In her new book, The Developmental Science of Early Childhood: Clinical Applications of Infant Mental Health Concepts from Infancy Through Adolescence, Claudia M. Gold draws upon recent research, theory, and vignettes to delve into the world of young children and show just how we may better understand them, now, and as adults.

“Whether a client is one day or twenty-one years, the developmental science of early childhood offers a conceptual framework from which to understand, to make sense of, his or her story,” writes Gold.

The infant mental health paradigm, Gold tells us, is characterized by four key components — it is relational, developmental, multidisciplinary, and reflective. However, we must also shift from asking what (as in, what is wrong with the child) to why (as in, why is she behaving in the way she is).

“When we let ourselves listen without need to make a diagnosis, we have the opportunity to think creatively to make sense of stories that have multiple layers of complexity,” Gold writes.

Of particular importance — if often overlooked — is the mother’s preoccupied state, which is exemplified when the expectation that what should come naturally does not, and the new mother finds herself feeling inadequate. As these feelings make reading her infant’s cues more difficult, the result is a downward spiral of mutual dysregulation. Here, it is the mother herself who may need more than instruction.

Gold quotes renowned development expert Donald Winnicott, “Mothers who do not have it in them to provide good-enough care cannot be made good-enough by mere instruction.”

Gold offers the example of a young mother who comes to her office after having been referred by a pediatrician concerned about her anxiety and multiple visits for colic despite reassurance that there was nothing wrong. As the baby begins to wake and fuss and the young mother’s anxiety builds, she begins searching for her “colic drops.”

Gold gently encourages her to wait and take some time to observe the baby. As the young mother soothes the baby and he eventually falls back to sleep, Gold notices the difficulty he has in transitioning from wake to sleep. Calmed herself, the young mother then reflects on her own mother’s anxiety, intrusiveness, and her doubts as a single mother.

By offering her the safe holding environment that she never received from her own mother, Gold is able to teach her to tolerate her own failures, see her baby as his true self and not a reflection of her failings, and find a way to be a good enough mother herself.

Gold also looks to attachment theory with a new insight — that in order to raise securely attached children, parents have to be able to hold the child in mind, both emotionally and cognitively. Called mentalization — or reflective functioning, which derives from the theory of mind — this process lays the groundwork for the child to hold themselves and others in mind and later develop the capacity for internal regulation. Golds also describes several cases where mentalization fails — often due the parent’s difficulty with emotional regulation — and children become dysregulated, often acting out in explosive ways.

Yet when a mother learns to interpret the meaning behind her child’s actions, and engage with the child in mutual regulation, the relationship itself changes not just the way the child learns self-regulation, but also the way his genes express themselves.

“Experience shapes genetic potential, and early life relationships are critical in influencing development of the brain,” Gold writes, describing a very new field of study called epigenetics.

While children may have genetic predispositions to mental illness, the relationship they develop with their caregivers can act as a buffer against the type of dysregulation that sets the stage for mental illness to develop. Gold describes a young couple whose previously easy going two-year-old son had begun having aggressive tantrums.

Upon exploring, Gold uncovers that the child’s father had received “bare-bottom public spankings” as a young child, and now, seeing his young son act out, dissociated from him, unable to be empathically present. Yet, through becoming aware of his tendency to disconnect from his own troubling past, the father was able to learn how to stay present with his son, even in difficult circumstances.

Interventions like this are possible, Gold tells us, when the clinician holds the caregiver in mind and listens to them in a way that helps them find meaning in their child’s behavior. Through applications such as taking a textured early developmental history, reframing postpartum depression, and listening for multigenerational trauma, clinicians can help caregivers reframe their children’s behavior in ways that move beyond diagnostic categories to better describe the meaning behind what they do.

While children can act out for a variety of reasons, these moments also provide tremendous opportunity for reconnection between parents and children.

“The relationships between parent and therapist, between child and therapist, and between parent and child provide the healing,” Gold writes.

Filled with brilliant insights, transformative vignettes and directly applicable tools, Gold’s new book shows just how clinicians can learn to offer the space that provides for this healing.

The Developmental Science of Early Childhood: Clinical Applications of Infant Mental Health Concepts from Infancy Through Adolescence
Claudia M. Gold
W.W. Norton & Company, 2017
Hardcover, 258 Pages
$27.95

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