Infant–parent psychotherapy. A handbook | Signs of Autism in Infants: Recognition and Early Intervention
Experts from a book review essay by Angela Joyce (Anna Freud Centre, 21 Maresfield Gardens, London, NW3 5SD, UK — angela.joyce1@btopenworld.com) which was published by the International
Journal of Psychoanlysis 2006; 87:881-7.
Infant–parent psychotherapy. A handbook is by Stella Acquarone who has been one of the pioneers of direct work with infants and their parents in the UK. [She] addresses psychoanalytic work with children, and the complexity of the child psychoanalytic field in the UK today.…The world of private practice that is the hallmark of psychoanalytic work with adults affording some potential for ‘intensive’ treatment defined by the frequency of sessions is to all intents and purposes nonexistent in work with children.…Perhaps inevitably, the disturbances of child patients referred for treatment to these clinics have presented practitioners with great challenges in terms of technique, as well as in the theoretical assumptions that drive technique. In reading [her book], we can see how these challenges have led the original theoretical paradigms to be extended and modified—in some cases radically so. Certainly, the adaptation of technique to meet the needs of these new patient populations is apparent and to some degree celebrated.…Acquarone’s work carries the subtitle: “A handbook,” rather like a manual of how to do infant–parent psychotherapy. Acquarone is herself a very experienced child and adult psychoanalytic psychotherapist, but is also one of the few in the UK who has also taken her craft to this largely uncharted territory. There is a growing literature on direct work with babies and their parents that has been largely influenced by attachment theory, as well as by the impressive body of neuroscientific and infant research that has reinforced the relational context of development. Acquarone’s text adds considerably to this literature through her integration of these aforementioned theories with mainly Kleinian but also other concepts from psychoanalysis. She has considerable experience in working with babies and her list of references is testimony to the breadth of her sources in seeking ideas for understanding the territory. The evidence of infants’ vulnerability to adverse emotional environments has been gathering for some time, but there has been little easily available literature outside specialized journals, which can be difficult to get hold of. Acquarone is the first book available which brings together this theoretical knowledge with a clear exposition of a treatment intervention with which to respond.Acquarone covers an impressive field. The first part of the book is given over to a survey of the theoretical foundations of this new treatment modality, encompassing infant development, family/parental dynamics, and the concepts from psychoanalysis and observation that she sees as the bedrock of her method. Later she describes in detail, and with many clinical vignettes, the mode of treatment she has developed in her infant–parent clinic in north London. The consequences of less than optimal care for babies is spelled out, indicating the potentially serious consequences if these vulnerable babies and their parents are not helped in good time. She demonstrates explicitly and unequivocally that neglect, trauma, abuse and other forms of this less than optimal care can have a devastating effect upon babies, including at the level of their developing brains. The relatively recent knowledge that infants’ brains develop exponentially in the post-natal period in a way contingent with the emotional quality of the care they receive, is described in an accessible way. Those babies, whose parents are unable to offer them loving joyful care but instead, unwittingly or not, give them experiences of fear, panic and anxiety, are likely to experience chronic or unpredictable states of hyper- or hypo-arousal, and have to resort to defences such as avoidance (expressed through gaze aversion) or in extreme cases dissociation. These babies suffer a variety of consequences of varying degrees. They are prone to have inhibited growth of the neuronal pathways that carry positive connections and suffer restrictions in their capacities to relate, have emotional and cognitive impairments, developmental delays, and a propensity to unmitigated anxiety, agitation, and so on. The idea that babies can be ill in these ways is still not widely recognized, and of course robustly challenges an exclusively one-person model of the human mind. Acquarone usefully charts some of the direct consequences of different kinds of experience for infants, which will be very helpful for any practitioner.…Acquarone describes this parenting in psychoanalytic terms, locating development in the dynamics of the parent–infant space containing the tension between two registers of the ‘real relationship triangle’ and the ‘internalized one’. As such, she continually goes back and forth across this complex divide of inner and outer, constantly aware that what children experience at the hands of those who care for them is just as significant (if not more so) as its fate in their internal worlds. Acquarone’s psychotherapeutic model takes this into account as she describes working at the interface between the baby’s ‘real’ experience and the place they occupy in the parents’ inner world of representations, in turn giving rise to the baby’s own representations which act as a template for all their future relational experiences. Addressing these representations and their potentially pathological impact on the developing baby is the stuff of infant–parent psychotherapy. As she says, ‘there is a fundamental necessity for parents to become the parents this particular child needs’ (p. 82). Sometimes they are not able to make the adaptations necessary and need help to do this. Many of the children described [other professionals] might have been saved the terrible traumas they suffered at the hands of their parents if their families had received the highly skilled therapeutic intervention that Acquarone describes when they were babies.
Signs of Autism in Infants: Recognition and Early Intervention is published by Karnac Books (www.karnacbooks.com) and is scheduled for release in February 2007.International researchers and clinicians renowned for their work in the field of early autism come together to resolve queries around the long debate on the development and resolution of autism. In this book contributors outline their views on the possibility of preventing the full development of autistic behaviour. They set down clear guidance for professionals in identifying early signs of alarm and offer models of psychoanalytically informed interventions to treat the pre-autistic infant. “This book brings hope where despair has prevailed. It offers the prospect of early detection of prodromal signs of autism and the possibility of effective therapeutic mitigation of the parents’ unbearable predicament of perpetually failing to engage a seemingly unresponsive infant.” – Professor Joan Raphael-Leff from the Introduction
Contributors: Hanna A. Alonim, Graciela Cullere-Crespin, Prof Laurent Danon-Boileau, Prof Marie-Christine Laznik, Dr Henry Massie,MD, Prof Sandra Maestro, Prof Filippo Muratori, MD, Prof Maria
Rhode, Catherine St Clair, Prof Colwyn Trevarthen, Prof Joan Raphael-Leff.