific domains can have a cascading effect. It is challenging to keep pregnancy, infancy and toddlerhood in mind when assessing and intervening with children of this age, but it is imperative to explore all phases of the child and family’s life so that the gaps in development and areas of regressive behavior can be recognized and used to inform and support the family. This highlights the difference between a child’s chronological age and developmental age, especially when the child is under stress. Through observation, an adult can take this developmental knowledge and begin to learn the child’s subtle cues of competency and distress and through this understand the underlying need for scaffolding and support. This discernment can lead to more sophisticated assessments and ports of entry for the dyadic work. This detective work can be difficult and requires patience, practice, and a calm center from the responsive adult.

    As we have discussed, development takes place on both an internal and external level, and is a unique journey for all children. Unfortunately, all development is highly susceptible to inner and outer stressors and regulation capacities. Why is it that the same child who can discuss the correct prehistoric age of a dinosaur at one moment becomes unable to access this coherent language when distressed? When too stressed and unable to stay well regulated, a child may revert to previously mastered coping and communication skills to feel safe and in control. Similarly, when an agitated or fearful toddler suddenly trips and falls, he will revert to more toddler-like communication and strategies. This can be confusing for the adults in their lives, especially secondary caregivers like teachers. Less familiar adults may expect these children to use their new expressive language skills at all times, which may heighten anxiety in an already stressed child. For example, a well-intentioned adult may instruct a child who is in a conflict with another child to “use your words.”  Unfortunately, the acquisition of a skill and the mastery and use of that skill as the default mode of communication can take many more years of practice, patience, and learning. To complicate things even more, often there may seem to be a dissolution of skills out of the blue when triggered by a purely internal stressor.  Without a developmental lens this screaming child may seem to be manipulative or even spoiled because he needs to connect with the adult, but has fewer resources and capacities in that moment.

    Many unseen stressors can also overload the preschooler’s ability to cope with new developmental anxieties: For example, the new mastery of bodily functions, such as toileting, can be a source of worry regarding any failures in maintaining this milestone.

    The focus on peers and friendship also opens up concern about rejection and disapproval, while their feelings of anger can elicit fears of being out of control or of being inherently bad. Magical thinking, while a source of joy and curiosity in play, can lead to false beliefs through the lens of egocentrism. Emotionally evocative situations, such as parental divorce, can lead to misunderstandings for the young child. In the absence of information and understanding at their developmental level, the child may use their inconsistent grasp on reality and cause and effect to develop an alternate narrative, with themselves as the central player in the story. The more aware we adult companions are of these internal struggles, the more we can give voice to assumptions and clear up misperceptions.

    The role of the nurturing, in-charge caregiver re-establishes the world as a safe, predictable, understandable place, allowing the child to return to a curious, engaging stance.

    Through self-talk by the parent, or co-construction of an emotional narrative, or a reassuring glance, an attachment figure can shore up the child to do the hard work of growing into new skills. Over time, adults learn the child’s patterns of stress and skill regression and can use new attachment tools of language, storytelling, and play to support the child through challenging times.

    Understanding Attachment in the Preschool Period

    Ultimately, the role of the attachment figure still plays a foundational component for the preschooler’s development. To better understand the expression of and role of attachment during this time, researchers Cassidy and Main, and Cassidy and Marvin adapted Mary Ainsworth and Mary Main’s infant and toddler attachment classification system. Ainsworth and Main developed these categories based on observation of infant-caregiver separations and reunions using the Strange Situation, a standardized laboratory procedure. Through their work, reunion behaviors were found to be indicative of the quality of attachment, due to the importance of reconnection with the caregiver as a safe haven, a place to be received, calmed, and restored. Cassidy, Marvin, and Main found that based on changes in internal and external developmental skills in preschool, the ways in which the 3- to 6-year-old and their parents negotiate the attachment relationship changes greatly throughout this period.  Therefore, preschool attachment was expanded to include: Secure, Insecure-Avoidant, Insecure-Ambivalent/Dependent, Insecure-Disorganized/Controlling, and Insecure-Disorganized/Other. (For a through explanation and description, see Humber and Ross 2005.)

    Secure Attachment in Preschool  

    The Secure preschooler displays increased ability to remain calm and either play alone or seek out the “friendly stranger” at separation. Upon reunion, this child is usually calm, relaxed, and confident. They demonstrate openness to verbally expressing their dissatisfaction about the separation, and are more willing to accept the parent’s explanation and response about the separation as part of their ability to regain composure. Secure preschoolers use language in increasing frequency over the strategy of proximity seeking. The parent is open and accepting of the child’s dissatisfaction and negative expression about the separation, and is able to validate their feelings, provide context for the stressor, and follow the child’s lead. The child then is able to return to play, providing a narrative about what she was doing in the caregiver’s absence and plans for future play and engagement. Original attachment strategies, such as proximity seeking and gaze and affective holding are still important for the secure preschooler, especially during heightened times of stress, such as long separations and novel or evocative experiences.

    The Securely attached preschooler has a consistent, sensitive, responsive parent, similar to the infant and toddler. These caregivers increase their use of language and play to provide the emotional scaffolding needed for the child. Through open emotional expression of increasingly complex feeling states and use of self-talk as a way to model problem solving for the child, there are ample opportunities to practice self-regulation skills. These parents demonstrate vulnerability and openness about themselves and are socially competent and accepting (Cassidy & Main, 1993). Secure caregivers see the negotiation and co-creation of narrative and problem solving as growth for the child (though the constant “whys?” can try even the most patient parent). Through attunement, balanced emotional expression, and respect for reciprocity, the preschool parent encourages the initiative and engagement of the child.

    Insecure-Avoidant Attachment in Preschool

    The preschooler with an Insecure-Avoidant classification displays “neutral coolness toward the parent, with a minimizing of physical or verbal contact” (Moss, Berrera, et al, 2004) upon reunion. During the Strange Situation assessment, this child deflects any attempts by the parent to reconnect. The child turns away to play, does not answer questions from the parent, or responds in a curt fashion, and chooses not to engage in any conversations about the separation, themselves, or their play. The children become detached from the caregiver in stressful situations, and minimize any expression of negative affect. One noticeable effect on learning and expression is this child’s “falling into parallel play … (or) highly individualized task-oriented mode with little interpersonal content” (Humber & Moss, 2005) seemingly due to the inability to use the caregiver as a safe secure base.

    Insecure-Ambivalent/Dependent in Preschool

    The second insecure classification is Insecure-Ambivalent/Dependent. Similar to the ambivalent infant/toddler style, these children show exaggerated involvement with the caregiver. Contrary to their developmental level or skill level, these preschool children stay connected with their caregiver through immaturity or can display subtle signs of anger.  Separations are long, arduous negotiations, with high degrees of conflict and highly evocative content. The child may disintegrate to the point of tantrums, cajoling the caregiver to stay though the triggering of guilt. The caregiver on the other hand is less emotionally available, with lower use of language for connection or elaboration (Huber & Moss, 2005, Moss, Bureau et al, 2004).

    Disorganized attachment in Preschool

    Disorganized attachment styles become two different categories in the preschool period: Insecure-Disorganized/Controlling and Insecure-Disorganized/Other. Lyons-Ruth et al. (1999) describe the Disorganized/Controlling strategy as “one partner’s initiatives are elaborated at the expense of the other partner’s.” Marked by the presence of role reversal, the child becomes either punitive or excessively caregiving to assert control within the environment. In relationship with the victimized parent, the child provides an emotional framework to compensate for the passive, inconsistent parent. Driven by hypervigilance, the child works hard to bring the parent to life or keep them in a good mood. This may be the overblown “performer child” or the child who is excessively comforting to their parent when they are distressed. On the other side, the punitive child becomes verbally or even physically aggressive, demeaning, and derogatory in the face of fear or through over-identification with the aggressor (Moss, Cyr, & Bureau, 2005; Marvin & Britner, 1999).  The final category, Insecure-Disorganized/Other retains the lack of predictable attachment strategy in the face of stress, displaying erratic, inconsistent behaviors and regulation.

    Caregiving in the Preschool period — “Oh baby it’s a wild world” 

    Attachment styles, and their corresponding IWM, are strong but are also sensitive to intentional, attuned caregiving. Parents through dyadic work can repair the challenged relationships with their child. Through the disconfirmation of the child’s expectations, attachment figures can create a different lived experience. In his article about a therapeutic preschool, Doug Davis speaks of supporting teachers in identifying each child’s IWM. From this curious mindset, he encouraged them to identify how these children viewed adults in their lives. Were they helpful? Hurtful? Predictable? From these explorative reflections, teachers were encouraged to demonstrate predictability, sensitivity, and empathy (Davies, 2010).

    Through the safe holding environment of the therapist-parent relationship, parents too can develop a curiosity about what their children are displaying and learn how to respond to the need, not the lead in their interactions. Through ongoing consistency and predictability there can be healing. This process can be slow, and change seemingly microscopic, but it will benefit the child throughout their entire life.

    Let us also always remember the importance of relationship for both sides in the preschool-parent dyad. As parent and child move together out of toddlerhood, the parent does not know what lies ahead: good and bad days, filled with dinosaurs, tea parties, skinned knees, and tears. We should keep in mind the developmental challenges for the preschool parent to stay present and attuned, while also celebrating the separateness of their courageous preschooler. Erna Furman, in Early Aspects of Mothering: What Makes it so Hard to be There to be Left, writes about the difference in parenting a dependent toddler versus the outward facing preschooler. “The anxiety is separate from and unmitigated by her (the mother’s) pleasure in her child’s growth as well as by her ability to recognize and feel sad that his (her child’s) new achievement implies a loss of earlier closeness in their relationship” (Furman, 1994).

    The transition for the caregiver to more of a secure base is indeed bittersweet, yet it is vital to allow the child to focus on their own curiosity and learning.

    These preschool years are filled with hopes and excitement about future victories, school parties, and the first best friend, as well as new challenges of the child who found his voice, wants to let you know when they disagree, and wants to be comforted when they do something wrong. Fortunately, the rollercoaster of preschool prepares us for the next stages of development and all the challenges of school-aged and teen children. So let us celebrate now the “Whys” and the “Nos!” of the creative, independent preschooler as much as we celebrated those first steps in infancy. I invite you to sit back, and enjoy the preschool ride — and join the race to space with Superman, a sparkly unicorn, and, George, the pet snake. Who knows where it may take you?

    Bibliography

    Brazelton, T. B., Sparrow, J. D. (2001). Touchpoints: 3-6: Cambridge, MA: Perseus.

    Britner, Preston & S Marvin, Robert & C Pianta, Robert (2005). Development and preliminary validation of the caregiving behavior system: Association with child attachment classification in the preschool Strange Situation. Attachment & human development. 7. 83-102.

    Bulgarelli, D., & Bianquin, N. (2017). 3 Conceptual Review of Play.

    Davies, Douglas (2005, July-September). “Introduction to Attachment,” The Infant Crier, #109, Michigan Association of Infant Mental Health, 4-7.

    Davies, Douglas (2010, Summer). “The Therapeutic Preschool: An Intensive Extension of Infant Mental Health to Meet the Needs of Traumatized 3-6 Year Olds,” Infant Crier, #133, Michigan Association of Infant Mental Health, 4-8.

    Furman, E. (1982). Mothers have to be there to be left. The Psychoanalytic Study of the Child, 37, 15-28.

    Furman, E. (1994). Early Aspects of Mothering: What Makes it so hard to be left. Journal of Child Psychotherapy, 20(2):149-164.

    Handbook of Attachment, Third Edition: Theory, Research, and Clinical Applications, edited by Jude Cassidy and Phillip R Shaver, Guilford Publications, 2016.

    Humber, Nancy, and Moss, Ellen. “The Relationship of Preschool and Early School Age Attachment to Mother-Child Interaction.” American Journal of Orthopsychiatry, vol. 75, no. 1 Educational Publishing Foundation, 1/2005, pp.128-41.

    Meins, Elizabeth, Bureau, Jean-Francois, & Fernyhough, Charles. “Mother-Child Attachment From Infancy to the Preschool Years: Predicting Security and Stability.” Child Development, May/June 2018, Volume 89, Number 3, 1022-1038.

    Moss, Ellen, Cyr, Chantal, Bureau, Jean-Francois, Tarabulsy, George M., & Dubois-Comtois, Karine (9/2005). “Stability of Attachment During the Preschool Period.” Developmental Psychology, 41(5), 773-783.

    Moss, Ellen, Bureau, Jean-Francois, Cyr, Chantal, Mongeau, Chantal, & St-Laurent, Diane (2004). “Correlates of Attachment at Age 3: Construct Validity of the Preschool Attachment Classification System.” Developmental Psychology, 40(3), 323–334.

    Piaget, J. (1999). Play, dreams and imitation in childhood.

  • A Beautiful Mess: Early Childhood Consultation – Building Relationships in the Classroom

    A Beautiful Mess: Early Childhood Consultation – Building Relationships in the Classroom

    This article is the work of the Circle of Caring team under the clinical supervision of Vickie Novell, LMSW, IECMH-E® with the support of the consultants: Wendy Dawson, LLP, IMH-E®, Danielle Davey, LMSW, IMH-E® and Jill Vandoornik, LMSW, IMH-E®.

    Welcome to the delicate world of childcare. The days begin and end with separations and reunions, some for the first time in very young lives. How do we support these precious moments of transition? How do we support the caregivers? Emotions and memories are gathered and created, swirling around the room filled with colors and caregiving. Whom do we trust with this space for such young souls? Fortunately we work with caring teachers who step up to share their creativity and energy with these young families. Of course, teachers bring their own emotions and memories but are often asked to  “leave them at the door” as they care for other people’s children. On the best day, there is care and concern, victory and resolve. On other days, there are different feelings — ones sometimes not acknowledged or even known. Where do these feelings go? What kind of memories do they awaken? What kind of memories do they make?

    Given the Herculean task of development in all domains — the body, the heart, the soul, and the mind, the Early Childhood educator is indeed a jack of all trades. As pressure from the dreaded K (kindergarten) rears its ugly head and families bring in enormous burdens of poverty, trauma, and loss, teachers are often torn. Teachers are torn between the urgency to “get children ready for school” and “Did you hear what happened to that child/family?” Day-to-day priorities in the classroom are often at odds, not always based on child needs, sometimes driven by assessments, scores, and monitoring. Parents come and go, sometimes through only brief interactions, strained by their own days ahead and ones past, with their own journey of school and authority ringing in their hearts and minds. Let us not forget the lives of the teachers; those lives they are supposed to leave at the door. They, too, may be carrying emotional burdens — family illness, financial challenges, family stress, as well as their own trauma and loss.

    Positive early childhood teacher-child relationships are highly correlated with future school and peer success, according to a growing body of research. Yet more and more young children are entering our classrooms with insecure and even disorganized attachment styles.

    These children seek connection and support in challenging ways, sometimes struggling to accept emotional support and guidance from the kindest, most well-intentioned teachers.

    So, what are we to do with these rooms filled with energy and possibility, bathed in feelings and memories? There are opportunities for teachers to find high-quality training in child development, trauma and special needs, but teachers are still understandably struggling. Even the best-trained teacher can still experience suffering and vicarious trauma. Developmental trauma or toxic stress occurs when “emotional pain cannot find a relational home in which it can be held” (Epstein, 2014). Early Childhood Educators are a relational home for the children in their care, but the load can be heavy.  Where is the teacher’s relational home?

    The Circle of Caring Early Childhood Mental Health Consultation program at The Guidance Center is helping construct such a home. Through a generous grant from the Head Start Innovation Fund, four Infant and Early Childhood therapists have been working in 10 Head Start classrooms over the past 2½ years. Through monthly group reflective consultation for teachers and weekly classroom-focused reflective consultation, these teaching teams have developed a strong working relationship with their consultants. Based on the original statewide Circle of Caring Child Care Expulsion Prevention Program led by Kathleen Baltman, MA, IMH-E, our consultants  have been learning and growing alongside the staff and teachers. Through our transformation from IECMH therapist to ECMH consultants we have experienced first-hand how beautifully IMH principles and practices address the much-needed emotional support for these classrooms.

    Early Childhood Mental Health (ECMH) consultants have a great opportunity to create a holding environment with the teachers so that they, as Jeree Pawl would hope, provide the same for the children and families. Thanks to researchers such as Walter Gilliam, Kadija Johnston, and Charles Brinamen, this growing field is revealing the critical and interdependent needs of these very young children, their families, and the teachers who care for them every day. As part of this professional community, Infant and Early Childhood therapists are well suited to offer this gift of presence for these systems and communities based on our training, experience, and deep commitment to reflective supervision and practice.  While our background provides a strong foundation for consultation work, the transition from clinical work to consultation requires training, support, and reflection.

    “What about the baby?  Which baby?”

    So how do we begin? Our port of entry and intervention is the relationship, but which one?

    As one consultant remarked, “Being in the classroom is like being at a home visit — at the highest volume.

    So many needs and feelings coming from so many different directions — teachers and children alike. At first glance — and feel — it can be overwhelming and seem like an impossible task. Me contain this? Where do I look? Where do I stand? Or sit? Who do I look at? Who on earth do I interact with? All consultants have experienced that moment of fight or flight, which professionally can look like flight/freeze — stand in the corner and just observe silently without looking at anyone. Or it can result in fight/control — take over group, intervene in behavior management, provide conflict resolution, and model. There is a flush of panic and responsibility, sometimes because of an acute attunement to the children and teachers’ internal experiences.

    ECMH consultation work, like clinical IECMH work, begins with us, the clinician. Grounded in the belief that the port of entry and intervention is OUR relationship with the teacher, we have the responsibility of maintaining and repairing our centeredness so that our offering of ourselves can provide a place of calm and reflection. Disruptions are expected, as in all relationship work, and “good enough” consultation is the aim. Our response to the disruption — sensitive, thoughtful, and humble — is the very point of healing. Through the ongoing support of our reflective supervisor, we can work to return to that center. Our Circle of Caring program offers weekly group supervision to all consultants. Through this supportive environment, we learn to refine our internal instruments — our open, receptive, curious selves — so we can become more attuned to the implicit, affective communication of the teachers and children.

    And so it begins…

    At the start of the program more than two years ago, we were acutely aware of the need for a sensitive, deliberate approach. As in any relationship work, beginnings are an opportunity for a different felt experience of being seen, heard, and known. Leaning on the wisdom of mentors, we worked to keep in mind the “consultative stance” (Johnston & Brinamen, 2006) how the attunement to one’s way of being with the staff, teachers, and even the system, can communicate the calm, centered, curious state that will be the hallmark of the practice. From the details of meetings and schedules to the desire to approach as equals, we hoped that we were beginning the process of explicitly and implicitly demonstrating our goals and hopes.

    Through early interactions and observations, consultants expressed curiosity about the teachers’ experiences of help in the professional setting. From the orientation to the project to the first classroom sessions and groups, consultants remained open to learning about the teachers’ needs and hopes for support, communication, and comfort with vulnerability and change.  Throughout our work we became more and more attuned to adult internal working models (IWM) that inform  the internalized expectation of their worth as a teacher/human, their efficacy, and their beliefs about others being helpful (or not), caring (or not), and accepting (or not). The teachers’ own personal IWM has been internalized and adapted based on their earlier caregiving experiences. We became more aware of the concept of professional IWMs. Often rooted in one’s personal IWM, professional IWMs are the ghosts of past helpers, site leaders, monitors, specialists, parents, and children. Sometimes coined bureaucratic transference, these are the conscious or unconscious expectations and predictions of how the professional will be assessed, be seen, be deemed worthy of help, and how efficacious they will be with the children and families. In addition, the professional IWM contains the experience and expectation of the availability and dependability of professional and emotional support from the work culture: Is it safe to ask for help, and how will that help feel? The following example occurred frequently at the beginning of the project, and again at crisis points in the work:

    Teacher “Mary” had recently entered the program from another agency. During one of the first weekly classroom consultations, the consultant observed a busy, highly emotional classroom. Mary was working with a pair of children who were having difficulty with transition and ownership of materials; she stayed patient and present throughout the conflict. The situation resolved well and the children moved on to another activity.  During a lull in the commotion, the consultant took the opportunity to approach Mary and remark on how she noticed the positive effort that Mary had made, noticing that she was able to contain their feelings and help the children through a difficult time. Mary became teary-eyed and thanked the consultant. The consultant expressed surprise at Mary’s reaction, which seemed tinged with sadness. Mary went on to disclose that she had recently left a different system that  was highly critical of her, leaving her feeling judged and ‘less-than’ as a teacher. She was worried to have a consultant in the classroom and relieved to hear positive remarks. The consultant thanked her for being so open and they went on to discuss the goals of the supportive classroom work.

    As we entered these relationships we became acutely aware of the need for transparency, predictability, and reliability for these teachers. Not unlike a family in crisis, teachers feel under the microscope and, unfortunately, bear the increasing weight of academic demand, monitoring stress, and systemic expectations. Explicit discussion of what the consultant would and would not do was an important part of the ongoing demonstration of our unique perspective. For example, we communicated at the beginning that there would be no writing down of thoughts or ideas, no strategies or lesson plans, no monitoring or reporting to the administration. Repeatedly we spoke to the concerns, spoken or not, of the worries about judgment and reprisals. We heard the requests for advice and strategies as an indirect expression of a variety of possible feelings. “Am I enough? I feel inadequate. Will you judge me? Are you better than me?” We worked to respond to the underlying feelings of fear, worry, insecurity, and apprehension through our calm, mirroring presence and reflections. Through our words and actions, we strived to communicate that the teachers are the experts and they are enough for these children and families.

    “The eye of a hurricane”

    Early Childhood classrooms, and especially Head Start classrooms, are a sea of emotions and experiences. Competing developmental and emotional agendas call out for skilled teachers who use their ability to stay present and calm to accompany the children through challenges and failures. This emotional work is the heart of learning, the creation of a safe haven and secure base from which to explore. An early childhood teacher must multi-task this emotional work with little to no time to pause, reflect or plan.  Add to that the unknown stress and trauma of all classroom participants, and you may wonder how teachers are able to stay present and connected at all. Though we all fall out of the calm center, it is no wonder that teachers feel barraged by needs, both concrete and emotional, and may go into autopilot or fight or flight. No wonder they may lose perspective; hence the need for support to regain their footing.

    A central tenant of our program is the firm belief that teachers have their own powerful intuition and ability to create supportive, nurturing responses to children and experiences.

    The barrier to these responses is, understandably, the dysregulation that occurs when faced with such high needs and limited reprieve and support. Our role with the teachers is to create a safe space where they can become more regulated, whether in the classroom or group setting. Knowing that the purpose of attachment is to promote safety and exploration, we look for opportunities to assess the state of being of the teachers and allow our relationship to become their secure base and safe haven. Inherent in this structure is the belief in developmental drive, “motivational structures (that) can also be regarded as fundamental modes of development. As such they are life-span processes that can be mobilized through empathy in the course of therapeutic action with adults”. (Emde, 1990)

    We stand firmly in the belief that our role is to promote regulation, which will intuitively lead to curiosity. Co-regulation allows for the preoccupation with safety to shift to the “other,” us as consultants, the environment, and the children, not from a fear response, but from a neutral or curious state. Creating a safe relationship with the teachers and with each other in the group setting takes time and a gentle approach. At the beginning, “do for” is a state of a sensitive approach to joining the teachers in relationship, all the while remaining keenly aware of the cues and miscues of comfort and acceptance of intimacy. Keeping the components of attachment-seeking behavior in mind, consultants learned each teacher’s comfort by noting the affective content of greetings and goodbyes; content and tone of shared work or personal stories; physical cues such as proximity maintenance and comfort, and gaze; and narrative cues, such as fluency of speech, tone, breadth and content of verbal communications. Through this ongoing assessment, consultants begin the process of learning how each teacher communicates emotions, needs, distress, and comfort with support.

    Lyons-Ruth et al. explored the concept of “relational knowing” or “how to do things with others” as the port of entry to change.  Lyons’ group offers the belief that this internal knowing is “as much affective and interactive as … cognitive… (and) begins to be represented in some yet to be known form long before the availability of language and continues to operate implicitly throughout life” (Lyons et al., 1998). This speaks to the belief that our relationship is the agent of change. What exactly, especially in the early education realm, is the underlying mechanism for change? Through creating a “moment of meeting,” two equals bring their perspectives, belief systems, and expectations together to co-create a new way of being. With “self as therapist,” the consultant will move into the emotional space with a teacher with curiosity and empathy for the teacher’s emotional experience. Often seen physically as a moving toward and away, the consultants pace and dose the “being with” according to the assessed comfort of the teachers. Throughout, the consultant develops an awareness of how, and in what circumstances, the teachers become dysregulated; what cues they feel safe showing, and how and if they use the consultant for support from the beginning.

    Through the attachment relationship with the consultant, the teacher is given permission to speak the unspeakable without consequences. Robert Emde speaks of developmental empathy as a “…temporary sense of oneness with the other, followed by a sense of separateness to be helpful” (Emde, 1989). Through the process of marking and containing affect, teachers are shown that all feelings are accepted and safe to be expressed. Interacting at the level of IWM, these interactions are “new … nonverbal encounters (that) suspend the procedural relational knowledge … ( which) overrides earlier relational experiences. It thereby overwrites earlier memories” (Gossmann, 2009).

    The nature of early childhood development and early parenting offers us a roadmap for the supportive work with teachers and staff.   As trust and feelings of safety increase, the teacher-consultant will begin to make use of social referencing as a regulation strategy. Robert Emde writes of social referencing as “a process whereby an individual, when confronted with a situation of uncertainty, seeks out emotional information from a significant other in order to resolve the uncertainty and regulate behavior accordingly” (Emde, 1989). During classroom consultation and times of distress, the benevolent presence and non-verbal encouraging stance of the consultant can have the same grounding effect on a teacher. Joint attention regarding a potential conflict or during an evocative experience creates a felt sense of being held in mind, while the consultant attends through a quiet presence, as Winnicott wrote, “being alone in the presence of another” (Winnicott, 1958). This encouraging, quiet attending is similar to a loving mother staying attuned to the almost-rolling infant’s expression of distress. That mother expresses a quiet reassurance and confidence in the child’s ability and need to struggle through the discomfort, while keeping attuned to the level of frustration so that it does not become flooded or lead to decompensation. If the arousal level becomes threatened, the mother knows the signs of dysregulation and moves in to repair and comfort. One classroom scenario speaks to our work from this vantage point:

    Teacher “Kay” and her consultant had spent considerable time over the years talking about the challenge of being with children while they were distressed without becoming punitive, directive, or moving away. During one observation, a child became inconsolable, and Kay approached him. Knowing this was a touchstone moment for their relationship, the consultant moved physically closer to her in the room while attending silently. The teacher looked to the child, then the consultant, clearly showing signs of distress. The consultant remained quiet but demonstrated understanding and empathy through her body position and facial expression. In the silence, the teacher turned to the consultant and said, “I just don’t know what to do.” The consultant quietly vocalized empathy and understanding while staying physically present, but not moving to problem solving or even reflection. The teacher then turned back to the child and empathized with his feelings. The child calmed and was able, after a time, to return to classroom activities.

    This is a simple example of parallel process at work. Doug Davies, LMSW, PhD., wrote about this through his exploration of the role of the supportive other “to contain big feelings, remain attuned in the midst of distress, set limits on dysregulated or aggressive behavior, and put moment-to-moment experiences into words (which) disconfirms the trauma-based model that she(he) is alone and vulnerable and that relationships don’t help” (Davies, 2010).

    “You had the power all along my dear. You just had to learn it for yourself.”

     – Glinda the good witch

    Our program, and many other IECMH consultation programs, draw from the rich IMH traditions of building reflective capacity as a way to enhance compassion, insight, and empathetic response. Two-hour weekly classroom-focused consultation and monthly two-hour group reflective supervisions complement each other to access not only the explicit narrative reflection work, but also the often more difficult implicit IWM and affective experience support.

    Our monthly reflective consultation groups are a unique opportunity for teachers to pause, in a supportive atmosphere, and look more deeply on classroom experiences.  During these sessions, the teachers are encouraged to explore more deeply the children’s and parents’ experiences, as well as their own experiences, reactions and feelings. Over time, these moments support the expansion of their ability to be curious about the multiple meanings of children’s behaviors, the feelings behind that behavior, and ways the teacher can meet the underlying needs for emotional support and connection. Through the creation of an open, supportive group, teachers are given the opportunity to reflect on how their own inner perceptions and belief systems color their understandings of behavior and, in turn, their responses to challenging interactions. Through the gentle support of the consultant, as well as affirming peer presence, teachers have become increasingly more insightful to the families’ possible histories of trauma, school difficulties, communication challenges, and issues with shame, fear, and confusion.  The ability to practice creation of the narrative, and time and space for reflection, allows for a more regulated and deliberate approach to future children and interactions. Through case presentations and group discussion, individual insights become generalized to other children and classrooms. Though the pull for problem solving can be strong, consultants use their leadership to keep the reflective space for the whole group. There have been so many examples of how the change in perspective has directly affected the relationships and children in the classrooms. Here are two brief examples from the groups:

    Teacher “Julie” discussed a family whose child had great difficulty following any routines or group activities. Julie shared that she felt pressured by the mother to force the child to participate, even though by Julie’s assessment this was too challenging for him. Through empathy and curiosity about mother’s felt experience, Julie began exploring the mother’s fears about her child’s possible disability and future struggles. Speaking to the consultant the following week, Julie reported that she went from feeling anger and frustration with the mother to sadness and compassion. Julie shared that the next time she saw the mother she noticed that the mom was hovering in the background. From a place of compassion, Julie was able to see the sadness behind the annoyance. She then went over to the mother, stood by her side, placed her hand on her back while they looked together at her child, quietly. Over the next weeks, the mother began sharing her fears about her child’s future, and over time was more flexible and worked as a team with the teachers.

    Teacher “Alice” found one of the children in her classroom emotionally draining due to his ongoing behavioral challenges, high activity level, and great need for interaction and guidance. Through the support of the consultant and encouragement of her peers, she was able to admit that she was frustrated. The consultant and peers expressed empathy and compassion, communicating to Alice that her feelings were justified and tolerable in the group. There was a brief conversation and the group moved on to another topic. At the start of the next classroom observation, the teacher approached the consultant with positive energy. Alice had taken the weekend to consider the child’s perspective, wondering about his feelings and returned with a special backpack, embroidered with his initial, which just happened to be the same as her son’s. She encouraged him to wear it around the classroom whenever he wanted and to collect and keep whatever he wanted in it for the day. The consultant noticed he was more focused, better regulated, and able to follow routines, and though he still struggled in many ways, he was calmer. This was a wonderful example of empathy and parallel process.

    The process of change in classroom-based consultation goes through many stages, from building the relationship, to “being with” as a co-regulation strategy, to the co-creation of new narratives and perspectives.

    This process is not linear or static and is greatly affected by the stressors and regulation of all the players involved. The co-creation of perspectives and narratives takes place in the shared curious space — the “zone of proximal development,” as coined by Vygotsky — and is scaffolded by a trusted advisor to move to higher developmental levels. In the consultative relationship, this may include offering the consultant’s perspective as slightly different, in the effort to “see the same child.” Different from didactic instruction, this perspective sharing is the meeting of equals with different perspectives to create curiosity and creativity in assessment, and ultimately different responses. In this creative, safe space, dyads explore concepts such as cues and miscues, the effect of trauma on attachment and development, and how perceptions and IWM may affect an objective view. Far from the role of expert, the consultant is a side-by-side companion in the experience of turning toward a challenging situation. Through these experiences, a well-regulated teacher can make leaps of perspective and intervention based on new information regarding development, trauma and perspective. Here is a simple example.

    Teacher “Cindy” began watching a child with the consultant in the classroom. This child was very busy, but Cindy had positive regard for him and expressed confusion and curiosity about his ability to engage in classroom routines and activities. The consultant took this opportunity to share her observation about the child’s limited play skills. She shared her observation that he confidently seemed to play on his own, but could only maintain cooperative play when Cindy and the other teacher supported him. The next week Cindy reported that she had spent the last week more specifically observing the child and providing teacher-led experiences with him and other children, with the long-term goal of building his independent skills to play with others. Cindy also reported that she had begun noticing that other children in the room had varying skills in cooperative play and she was intentionally scaffolding them as well.

    The dance of the relationship

    Our work through Circle of Caring has been an amazing, emotional, and growing experience. We have borne witness to teachers growing in confidence and peacefulness.

    Over these few years, teachers have begun instinctively developing curiosity and compassion for even their most challenging children and families.

    Through an empathetic lens, these amazing teachers are beginning to become freed up to create ways to develop new connections and build safety within their classrooms overall.  We have seen first-hand that the strategies and interventions that curious and compassionate teachers create are unique, individualized, and child focused. This confirms our worldview that the creation of a safe space for feeling and being seen and held leads to amazing discoveries. These innovative ways of teaching cannot be taught; these attuned ways of responding to the children come from their own hearts. Hearts that are given a safe space through reflective consultation to speak the unspeakable, process the intensity of the classroom environment, and allow themselves to be open and fully human.

    A final story tells the beauty and hope for this work:

    Upon entering into one of my new classrooms in my role as a reflective consultant, I remember taking the time to pause. As I listened to the harmonious sound of the children at play, I noticed a bright yellow beanbag chair on the floor. It was a particular shade of yellow that demanded attention. As the weeks went by, the teachers and the children began to show me the meaning of the yellow beanbag chair. This teaching pair showed me many of their individual strengths right away. They were able to respond, attend and support the children when both teachers felt confident in “knowing the problem” and could quickly provide a resolution that worked. When a child became dysregulated to the point of screaming, crying and throwing themselves onto the floor, the teachers would move toward the child, using all of the tools in their toolbox to try and calm them. When this did not work, they would give into the intolerance of the child’s big feelings and gently carry them over to the yellow beanbag chair. The screaming child would then be instructed to sit there until they could calm themselves down. This was a pattern that I began to see emerge as the months went by. Together the teachers and I remained curious about the times that they felt confident and the times that they “just didn’t know what to do; nothing is working.”

    Several months into our work together, one of the teachers discussed a difficult child during the monthly supervision group. As the consultant, I remained attuned, connected and empathic as the teacher spoke about her experience with this child. Some of the group members wondered if this child was “an only child and spoiled.” The consultant explored this concept of the spoiled child more with the group. The group worked to define this idea of a spoiled child. “A spoiled child always gets what they want and can do anything without consequence.” One of the teachers then began to share her own childhood experience of being like that child. The consultant noticed a slight shift in the tone of this teacher’s voice as she spoke. When asked how that felt as a child, the teacher shared, “I was alone a lot. I was left to take care of myself.”  The group became quiet for a brief few moments. The teacher who was presenting broke the silence by being curious about the use of the yellow beanbag chair with this difficult child.  With support from the consultant, the group began to wonder about this experience from the child’s perspective. The teacher wondered out loud, as if speaking for the child, “I’m screaming and crying and need help and now I’m alone.” The conversation was not without debate and quickly shifted to the other’s perspectives. However, as the consultant, I noticed that something shifted for that teacher in that moment. The beauty of this program is that I knew I would see this teacher the following week in the classroom and could revisit this one on one.

    The following week the teacher tried to put into the words her experience in the group. The safe exploration and curiosity around the use of the beanbag chair and the teacher’s felt experience in the group created a space for both the teachers and the consultant to begin to name when this was happening in the classroom. This allowed the teachers and the consultant to create a language around not only the use of the beanbag chair but the teacher’s internal experience that drove her to directing a child to the chair.

    Several months later, two children were having difficulty sharing a toy in the classroom. One of the children became very distressed by this and began to cry, letting out a high-pitched shrieking sound that built in intensity. One of the teachers moved close to her. As the consultant, I moved in closer to the teacher as well. She tried talking to her as she swiftly moved in to pick the child up and place her on her lap. This only made the child more upset and her cry more intense. The teacher stood up with the child in her arms and brought her over to the yellow chair. However, today she did not walk away but instead sat close beside the child as she cried. I watched as the teacher’s eyes boomeranged around the room until landing on me. Our eyes met and without any words,  she conveyed to me her awareness of the change. I stood up and walked over to the teacher and the crying child. I sat next to the teacher and we both took a deep breath. The teacher expressed feeling helpless and unsure. She felt perplexed that trying to hold the child appeared to make things worse. Together we sat through each other’s discomfort and, over time, the child calmed. From that day on the yellow chair was no longer used. When children became upset, the teachers would join them where they were, physically and emotionally.

     This is why we do this work; why we wade through the emotions and memories with the teachers on behalf of the children and families. Together we work to create possibilities for the teachers, the young families, and ourselves. This journey and dance of healing is paved by presence, empathy, and curiosity with the dream to create a greater world full of loving, relational homes. We, the consultants of the Circle of Caring, are grateful for being able to share in this experience and look forward to the discoveries ahead.

    Bibliography

    Davies, D. (2010) Child Development: A Practitioner’s Guide. 3rd Ed. New York: Guilford Press.

    Emde, Robert. (2009) Facilitating Reflective Supervision in an Early Child Development Center. Infant Mental Health Journal, Vol. 30(6), 664–672 (2009).

    Emde, Robert N. (12/1990). Mobilizing Fundamental Modes of Development: Empathic Availability and Therapeutic Action. Journal of the American Psychoanalytic Association38(4), 881–913. Research Support, Non-U.S. Gov’t, Los Angeles, CA: SAGE Publications.

    Epstein, MD, Mark. (2103) The Trauma of Everyday Life. Penquin Press.

    Gossmann, Martin. (2009) Affect-Communication: The “Something More Than Interpretation.” International Journal of Psychoanalytic Self Psychology. 3:3, 330-353.

    Johnston, K., & Brinamen, C. (2006). Mental Health Consultation in Child Care: Transforming Relationships among Directors, Staff, and Families. ZERO TO THREE.

    Johnston, K., and Brinamen, C. (2012) The Consultation Relationship – From transactional to Transformative: Hypothesizing About the Nature of Change. Infant Mental Health Journal. 33(3), 226-233.

    Lyons‐Ruth, K., Bruschweiler‐Stern, N. , Harrison, A. M., Morgan, A. C., Nahum, J. P., Sander, L. , Stern, D. N. and Tronick, E. Z. (1998), Implicit relational knowing: Its role in development and psychoanalytic treatment. Infant Mental Health Journal, 19: 282-289.

    Winnicott, D.W. (1958) Collected Papers: Through Paediatrics to psychoanalysis. London. Tavistock.

    Other Helpful Texts

    Davies, D. (2012, Summer) “The Therapeutic Preschool: An Intensive Extension of Infant Mental Health to Meet the Needs of Traumatized 3-6 Year Olds.” The Infant Crier, #133, Michigan Association of Infant Mental Health, 4-8.

     Heller, S., Boothe, A., Keyes, A., and Nagle, G. (2011) Implementation of a Mental Health Consultation Model and Its Impact on Early Childhood Teacher’s Efficacy and Competence. Infant Mental Health Journal. Vol. 32(2), 143–164.