17 July 2006
Watch and learn therapy helps mothers bond with children
A therapy developed in New Zealand to help parents tune in to difficult children has been taken up in Australia but ignored at home. The new technique is based on the idea that parents need to get to know their babies by "just looking" at them for a long time before taking care of them. Mothers who miss out on this stage because of a traumatic birth or other issues may never be able to tune in well to their children, sparking behavioural problems.
Heather Chambers of Porirua's Child and Family Development Centre says her "supported looking" therapy helps mothers see their children as if they were newborn babies, even when they are older. "We tend to be working up to about age 11, but once you understand what you are doing you can adapt it to any age," she says.
Dr Jackie Amos, a psychiatrist at Adelaide's Flinders Medical Centre, has picked up the technique and introduced it to child mental health teams in South Australia. "The work is fabulous," she says. "It would be great if it could be taken up more in New Zealand." Ms Chambers developed the therapy "out of dire need - there were no answers out there". "Instead of looking at symptoms [such as a child's bad behaviour], it starts really handing back the remedy into the parent-child relationship," she says.
In a case study published in the latest Australian and New Zealand Journal of Family Therapy, she quotes a mother, Sue, who sought help for her four-year-old son Josh. He was clinging to her, needed her for everything and reacted against any instructions or requests. "Sue described how he had changed from a laughing, happy boy to one who now refused to eat, had nightmares and was afraid of everything."
The therapy gets the mother to talk with a therapist and the child about his birth and development. Although older children can also speak for themselves, in Josh's case he played while his mother talked, and the therapist spoke for him. Sue described her pregnancy as a nightmare. She had wanted a home delivery with soothing music, but instead she needed a caesarean and Josh was sick for his first few days. Sue had wanted a girl and rejected him. As Sue told this story, Josh enacted a plane getting caught in a storm and unable to land, and a truck and trailer that could not join together. The therapist wondered aloud whether he felt unwanted and unloved.
The therapy looks for the "good intentions" behind events. The therapist interpreted Sue's desire for a girl as feeling more confident of parenting a girl, and noted that her plans for the home delivery showed she had wanted to minimise her baby's distress. Sue was then asked to talk about her own childhood. Her mother had rejected her, just as she had rejected Josh. She came to see herself as a child in emotional pain, not as a "difficult child". Next, she went behind a one-way screen allowing her to watch while Josh played with a therapist.
She was delighted that he was the same with the therapist as he was with her. "You can have a very distorted picture of what's in front of you if you don't have the chance to step back," Ms Chambers says. Gradually Josh became confident that Sue loved him and was available for him, and his behaviour improved. Ms Chambers says likely problems in mother-child bonding can be picked up in pregnancy and soon after. "There are some beautiful interventions we could do in the first six weeks after birth if we wanted to," she says.
"My perception would be that there would be a massive reduction of post-natal depression and the children would be much more settled and not have the difficulties that we see now. Plunket could do that really well." Dr Amos says the technique works even for some adolescents with attention deficit disorder who might otherwise be prescribed Ritalin. "It would be premature to say that it might be an alternative to Ritalin," she says. "But certainly we are finding that it tends to work with children where there is a lot of out-of-control behaviour, aggression, non-compliance with adults, inability to express their feelings and noticeable difficulties in all their relationships. "At the very core of this therapy is the absolute determination to find the goodness in both the child and the mother no matter what happened between them. "
15 July 2006
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