Title: Watch, Wait, and Wonder
1Watch, Wait, and Wonder An Infant-led Approach
for Working with Infants and Their
Parents Nancy J. Cohen
Hincks-Dellcrest Centre University of Toronto
2COLLABORATORS Mirek Lojkasek Elisabeth Muir
3GOALS
- Discuss the underpinnings of Watch, Wait, and
Wonder in attachment theory - Compare Watch, Wait, and Wonder to other current
interventions - Describe Watch, Wait, and Wonder technique and
process - Summarize research results on Watch, Wait, and
Wonder - Consider applications of Watch, Wait, and Wonder
4On the surface, some infant problems may not
appear to be relational. However, they often
reflect the infants separation anxiety. The
difficulties do not reside solely in mother or
child but in the relationship.
5SYMPTOMS THAT BRING INFANTS TO CLINICAL ATTENTION
- Infant Symptoms
- Irritability and difficulty being soothed
- Excessive tantrums
- Sleeping problems
- Eating problems
- Clinginess
6SYMPTOMS THAT BRING INFANTS TO CLINICAL ATTENTION
- Parent Symptoms
- Depression
- Anxiety
- Risk for or allegations of abuse
- Complaints of not feeling bonded or attached to
infant
7A baby has none of the conventional attributes
of a psychiatric patient. He cant talk about
his problem. He cant form a therapeutic
alliance. He has no capacity for insight. Such
patients are usually labelled not suitable for
treatment in the language of psycho- therapy.
8CONDITIONS FOR SECURE ATTACHMENT
- Accurate perception of infant cues
- Sensitive responsivity to infant
- Display of affection
- Acceptance of infants behavior and feelings
- Physical and psychological accessibility when
infant is distressed or when exploring
9IMPLICATIONS OF ATTACHMENT SECURITY
- Regulation of emotions and behavior
- Sense of self
- Curiosity and exploration
- Cognitive and language competence
- Capacity to relate to others
- Capacity to parent
10Individual Differences in Infants Contribute to
the Relationship
- Infants have different personalities or
temperaments from early on - These traits evoke different responses (e.g.,
some babies are soothed easily) - Some parents find it difficult to establish a
fit with their infant. - The parents often have expectations of how their
child should be. These expectations may be
conscious or unconscious.
11- Even when the problem is attributed to something
else (e.g., FAS developmental exceptionality) a
relationship focus can be of benefit.
12- SECURE BABIES
- Explore freely and seek contact with the
attachment figure as necessary.
13- INSECURE BABIES
- AVOIDANT BABIES
- Do not show attachment needs in order to avoid
rejection. - AMBIVALENT
- Preoccupied with the availability of an
inconsistent caregiver and make repeated high
intensity demands to ensure at least some elicit
attention or are extremely clingy.
14- DISORGANIZED BABIES
- Do not have an organized strategy that elicits
care when distressed.
15- INTERNAL WORKING MODEL
- Internal working models of self in relation to
others are set down and unconsciously guide and
filter attention and processing of experiences
with regard to attachment. In this way, they
impact on the course of future relationships.
16- An intervention consistent with attachment theory
needs to meet a number of criteria - Provides emotional and physical access to
mother. - Focuses directly on maternal sensitive
responsiveness to the infant's behavior
and emotional signals. - Places the mother in a non-intrusive stance.
- Provides a space in which the infant can work
through relational struggles through play and
interaction with the mother. - Provides a therapist who can function as a
secure base for the dyad.
17OTHER INTERVENTIONS Support
- Assist mothers to access community resources,
such as housing, work, child care. - Counselling the mother or teaching social skills.
- Therapist is resource.
18OTHER INTERVENTIONS Developmental
Guidance
- Provide information to the mother on infant
abilities, developmental milestones and needs,
and practical caretaking issues individually or
in group format or informally during infant
medical check-ups. - Therapist is resource.
19OTHER INTERVENTIONS Relational Guidance
- Help mothers increase knowledge of and experience
with infant in the context of spontaneous
interactions. - Mothers helped to attend to their infants
idiosyncratic cues. - Therapists provide feedback directly or by
reviewing videotapes with the mother. - Therapist may also model parenting behavior.
20OTHER INTERVENTIONS Psychotherapy
- With help of therapist, the mother gains access
to repressed early experiences, re-experiences
feelings associated with them, and achieves
insight into the relational difficulties with her
infant. - Infant included as a catalyst for change.
- Repetition of the mothers past primary
relationships in her relationship with the
therapist - Therapist interprets and helps mother make links
between past and present. - Therapist may guide mother to interact in a
different way.
21In spite of our current knowledge that infants
contribute to relationships, all of these
therapies focus on the mother and assume that the
work needs to be done with her before the infant
can benefit. None of these therapies have as
their goal that the infant should be able to use
the time therapeutically himself.
22- Although it is the infant who is the greatest
clinical concern, the actual focus of treatment
is usually the mother. In our work, we have
focused on how best to include the infant in
infant-parent dyadic therapy directly through the
infants activity.
23You be this way or else you will cease to exist
in my eyes.The mother can only see certain
behaviors. The dilemma for the infant is that if
he is himself he loses his mother. If he loses
his mother he loses himself. Ironically, if he
keeps his mother he also loses himself. The
outcome of this experience is separation anxiety.
24HOW DO WE INCLUDE THE INFANT IN PSYCHOTHERAPY?
- Allow the infant to explore and show his
curiosity about the environment. through
sensorimotor activity and play. - Use observation of the infants spontaneous
gestures as a reflection of his innate potential. - Use a medium in which infants can seek and
establish relatedness.
25WATCH, WAIT, AND WONDER SESSIONS
-
- Infant-led activity
- Discussion
26SUGGESTED LIST OF TOYS FOR WATCH, WAIT, AND WONDER
New born baby anatomically correct dolls with bottles and diapers an blankets Stacking cups
Dolls crib that is large enough for child to crawl into, or set up a space on the floor with a pillow and blanket defining a bed Blocks
Bean chair Small cars including ambulance
Two telephones Medical kit with stethoscope
Mirror, (shatter-proof) Sets of vinyl family dolls (black and white
Activity board Set of tame and wild animals large solid variety
Soft ball Bowls and mixing spoons
Stacking rings Train set
Policeman helmet or some other official hat Heavy duty blue vinyl (Pool manufacturers)
Undermatting polypropylene for padding
NOT ALL OF THESE TOYS ARE REQUIRED. IN FACT,
WWW CAN BE DONE WITH VERY FEW TOYS IF NECESSARY
27INSTRUCTIONS FOR WATCH, WAIT, AND WONDER
- Get down on the floor with your baby.
- Follow your babys lead at all times.
- Do not initiate activities yourself.
- Be sure to respond when your baby initiates but
do not take over his activities in any way. - Allow your baby freedom to explore whatever he
wants to do is okay as long as it is safe. - Remember to Watch, Wait and Wonder.
28DISCUSSION
- What did you observe?
- What was your infants experience?
- What was the play about?
- What were your thoughts and feelings?
29RESEARCH OUTCOMES KEY AREAS OF MEASUREMENT
- Symptom reduction
- Mother-infant relationship
- Infant competence
- Maternal distress and confidence
30RESEARCH OUTCOMESPRE- TO POST-TREATMENT
- Both treatment groups exhibited symptom
reduction, improved quality of mother-infant
interaction, and reduction in parenting stress. - Greater gains were made from the beginning to
the end of treatment in the WWW group in
attachment, infant cognition and emotion
regulation, and maternal depression and
parenting efficacy.
31RESEARCH OUTCOMESPOST-TREATMENT TO FOLLOW-UP
- Improvements that were observed at the end of
treatment were maintained. - In some respects, further improvements were
observed six months after treatment ended in
reduced infant symptom severity, maternal
intrusiveness, and dyadic reciprocity and
parenting stress. - Changes emerged in WWW and PPT at a different
pace. Dyads receiving PPT showed gains in
infant cognitive development, attachment, and
maternal depression at follow-up that had been
observed in dyads receiving WWW at the end of
treatment.
32WHAT MIGHT ACCOUNT FOR DIFFERENTIAL TREATMENT
EFFECTS - 1
- Watch, Wait, and Wonder maximizes the
requirements for forming a secure attachment
relationship by providing psychological and
physical accessibility to the mother and
enhancing her capacity to respond to the infant
reciprocally and without intrusion.
33WHAT MIGHT ACCOUNT FOR DIFFERENTIAL TREATMENT
EFFECTS - 2
- In PPT, the primary focus is on the mothers
representations and the transference
relationship. The latter focus may delay changes
as the mother needs to work through earlier
relationships before new insights can influence
the relationship with her own infant.
34CONCLUSION
- All roads lead to Rome but taking some roads
takes less time than others.