Category: News

Introduction

Preschool play is complex and between the ages of 3 and 6 years, imaginative fantasies, narrative language and mentalization all begin to emerge (Davies, 2011; Luby, 2006; Meersand & Gilmore, 2018).  It is during this developmental period that play becomes one of the “primary mediums for communication, relationship building and therapeutic action” (Meersand & Gilmore, 2018, p. 11).  Given the clinical utility of play across multiple early childhood mental health interventions, it’s important to bring awareness to our relationship with play.  Reflecting on our own early childhood play experiences can deepen our understanding of the play experience and the role of others in play.  These reflections can help us gain insight into our work including how we create play spaces to facilitate relationships between young children and parents/caregivers.  

Exploring Our Play Experiences

Play is something we begin to experience in infancy and throughout our lifetime. When we play, we experience ourselves and others in different ways that can naturally lead to moments of trust, empathy, regulation, tolerance and/or resolutions.  One of my favorite quotes about play is “Play matters because people matter. It reminds us of our interdependence and gives us a chance to really see other people and, in turn, to be really and truly seen” (Vialet, n.d.).  One way to bring awareness to our relationship with play is to think about the context of our play experiences.  As a young child, where do we remember playing the most (e.g. home, school, neighborhood)?  How often did you play?  Who did you play with (e.g. siblings, parents, peers, others)?   When you think about these memories, take a minute to notice what you are feeling and where in body you are feeling this.  Keeping a journal to write (or draw) your reflections and sharing them with your reflective supervisor can be very helpful in this process.  In thinking about the play itself, did you have a favorite toy, game or other play memory?  Does your favorite memory include non-directive, directive or a combination of both types of play? You may also want to explore the process of play and how you participated in the play.  Did you take the lead in the play?  Were you comfortable taking the lead? How did others participate in your play? When others participated, did you feel seen and/heard?  When exploring these particular aspects, do you notice similar or different feelings than you had before.  If so, add these to your journal and/or artwork and again and/or share with your supervisor.      

As you explore your play experiences, you may notice a cultural context to them.  In early childhood and throughout adolescence, our play can influence the development of our racial, ethnic, gender or religious identities (Davies, 2011; Meersand & Gilmore, 2018). Our cultural identities can also influence our play, and this includes the exploration of adult roles and social norms in sociodramatic play (Meersand & Gilmore, 2018). Additionally, our cultural identities can shape our play preferences, the time and space allotted for play and/or the availability of play partners (Gosso et al., 2013).  Individual and parent perception about the function of play (Izumi-Taylor et al., 2010) and parent and community investments (Roopnarine & Davidson, 2015) are also cultural aspects to consider. 

Examining the cultural context of our play helps us to gain insight into the role that our identities have in shaping early childhood play experiences. 

Given our identities change over time, it may be helpful to think about how our play stayed the same or changed later in childhood and adolescence.  

Supportive Play Spaces in the Assessment Phase

An increased awareness of our relationship to play and its cultural context can also generate understanding into how we create and facilitate supportive play spaces.  The assessment phase is often when we begin to bring toys and/or play into the clinical space.  It is important to talk with parents and provide psychoeducation about why we use play as a primary tool with young children ages 3 to 6 years.  It can also be helpful to explore the parent’s experience with play as part of the assessment.  We can ask the child, “What is your favorite toy or game?  We can ask parents if they “had a favorite toy, game or play memory from their childhood?”  Taking notice of what type of play the parent describes and if/how others were involved in the play can lead to other questions like, “Do you play the same game with your child or is there a different game that you like to play?”  These responses can help to assess the types of play the parent has experience with as a child and with their own children.  We can also begin to learn about the possible role of play within the parent-child or other relationship.  

The use of non-directive/child-centered play in the assessment process is considered an evidenced-based practice (Mortenson & Mastergeorge, 2015).  These observations help clinicians to assess toy or play preferences, play skills (e.g. ability to lead or follow the play) and if/how the play facilitates parent-child interactions.  This can be set up by asking the parent and child to play together for a brief amount of time (maximum of 15 minutes).  A range of toys that facilitate interaction and imagination can be selected by the clinician and the play space can be established with a blanket or an area within the home.  During this time, the clinician’s aim is to observe unless asked to participate by the child or parent. Directive or structured play can also help to assess tolerance and other play skills such as permissiveness.  The toys and materials for these play activities may be different and require the clinician to structure the task and/or provide support throughout.  Processing the play with parents afterwards is very important to building the clinician-parent relationship. However, equally important is the need for you to reflect on your observations or experience being involved in the play.  Knowing your relationship to play will help in this process as you begin to identify what relationship and/or play supports may be needed. 

Supportive Play Spaces in the Intervention Phase

As we move into the intervention phase, we need to continue to be intentional about supporting and creating safe play spaces. After checking-in with parents each week, it can be beneficial to prep parents before the play session on the overall aim or focus of the play and their specific role (Farley & Whipple, 2017).  This allows parents/caregivers a space to ask play specific questions, practice play skills (if needed) and gain support for their role in the play process.  Research indicates that when check-ins include prepping parents for the play, it can increase parental engagement in sessions (Farley & Whipple, 2017). 

Once the play session begins, we need to be aware of our presence within this process. 

As previously highlighted by DeSchryver (2020), therapeutic presence can be defined as “…as having one’s whole self in the encounter with a client by being completely in the moment on a multiplicity of levels–physically, emotionally, cognitively, spiritually and relationally” (Geller & Greenberg, 2012, p. 7).  It can be difficult to be present while immersed in the playing state of a young child and equally focused on the centrality of relationships. 

We often reflect on the child and parent’s presence in the play, but it can also be helpful to think about our presence and its potential impact on the play.  

One way that we can monitor our presence is to reflect on some of the following elements outlined in a tool created by Yasenik & Gardner (2011) to monitor clinical use of self:   

• Verbal Discussions:   The amount that you were involved in verbal exchanges and who led the discussion and if these discussions were in or outside of the play activity. 
• Reflective Statements:  The amount that you tracked the play and/or providing reflective content on thoughts/feelings, decision-making, esteem or relationships.
• Emotionality:  The amount that your responses reflected or mirrored the emotions of the child or parent (this includes voice tone, facial or body gestures or comments made to elaborate expressions). 
• Physical Self:  The amount you engaged physically into the play, type of contact and level of energy.
• Interpretations:  The amount you included soft hypotheses and used the play to test these hypotheses or the amount you pointed out a pattern or directly made interpretations to raise a matter to conscience awareness.

Reflecting on these pieces can help to raise awareness of our play presence and its impact on the play and/or how it facilitates relationships.  Exploring these aspects with parents after the play may also help to increase their awareness into own presence and how they contribute and support the play process. 

Summary

Exploring our own play experiences can help us gain a greater awareness of our relationship to play. This awareness can deepen our understanding of our perceptions including the role of others in play.  Through this process, we can learn how play influences the development of our cultural identities and/or how our cultural identities shape our play.  These insights can ground our work and help us to create supportive play spaces that facilitate relationships. During the assessment process, we need to be intentional about gathering information about the child and parent/caregiver’s play experiences and facilitating play observations.  Observations can identify play strengths and areas of need, which allows us to identify specific ways we can help support parents/caregivers.  Within the intervention process, we need to work to actively engage parents/caregivers in the play process by providing psychoeducation and preparing parents/caregivers for each play session. Finally, we need to continually reflect on both our play and relational presence in order to begin “unpacking” the complexities of the parent-child relationships and meanings of play with preschool children and their parents/caregivers. 

References

• Davies, D. (2011).  Child Development: A Practitioner’s Guide. The Guilford Press. 
• DeSchryver (2020, November 10).  The Critical Component in Providing Relationship-Based Services via Telehealth. The Infant Crier. Retrieved from https://infantcrier.mi-aimh.org/therapeutic-presence-the-critical-component-in-providing-relationship-based-services-via-telehealth/
• Farley, J. & Whipple, E. E. (2017). Expanding Infant Mental Health Treatment Services to At-Risk Preschoolers and their Families Thought the Integration of Relational Play Therapy. Infant Mental Health Journal, 38(5), 669-679.  
• Geller, S. M. & Greenberg, L. S. (2012). Therapeutic Presence.  American Psychological Association (APA) Publishing. 
• Gosso, Y. & Carvalho, A. (2013). Play and Cultural Context.  Retrieved from:  https://www.researchgate.net/publication/304626147_Play_and_Cultural_Context
• Izumi-Taylor, S., Samuelsson, I. P., & Rogers, C. S. (2010). Perspectives of play in three nations. Early Childhood Research and Practice, 12(1), 1–12.
• Meersand, P. & Karen J. Gilmore (2018).  Play Therapy: A psychodynamic primer for the treatment of young children.  American Psychological Association (APA) Publishing. 
• Luby, J. L. (2006).  Handbook of Preschool Mental Health.  The Gilford Press. 
• Roopnarine, J. L. & Davidson, K. L. (2015). Parent-Child Play Across Cultures:  Advancing play research.  American Journal of Play, 7(2), 228-251.  
• Yasenik, L. & Garner, K. (2011).  Play Therapy Dimensions Model: A decision guide for integrative therapists.  Jessica Kingsley Publishers.

Covid-19 exacerbated the already cracking foundation of our childcare and education systems in the United States, as parents grappled with childcare arrangements while attempting to balance the demands of work and home, children were witnesses to it all. This pandemic has left no one unscathed and that includes our infant and early childhood mental health (IECMH) workforce, the professionals of varying disciplines who have been tasked with caring for our little ones. 

As a reflective consultant, I provide group reflective consultation to early childhood educators and the stories I’m hearing week after week in consultation are gut wrenching. As I work in earnest to provide emotional support and a holding container for the overflow of emotion that has been embedded in the bodies of educators, there is often a sense of being overwhelmed and feelings of defeat that permeate the air. 

More than ever, I hear reports of early childhood educators feeling frustrated at the limited social emotional capacity of the children they work with. 

There is a push to help children “catch up” without pausing to acknowledge what has slowed them down. 

What happened to children over the last two years? What has happened within their family over the last two years? Furthermore, what has happened to our IECMH work force over the past two years? We have experienced collective trauma, and many have not taken a moment to process. We are moving from moment to moment in an effort to survive and very little space has been created to stop and feel. 

Decades of research into child development have highlighted the role of trauma and toxic stress on the developing brain (Nelson et al., 2020).  Increased levels of ongoing stress, often referred to as toxic stress, can noticeably affect the developing brain of infants and toddlers. Changes in normal routines can be traumatic for very young children, particularly for children who don’t have an attentive caregiver who consistently responds to their needs.  Many people were out of work due to the pandemic and the financial ramifications have been significant.  The pandemic has intensified the housing crisis, food insecurity has rapidly increased, all the while rates of intimate partner violence and neglect have increased. Absence of concrete needs such as food, shelter, clothing, and medical care can make it difficult for caregivers to feed, nurture, and protect their children from harm (Weatherston, Ribaudo, 2020). For families of color, these issues are compounded by on-going systematic racism that inadequate access to resources. Adverse childhood experiences can have long-term implications for very young children.  

In my most recent group reflective consultation, I observed an early educator speak through tears after witnessing three separate incidents of physical aggression between preschoolers and feeling amiss at how to best support these very young children. This educator explained the increasing physical aggression amongst children and struggled to understand where the aggression was stemming from.  It felt important to remind the group of the crucial development that happens within the first 3 years of life.   The brain develops rapidly from the age of birth to 3, and constant stressors during the first three years of life can lead to changes in the brain’s structure and the body’s ability to regulate stress.  Many children have experienced ongoing and pervasive stress, and as such are in constant “fight” or “flight” mode. Children are entering childcare centers and schools and may appear withdrawn, aggressive, or unfocused. Our response can either add to the stress they are experiencing or provide a safe haven for comfort and safety in the face of fear or a threat.

The revolving door of quarantine, isolation, social distancing, shifting parenting priorities due to work demands, and closed childcare centers, created a mashup of confusion for our very young children.  It has been difficult for adults to predict what will happen next, the constant feeling of uncertainty can feel unsettling and unsafe.  As a consultant, I’m tasked with holding both the social emotional development of the young child in mind, as well as IECMH professional, who is struggling with feelings of needing to do more to support children and their caregivers, while simultaneously feeling tapped out. It’s important to acknowledge these dueling feelings exist. Early childhood educators are feeling the pressure to make up for the two lost years of the pandemic and as a reflective consultant it’s important for us to explore this together.

Encouraging educators to think about how their lives have been impacted over the last two years and to explore their needs in moving forward, creates space for them to be held and seen and room to think differently about how the children they work with may need to be held. 

We all are needing a collective sense of safety, after the grief, isolation, and uncertainty this pandemic has caused.  Thinking deeply together about what it means to be and feel safe is crucial in helping children who are struggling with their social emotional development. 

References: 

• Nelson C A, Bhutta Z A, Burke Harris N , Danese A, Samara M. (2020). Adversity in childhood is linked to mental and physical health throughout life.BMJ 2020;  371 :m3048
• Weatherston, D., Ribaudo, J., The Michigan Collaborative for Infant Mental Health Research (2020). The Michigan Infant Mental Health Home Visiting Model. Infant Mental Health Journal, 41(2), 166-177.

Infant mental health home visiting — as well as the Michigan Association for Infant Mental Health (MI-AIMH) — evolved from a request by Selma Fraiberg to the director of the Michigan Department of Mental Health (MDMH) in 1972 to fund graduate students to train in the developing Child Development Project in Ann Arbor. Betty Tableman, then a MDMH staff person who later became the Director of Prevention Services, suggested that staff already employed by Michigan community mental health agencies be funded to carry out the new intervention instead. 

In 1973, six clinicians from CMH agencies across the state formed the first training group, meeting bi-weekly in Ann Arbor under Fraiberg, Vivian Shapiro, and Edna Adelson’s guidance to learn about the infant-parent dyad.  Their work was based on Fraiberg’s intervention with blind children and their families. The work was complex and challenging, and the trainees asked for and received a second year of training.  They took their skills back to their home communities and found that their work had deepened; relationships between infants and parents changed, and development improved while their hunger to learn more increased. 

The trainees were on fire with their knowledge and wanted to follow Fraiberg’s dictum to “share what they were learning about mothers and babies with their colleagues.” They formed the Michigan Association of Infant Mental Health in 1977 and hosted its first conference with T. Barry Brazelton as the plenary speaker with more than 800 people attending. Wanting to continue to share the developing knowledge and information about service delivery in the state, the Infant Crier was born, again, under the leadership of Betty Tableman, who served as the first editor. Consider that at the time, there was no internet, no email, and no email blasts.  Rather than checking your voice mail, text, or twitter, you would look in your office mailbox for messages taken by department secretaries.  Reading the Infant Crier, which arrived in your mailbox rather than your inbox, became an important way to learn about this growing field and to connect with others sharing your interest and dedication promoting secure attachment relationships for very young children.

Looking back, we see Betty’s hand in Infant Crier articles that focused on social policy, news clips and emerging clinical content. Deborah Weatherston followed as editor from 1998-2009.  Under her editorial direction, the Infant Crier became a more clinically focused tool to share knowledge, personal reflections, and social policy. It connected those working with infants, very young children, and their families, across disciplines, from across the state and gradually across the country and world. The Infant Crier became a treasured publication to help develop and nurture understanding of infant, young child, and family development, attachment, and relationship-based work. 

As Debbie transitioned to MI-AIMH’s first Executive Director, Joan Shirilla served as the Associate Editor, beginning in 2002 through 2009. Articles from leaders in the field, such as Barry Wright, Ph.D., Doug Davies, Ph.D., Michael Trout, M.A., Julie Ribaudo, LMSW, and many others shared didactic information and personal reflections about the complex world of very young children and their families. Jeri Lea Lentini, LMSW, also served as co-editor for several years, sharing her wisdom and clinical expertise. She was followed by Jennifer DeSchryver, Psy.D., who served as editor, bringing with her extensive clinical insight and editing skills.

Joan stepped in as Infant Crier editor in 2013, sharing it for two years with Kerry Baughman, who moved the publication to its more updated online format, making the Infant Crier more accessible and less costly. 

In 2020, the leadership of the Infant Crier transitioned to Danielle Davey, LMSW, and Kristyn Driver, LMSW, both highly skilled and seasoned IMH clinicians and supervisors. Their passion for the field is apparent in their work and they are eager to provide a platform for both seasoned and new clinicians to share their work and reflections. They are committed to reflecting best practice in the Infant Crier, to offer a deeper exploration of issues of diversity, equity and inclusion in Infant Crier articles. We are excited to introduce our talented new editors and look forward to Infant Crier articles that continue to help us grow as clinicians and people.

Reference

Tableman, Betty. Reflections on MI-AIMH’s History. Reflections from the Field. 2017. 11-13. 

As infant mental health clinicians who have both been in the field for over a decade, we’ve found that the Infant Crier has always been a consistent part of our experience. It has informed our work and has created conversations and deeper relationships that have allowed us to feel more connected within the greater MI-AIMH community. As the new editors of the Crier, we hope to continue to cultivate a space in which all readers will see themselves reflected in the writings of their colleagues and that it will be an avenue to build their own unique connections and relationships within themselves, the organization and the field.

We’re trained early in our careers to be curious about the interactions between caregivers and young children. Therefore, we have an obligation to understand our own lens, how our cultural experiences shape how we understand and believe what the care of young children involves. We see the writing process as another way to channel the reflective process. It is a way of bringing the implicit to light. When we write, it is from our own perspective. As editors, we will be inviting prospective authors to be more intentional in thinking about who they are, who the other is and how that impacts not only how a relationship unfolded but  how they can share it with the broader community through their writing. 

The Crier is a tangible record of our history. As the new editors, we’ve spent time deepening our understanding of the history and intent of the Crier and value the work that has been done in support of representation across our field. However we recognize that more work lies ahead for the Crier to fully become an equitable space. As we will be inviting potential writers to be aware of their lens and what their limitations might be, as two white women editing the Crier we are committed to doing the same.

 Our first action step is to create an editorial team of diverse infant and early childhood professionals across the state to ensure that our issue themes, articles and authors reflect multiple perspectives, a wider range of experience and more inclusive wisdom and knowledge. Our hope is this team will open the door to authors we haven’t yet heard from to highlight the range of voices that make up who we are. 

Working within the infant and early childhood field we often think about the past, its impact on the present and how to intentionally affect the future. We hope the Crier will be an outlet for our field to be thinking about where we’ve been and where we’re going and that it can continue to be the record keeper of our history. 

Sincerely,

Danielle Davey, LMSW, IMH-E® & Kristyn Driver, IMH-E®, Infant Mental Health Mentor-Clinical

As the editors of the Infant Crier, it feels important to highlight the Commitment Statement created by the Centering Equity Committee, as we believe the Crier is another reflective space where we can uphold commitments to equity and inclusion throughout our community.

The MI-AIMH Centering Equity Committee, which is comprised of the MI-AIMH Executive Director, Central Office Staff, Board Members and Leaders, and Members, declare the following Commitment Statement:

As a committee, we commit to prioritizing diversity, racial equity and inclusion in all of MI-AIMH’s decision making, policies and practices. We recognize that actions and practices that MI-AIMH as a system has created, developed and engaged-in over time have perpetuated racist and inequitable practices, which has directly caused harm to Black, Brown, and Indigenous People of Color. The MI-AIMH Centering Equity Committee will work to dismantle white supremacy and create a foundation of culturally sensitive, anti-oppressive practices within the organization and among its members. The committee is dedicated to an ongoing critical review of all information disseminated by the organization that excludes, divides and is rooted in oppressive practices. We commit to reflecting and adapting our current practices and systems that have caused harm. The committee will work closely with the broader organization to ensure that voices from all races, cultures and viewpoints are represented within all parts of the organization. We value the diversity and unique perspectives among our membership and the families we serve. The committee will be intentional in amplifying the voices of professionals and communities that have long been excluded from the core of the Infant and Early Childhood Mental Health field and the MI-AIMH organization.

Initial Action Steps of the Centering Equity Committee:

1. To hold the MI-AIMH organization and its leaders accountable to uphold equitable practices
2. To intentionally embed Irving Harris Foundation’s Diversity-Informed Tenets for Work with Infants, Children and Families into all practices carried out by MI-AIMH
3. To revise racist and oppressive materials, publications and communications
4. To cultivate reflective spaces to engage in ongoing dialogue in regards to oppression, power, privilege, bias, white supremacy and racism that allows for a culturally reparative parallel process to unfold that reaches systems, professionals, communities, families and children

Introduction

Reflective Supervision/Consultation (RS/C) has been widely recognized as a key component in the provision of quality infant mental health (IMH) informed services.  RS/C can be described simply as a “relationship for learning” (Shahmoon-Shanok, 2006, p. 343).  Just as we know that babies can only learn and grow in the context of relationships, we believe that the same is true for professionals.

RS/C is a time for supervisees to examine their own reactions to the work with vulnerable babies and families and to use their new understanding to inform the services they provide.  As supervisees experience (and are invited to reflect on) their own learning and growth in the context of the supervisory relationship, they are able to harness the power of relationships in their own work with families.  As supervisees begin to feel safe, known and understood by their supervisor, they may find they are better able to quiet their inner experience, allowing more openness and curiosity about the experience of the baby and of the parent(s).  As the parent (or caregiver) is able to feel seen and known with the service provider, the parent may find that more space is available to consider the perspective of the baby.  In infant mental health work, this relational occurrence is described as the parallel process.  Essentially, the parallel process describes the way in which relationships impact relationships.

In this field, it has come to be expected that direct service professionals are aware of how their relationships are impacting their work with the baby and his/her relationships with primary caregivers.  This article will argue for an expansion of our thinking for a more comprehensive parallel process. This includes the assertion that it is best practice for leaders of programs, organizations and systems to have the opportunity to experience RS/C in order to advance this systematic awareness on behalf of babies and the adults who care for them.

Reflective Supervision/Consultation has become a crucial support for professionals in many settings, including early care and education, home visiting, infant early childhood mental health consultation, early intervention, behavioral health, general mental health here and many more.  It seems that funders and organizations have begun to recognize its value for frontline workers and, though less often, for their direct supervisors.  However, the concept, for leaders in policy and program administration, has not yet been fully embraced.  There are likely many reasons for this gap in professional support.  First, building RS/C into systems and providing it to all employees does come at a financial cost.  If the organization is not yet convinced of the value for those not providing direct services, it may be even more difficult to rationalize the additional cost of paying for qualified providers and the staff time that is spent in RS/C. Second, typically the conversations, published articles and research about the value of RS/C has centered on service providers and the direct impact on babies and families. This could give the false impression that its value is limited to the very immediate relationships between provider and family, and provider and supervisor.  Lastly, for those leaders who did not enter into the workforce with a human services or clinical background, the idea of RS/C as a way to reflect on one’s own thoughts and feelings may feel foreign and uncomfortable.  It may, in fact, not align with their values and beliefs around a leader feeling the need or pressure to be strong, tough and already possessing the answers.

If we remember the core IMH principle that all learning and growth happens in the context of (safe, healthy) relationships and we believe that relationships impact relationships, then it seems logical that the need for RS/C would not stop with direct service providers and supervisors.  In the absence of RS/C, how will a leader have the space to explore the work in more depth, to manage annoyance at a particularly stubborn employee, to practice slowing down and listening deeply to one’s own internal process as well as that of the team?  How will the leader be allowed to experience the vulnerability that inevitably arises when one is on the cusp of learning something new that might require them to change their practice?  What is lost if one does not have the support to venture into that new territory of learning? Taken one step further, if this leader does have RS/C, but the leader’s supervisor does not, then what happens to the parallel process?

Ultimately, how are those we serve impacted by this lack of reflection at the highest levels of a system? We believe it is the babies and families who will inexorably bear the burden of this cost.

These are important questions that lead us to assert that all professionals in the infant and early childhood system, including and arguably especially leaders, should be receiving consistent, relationship-based RS/C.

What Makes A Good Leader in Infant and Early Childhood Mental Health (IECMH) Systems?

First and foremost, leaders in IECMH systems are charged with keeping babies and families in mind, even though they are in a distanced role from them.  As policies for service provision and staff development are created and implemented, strong leaders should be asking themselves for nearly every decision, “How will this impact the infants, young children and families we are serving?”   In order to allow for this space to consider the vulnerability of babies and families, leaders must be willing to look inward and make space for their own sense of vulnerability.  It can be difficult to reflect on our own early experiences of feeling powerless and voiceless.  And yet our ability to do so allows us to hold deep empathy for those we serve, a key trait of quality service provision.  Second, leaders at all levels must be attuned to the staff and teams they lead:  What are their strengths and areas for growth? How do they best learn and grow? This level of attunement requires careful observation, listening, the ability to stay open to new information and integrate it into one’s thinking and decision-making.

The final skill, though we acknowledge there are many more, we believe is essential to strong leadership is awareness of one’s own biases; biases related to race, gender, sexual orientation, religious beliefs, political ideology, parenting, etc. Each one of us interacts with the world through our own unique lens, which is inevitably tinted by our life experiences.  As a result, explicitly and implicitly, we assign value, prioritize, and make decisions based on our own values and beliefs.  As a leader in a system, it is critical that one is aware of these values, beliefs, and biases and how they impact the creation and implementation of policy and program administration. RS/C offers the rare space to identify and examine these biases with a trusted other. Intentionally doing so creates the opportunity to not only recognize differences between self and others within and throughout the system, but also to identify ways to capitalize on these differences in order to enhance each layer of the system. This allows leaders to navigate the complex relationships within agencies, departments and organizations more effectively and efficiently to ultimately offer the highest quality supports and services for families.

RS/C with a consistent and skilled consultant allows a supervisee/consultee to engage in careful and thoughtful exploration of the work. It invites supervisee/consultees to be curious about the experiences of others and about their own experiences. Carefully placed reflections and questions invite supervisee/consultees to consider blind spots, things they may have missed, and perspectives not yet considered.  It seems to us an obvious conclusion that RS/C is immensely beneficial for any leader, and especially for those involved with systems and programs serving infants, young children and families.

Next, we will share our work together as an illustration of how RS/C benefits leaders and systems in powerful and pivotal ways.  We offer our story with the hope that it will inspire you to consider your own work and the ways in which RS/C already has been, or could be, beneficial.

Our Reflective Process

When we began our reflective consultation experience together, we both came firmly grounded in IMH principles.  We share a passion for and commitment to supporting babies, young children and families.  Because of this, we were able to start with a shared language and perspective. What felt unique was that Meghan was no longer working directly or even closely with children and families. Part of her new reflective work became bridging her felt experience with parent-child relationships and attachment frameworks to her systems work.  This intentional linking over time helped us consider the eventual impact of Meghan’s work on the vulnerable young children and families whom the system serves. What felt similar was being rooted in relationship, development and the power of the parallel process. For example, when Meghan tapped into feelings of being overwhelmed with new professional expectations of her and her own evolving professional needs, we were able to easily make connections and contemplate how the baby is impacted when a parent’s expectations and capacity to offer support may shift along with each developmental milestone, depending upon the extent of how the parent’s own needs are being met.

At other times, we did not explicitly link our work to a baby or family and instead relied on our trust in the parallel process in different ways.

There is another way of conceptualizing “the baby” in policy and systems work that is also useful.  The baby represents, among other things, vulnerable persons or populations who do not yet have a voice, but whose needs are clear.

This can be found either through data or anecdotally. For example, looking at the data that infants, toddlers and preschoolers are expelled from child care and preschool at 13 times the rate of children K-12 combined, and further that Black boys are expelled three times more than their white peers, it is evident that young children, and specifically African Americans, have a deep and complex experience that calls for radical systems change. This can feel like an enormous and daunting task for systems leaders to undertake.  RS/C offers the space to support  leaders in recognizing and processing evocative emotions that can result from startling data such as this in order to re-energize their own sense of agency, to stay connected with those in the system who are muted and disempowered, and to keep this work moving forward.

The following excerpt exemplifies how we used the reflective space to support Meghan in her role as a leader in a large system. This particular example is in relationship to Meghan and her team of colleagues; however, these concepts hold true to any variation of systems relationships.

We began our first session in person but most of the subsequent sessions were done virtually. This conversation took place about two years into our relationship.  A foundational relationship had been built for exploration and growth together and we had settled into a comfortable rhythm during our monthly RS/C sessions.

Meghan’s Perspective

“Our ability to be daring leaders will never be greater than our capacity for vulnerability.” (Brown, 2018, p 11)

My first experience of professional reflection was during my work as an Infant Mental Health home-based therapist. It was emotionally intense, intimate and clinical. This was also my introduction to the felt experience of RS/C. Often in the midst of overwhelmingly evocative emotions such as grief and despair, secondary trauma and hopeless incompetence, RS/C offered me the space to learn how to lean into the vulnerability of really feeling these emotions instead of running from them. I learned that only then could I regain a sense of organization, piece together a coherent narrative and most important, guide my work with the babies and families I was there to support. The magic of the parallel process came to life, and with it came the realization that RS/C is the unique vehicle to explore it. This experience was foundational to discovering and tapping into my best professional self. Therefore, when I found an opportunity to move into systems work, my biggest fear was to lose touch with the families, with “the baby” and with this reflective side of me. I knew I would need to find a new way to meet this professional need in this leadership role. For me, this meant finding a RS/C provider who could support me in this new systems world.

It may seem obvious, but one of the first lessons I learned is that systems are simply made up of people, and thus innumerous relationships. Therefore, the same IMH relationship-based principles apply — parallel process, rupture and repair, and the need for authentic connection to inspire high-quality work. This realization gave me comfort. I appreciated the familiarity of those IMH frameworks and recognized that working at a systems level required innovative ways of executing them in this new environment. As I began my new leadership role, I also embarked on a new reflective relationship with Faith, quite literally.

“In the absence of authentic connection -we suffer.” (Brown, 2018, p. 25)

As I began this new season of my career, I believed that I had a plan for how I could maintain my own professional need for connection. I knew this was a crucial element I needed in order to meet expectations set for me and  guide my work with others. However, as the work progressed, I noticed that I continued to miss the deeper emotional side of the process; the powerful experience of holding and “being with” others in a more profound way and of myself being seen in a more authentic way. Because of my deep appreciation of the parallel process, I quickly recognized that this void had begun to negatively impact my work, one of my greatest fears. This prompted me to reevaluate what I needed in order to be able to  be more authentic and effective.

My fear of failure was realized and exposed during a particular meeting when I felt that I wasn’t communicating effectively with my team. I felt reflectively rusty and that was a big red flag. Working with my team, familiar thoughts and feelings flared up in my chest like a wave of heartburn. “What if I’m not a good enough leader? What if I can’t give my team what each of them needs to do this work well? What if I fail at finding a way to keep this work going?” I began to internalize the notion that if I was not a good enough leader in this state systems position, if I couldn’t meet the needs of my team, the consequences would be exponentially deeper. If I was not able to find a way to sustain this work, the consequences would be exponentially greater. The weight of responsibility washed over me, and I felt overwhelmed not only by the needs of the metaphorical baby, but by the thousands of babies all over the state who would suffer if I was not enough. That narrative was paralyzing. I felt stuck, unable to even prioritize what task to begin next.

I brought all of these complex feelings and thoughts to Faith during our next session. I didn’t yet know how to organize them, but I trusted that by leaning into my vulnerability and sharing this in our reflective space, Faith would contain and validate these overwhelming emotions in a way that allowed me to process each of them, safe from judgment. And by doing so, albeit uncomfortably at times, only then could I join in her wonderings to move me from rigidity to action.

Faith’s Perspective

In working with Meghan, I found myself wondering: How do those who lead embrace vulnerability? What do they need from us?  How do we encourage their willingness to dip into the reflective space, into their emotional experience, on behalf of the babies, families and staff they serve? How do I use the familiar frame of RS/C to support Meghan in her leadership role? Over time, Meghan and I created a shared language that allowed us to explore all of these dimensions of the work together.

Meghan’s particular experience  felt so familiar. Who among us has not felt like the world, the systems we work within and their problems, are so big and we are so small?  I am aware that when we are working within complex systems, it can be hard to slow down, to focus on one thing and organize our many layered thoughts and feelings.  Working in large systems requires us to always be holding many perspectives and needs in mind, to be thinking on our toes, and to be willing to take risks.  It can feel overwhelming and heavy.  As she talked, I noticed a feeling rising within me that paralleled Meghan’s.  If these feelings had words, they would say to me, “Oh gosh, this is too big.  I’m not sure how to help.  Maybe another consultant would know what to do.”  I had been here before, many times, and I knew I could use my own experience to inform me as I supported Meghan.

When Meghan quieted and gave me the cue that she was ready for me to respond, I first took a deep breath.  I allowed a few moments of stillness and quiet.  Once we both had a chance to quietly breathe and re-center, I reflected to Meghan the emotional experience I heard her name — a sense of feeling overwhelmed and how that was leading her to feel  an intense sense of urgency. She agreed that this was how it was feeling to her, and that she was having a hard time regulating and organizing her thoughts.  This felt uncomfortable for her, as she was confused and could not figure out next steps when she was in this place.  As Meghan continued to describe the pressure she was feeling and the sense of being lost in all of the responsibilities, I was reminded of times in the past when she had come to our sessions with similar feelings. I had walked with her before through this process and knew she possessed the capacity to see herself through.  Since this emotional journey felt familiar, I decided to share that observation with her and wondered what she thought about that.  She immediately seemed to calm; her shoulders relaxed and she took a deep breath.  I asked her what she was thinking and feeling as she  remembered past conversations we had.  Meghan said she remembered that this is a familiar place of initial anxiety that she goes to, and she always finds a way through when she has the time and space to process.  I wondered with her if perhaps she comes to this place often because of how deeply she cares about the work, about her colleagues, and about the babies and caregivers she knows her staff are impacting.  Yes, she said, of course.  As we talked, she realized this place of feeling overwhelmed was not something she needed to fight her way out of.  It gave her important information. It reminded her that she was feeling strongly about something, and it offered her the opportunity to ground herself in her passion for the work. Our deeply felt desire to be helpful and make a difference for babies and families can be overwhelming, and it can also be energizing.  Once she felt like she had made sense and found some meaning in her strong reactions to this particular situation, her next steps became clear to her.  As her RS/C provider, I had the honor of holding the space while she made her way to a new place that allowed her to make a plan and feel empowered.

Shifting Outcomes/Resolution

RS/C is “A relationship in which strengths are emphasized and vulnerabilities are partnered.” (Shahmoon-Shanok, 2006, p. 343)

Meghan’s reflective experience was very much rooted in the attachment-informed developmental need for a secure base — she needed to touch the wall of being in the reflective space in order to hold the emotional sense of urgency and discomfort of those doing the work directly with young children and the adults who care for them. She needed to find the balance of keeping the flame of urgency present, and yet not allow it to get to a point of overwhelming paralysis. This sense of urgency driven by the immediate needs of all of those babies, of their rapidly developing brains and attachment relationships, can often dampen with the distance and slow-moving evolution of systems work. Meghan was also searching for a way to continue to have hope and agency in order to effectively support the professionals within her system who  are responsible for nurturing our babies and young children and their families.

Once she was able to “touch in,” to settle into that familiar and safe reflective space, she could then mentally prepare differently for the next team meeting. Here, she could foreshadow the possible triggering of the familiar internal narratives of self-doubt and incompetence. With the element of surprise inhibited, she could prepare a subtle regulation exercise that could re-ground her in that moment. During the next meeting, when the familiar feelings began to percolate, Meghan was able to respond rather than react.  She was able to recognize the physical sensations, name the parallel emotions, and lean into and contain them in a more controlled way. This allowed her to have the emotional energy to attune to the needs of the team, rather than expending that energy managing her own emotional response. As a result of this mental shifting, she was able to hear, validate and meet the needs of the team more effectively. This galvanized her belief that the responsibility of the growth and development of the team begins with her own willingness and capacity to embrace vulnerability.

In our further reflections, we wondered together what the consequences may have been if Meghan had not had the opportunity to process her emotional reactions through RS/C.  What would her actions have looked like had she gotten stuck in the emotional mud of negativity? Certainly, it would have taken much longer, if ever, for her to effectively identify her own needs in order to be able to see more clearly the needs of the team. Undoubtedly, it would have led to creating patterns of miscommunication, rigidity, perhaps even feelings of rejection on both or all sides of the parallel process. Regardless of the specific path, we are certain that without the space to intentionally reflect, the negative reverberations would have been felt by many, including the babies and families we work so tirelessly to serve.

Conclusion

The familiar phrase, “You can’t give what you don’t get,” still holds true in systems work. How can those who lead learn the value of leaning into vulnerability in the absence of having that repeated felt experience? Direct service providers and their supervisors are regularly asked to venture into the reflective space with a trusted mentor in service of their work with vulnerable babies and families.  But what about those who supervise them?

It is imperative for those creating policies and practices to keep “the baby” and all of the corresponding relationships in mind. Having access to RS/C space allows leaders to tolerate discomfort, mistakes, rupture, and vulnerability, all of which are necessary to access creativity, attunement, growth and mitigate bias.

Over the past two decades, the IECMH field has evolved to embrace RS/C as best practice for many varied roles. We believe the same expectation and support should exist for systems leaders as well.  Relationships impact relationships, and systems leaders will always be a part of the relational orbit surrounding direct service providers, families and babies.  Therefore, “how they are,” and not just what they do, matters greatly.  RS/C for leaders is a crucial strategy that needs to be woven throughout all levels of the system if we are to continue improving quality and outcomes in IECMH-informed services for our little ones and those who care for them.

References

Alliance for the Advancement of Infant Mental Health. (2018). Best practice guidelines for reflective supervision/consultation. Retrieved from https://www.allianceaimh.org/reflective-supervisionconsultation

Brown, B. (2012). Daring Greatly. New York, NY: Penguin Group (USA) Inc.

Shahmoon-Shanok, R. (2006). Reflective supervision for an integrated model: What, why & how? In G. Foley & J. Hochman (Eds.), Mental health in early intervention: A unity of principles and practice (pp. 343-381). San Francisco: Jossey-Bass.