As well as blog posts from our speakers, sponsors and conference organisers, we will also be sharing posts from selected Growing Families supporters in the lead up to our event in Manchester on Thursday 6th October. Growing Families: Facts, Fiction and Other Stuff is a not-for-profit event, created by four mothers, two of whom are also healthcare professionals. Our mission is to tackle the postnatal information that desperately needs covering for new families; to explore expectations and evidence around the early days with baby; and to give new families the confidence to face the challenges ahead.
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This post is from Dr Rebecca Johnson, Consultant Clinical Psychologist, Solihull Approach, Heart of England NHS Foundation Trust. Our thanks to Dr Johnson for her support for Growing Families.
Being married to a Clinical Psychologist it was inevitable that emotional health was going to be high on our list of aspirations for our children once my husband and I became parents. Isn’t it for everyone? But for us happiness is not the measure we are aiming for. It may sound a bit dull by comparison but above all we hope to be able to raise ‘securely attached’ human beings with the ability to ‘regulate’ their emotions!
I was already working with the Solihull Approach team before becoming a parent myself so, on top of my Clinical Psychology training, I had a good grounding in some helpful psychological theories. Containment and Reciprocity are two cornerstone theories of the Solihull Approach model, and are considered to be the building blocks of secure attachment.
But knowing what to do and actually doing it are not the same thing! This is perhaps because, unlike any other job, parenting involves our whole self, all our emotions, our own histories, with barely conscious instinctive responses coming into play? So the support of others who, either instinctively or through appropriate training, are able to help us with our own emotional turbulence so that we can better tune in to our children, are highly valuable in helping us provide the foundations for a secure attachment.
What is attachment?
The brain has an incredible design feature which is its ability to adapt to the environment once launched into the outside world. This includes the capacity to be sociable from the ‘get go’, the ability to read cues in those around us and to adjust its responses and behaviours accordingly. All designed to maximise chances of survival and get the best out of the care on offer locally.
Over the course of the first year of life, if we’re lucky, the brain can get organised. Which means it learns ‘if x, do y’ and begins to be able to predict what might happen next. In an ideal world the baby learns for example – if I’m in pain and I cry in this way then my need for help and comfort are likely to be met. But it might be that the care on offer is not very responsive and the baby may learn to cope, if their needs are not met, by switching themselves off (dissociating) from feeling overwhelmed. Even worse there may be a risk of out and out hostility from a carer, in which case the safest thing to do might be to keep a low profile – if I’m in pain switch off, don’t cry and I might not be yelled at. Other babies who receive a mixture of comfort at times with hostility at other times, may switch off emotionally in part whilst still trying to signal that they have needs – I’m hungry so I’ll cry but I’ll keep myself ready in case you’re not in the right mood. Different strategies suit different kinds of care available. It’s not hard to see which of these pattern is healthiest in the long run but the point is the strategies are designed to keep us ‘safe’ physically and emotionally in the particular environment in which we are being raised.
These organised patterns of responding are referred to as Attachment patterns: ‘secure’, ‘insecure avoidant’, and ‘insecure ambivalent’. If you’re really unlucky the care on offer is so unpredictable that it is hard to muster an organised response and chaos ensues, or, according to Pat Crittenden, it becomes necessary to flip between different strategies in order to find one that might work this time. This is known as a ‘disorganised’ attachment pattern and is generally thought to be behind the most challenging patterns of behaviour in older kids and adults.
There is no such thing as not being attached. Some patterns are considered healthier than others. It’s much better to be organised, and secure attachments are associated with better outcomes in life generally.
The word ‘attachment’ is often used loosely or colloquially, to refer to how warmly people feel towards one another, for example, a child might say ‘I love my mum’ and in layman’s terms we might describe this child as attached to the mother. Or it tends to be used as an alternative to the word ‘relationship’. But in fact it is only one part of a relationship, and, being a pattern of behaviours that are evoked in response to threat, is not observable just by looking at a parent and child interacting. In fact a child who appears happy and smiley with their parent may have learned to present themselves in a certain way in order to protect themselves, but it doesn’t follow that they are securely attached. David Shemmings describes this in more detail here. www.theguardian.com/social-care-network/2016/feb/15/attachment-theory-social-work-child-protection
Bonding and attachment are related but not the same. Bonding refers to the feelings of the parent towards the child. For some parents this is instantaneous, for others it may take a while to come. A strong bond helps the parent feel driven to meet the child’s needs and in this way it contributes to the child being able to develop a secure attachment pattern. So you could say parents bond, infants attach!
Why does attachment matter?
Once we become mobile our attachment to our carer helps with our continuing learning and development. We are able to explore the world if we know that we have a secure base to come back to. Trust that we will get a helpful response from our carer if we encounter something worrying or dangerous enables us to manage the enormity of the world that is opening up.
But the really significant thing about the patterns that we establish in our first year is that they set the tone for our future relationships. In the same way that the brain has a window for learning a native language, it also has an area receptive for learning the language of relationships. Whilst this can be overridden later, the fluency acquired in the beginning – whether helpful or unhelpful to us in later life, is what we fall back on instinctively when responding to people for the rest of our lives.
When we become parents our own attachment patterns emerge strongly in our instinctive responses – only this time we are on the caregiver side of the equation. It is actually possible to predict a baby’s attachment pattern by looking at the pattern of his or her parents. But there is no inevitability about it. Bad things happen to securely attached parents that interfere with their ability to meet their babies’ needs, and insecure or disorganised attachments can be mediated by other relationships in our lives, a responsive grandparent, a caring teacher, even a secure partner.
What are the secrets to nurturing secure attachments?
There is lots we can do to help babies develop a secure pattern, or in other words help them trust that on the whole their carer is available, keeps them in mind and is capable of doing a good enough job of meeting their needs. Personally I take great comfort in knowing that a secure attachment pattern is not based on perfection, generally being responsive alongside being able to repair when things go wrong, as they inevitably will, is all that’s required.
Babies are born ready to attach; they become accustomed to their mothers’ smell, voice and taste of milk before birth; they have a strong preference for human faces; they seek out eye contact; they have an innate ability to copy expressions.
It is widely accepted that key ingredients in the adult carer include a) being available in body and mind to think about and meet the baby’s needs, and b) a willingness and ability to try and interpret the baby’s signals.
Sounds easy right? Well no, actually. Being available is a real challenge when you are facing the stresses and strains of becoming a parent. It is easy, and perfectly normal, to feel completely overwhelmed by powerful feelings, be it anxiety, fear, exhaustion, isolation, or even some ghost from our past that sees the transition to parenthood as the perfect moment to pop up and wreak havoc with our emotions.
What can help is someone who listens without judging, or even advising, but just listens carefully and shows us, by their own thoughtful handling of the feelings we convey, that these feelings can be tolerated and won’t destroy us. Bit by bit we can start to regain our capacity to think, and as the panicky part of our brain (the limbic system) calms down, the availability of the thinking part of our brain (the cortex) comes back online and is more available for the baby. This process is called Containment in psychotherapy terms but it happens spontaneously many times a day for many people, between friends, partners and hopefully when reaching out for support from professionals.
The second ingredient is known as Reciprocity. This refers to the two-way dance of communication between carer and baby. It requires: sensitivity to the baby’s individual body language, mood and temperament; slowing down to give the developing brain time to process; the opportunity for the baby to have his turn in an interaction and be an active part in the relationship; being a partner in the dance between you, not just doing unto or not doing at all. Not too little, not too much.
Successful two-way interactions are beautiful to behold, there’s turn taking, mutual enjoyment, a rise and fall of excitement or interest and a gradual winding down and withdrawal before it starts again. This type of interaction is ordinary, everyday. But again not so easy if you feel so low that taking care of physical needs (yours and the baby’s) is barely manageable, or if you are overwhelmed and stressed. It may be that you did not experience these types of interactions in your own infancy, so have less to instinctively draw on.
You might be a parent reading this. What opportunities do you have to make use of someone else’s brain capacity when yours is overloaded? Reach out, ask for help. It’s amazing how a listening ear can help put things back into perspective, even before solutions are offered. You may like to spend time observing your baby. See if you can spot ways in which he or she starts a ‘conversation’, notice how involved they are in it, and ways in which they withdraw their attention and ‘turn away’ to process what just happened. Zero To Three have a really nice video about the importance of everyday interactions here https://www.zerotothree.org/resources/230-responsive-care-nurturing-a-strong-attachment-through-everyday-moments
You might be reading this as a professional. Think about the relationships you support. What opportunities do you have to promote secure attachments? This could be in the course of conversations about other things, for example you may be a midwife, a teacher, an infant feeding supporter, a health visitor, a sonographer, a childminder… Can you resist the urge to ‘fix’ the situation and offer a solution? How would it feel to sit with and ‘contain’ strong, powerful feelings? How can you access support when you yourself feel overwhelmed? Advice is invaluable but ideally comes at the end of a process of understanding where this parent and this infant are at. That way it becomes tailored, individualised and more likely to hit the spot.
The Solihull Approach helps parents and practitioners by providing a framework for thinking about relationships, and incorporates Containment and Reciprocity, the building blocks of secure attachment, along with Behaviour Management, into a practical and helpful model. There are evidence based, quality marked face to face and online courses for parents (Antenatal, post-natal and 0-18 years) based on these key ideas www.inourplace.co.uk as well as a range of training courses for professionals www.solihullapproachparenting.com. @solihullaproach
Dr Rebecca Johnson