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.
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 Association, 38(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.