Using attachment theory in assisting parents and infants engaged in stressful interactions - Term Paper Example

? Using Attachment Theory in assisting parents and infants engaged in stressful interactions. Tony* is a healthy nine-month-old male child, the product of an uneventful pregnancy followed by an uncomplicated full-term vaginal delivery. Ellen and Roger, Tony's parents, are both overweight (BMI 31 and 29 respectively), but have otherwise no significant health issues. They are in their early thirties, and have been involved in a relationship continuously for the past sixteen years. Tony was actively planned and eagerly welcomed by Ellen and Roger, as well as extended family. (*Names have been changed for privacy.) When Tony was six months old, Ellen and Roger decided to train Tony to sleep through the night independently according to the method outlined by Ferber in “Solve Your Child's Sleep Problems” (Ferber, 2006).This method involves allowing the child to cry himself to sleep; As such, it is frequently referred to colloquially as the “cry-it-out method” or “CIO.” In literature, it is called “graduated extinction” (Dewar, 2008). Ellen and Roger agreed that this was the most appropriate decision for their family based primarily on their desire to ensure both their own sleep and private time to engage in leisure activities, jointly and separately. Both committed to complete the first three weeks of sleep training, and to re-evaluate the program if it was not having the desired effect on Tony. The Ferber Method has received a great deal of criticism from parents and scholars, and while it is one of the best known sleep training regimens it is also one of the most controversial for several reasons (Dewar, 2008). Ferber acknowledges in his book that this process does not teach children how to sleep independently, it merely deprives them of access to their parents as sources of comfort (Ferber, 2006). Ellen and Roger successfully employed Ferber's techniques over a two week period, during which Tony would initially cry himself to sleep. When he awoke during the night a parent would stand near the door of Tony's bedroom, outside of his visual range, and attempt to ascertain his physical state of being. In the event of specific concerns relevant to physical health or comfort, those concerns were addressed quickly by the attendant parent, and without fanfare. There was minimal parent-infant interaction during these addresses. Diaper changes accounted for the overwhelming majority of these concerns. If there was no specific physical concern to address, Tony was allowed to continue crying in his crib. Though Tony's cries were extremely distressing for both Ellen and Roger to endure, the two of them persisted in their efforts to teach Tony to sleep on his own. Over the first two week period of sleep training, Tony began crying less, fell asleep more quickly, and stayed asleep for longer periods of time. By the end of the first two weeks Tony was sleeping from 19:00 local time through 0:800. Caregivers who sleep train their children believe that they are teaching the children to self-soothe and encouraging independent behavior. In reality, infants who are left to cry alone are at high risk for developing ambivalent relationships with their caregivers. Tony internalized the lesson that after the lights have been turned off, his needs will not be met, and as a result his behavior, particularly in the evenings as bedtime approaches, Tony's behavior is that of a child who is ambivalently attached to his primary caregivers. Tony's behavior has become more subdued in general; He spends less time in both active alert and crying phases. Tony hardly seems to notice when he is separated from his parents, but he does actively prefer them to strangers. Ellen, Tony's mother, truly believes that sleep training was an appropriate choice, and defends her decision vociferously. She points to the ease with which Tony sleeps and his cooperation in the evenings as proof that she and her husband made the correct decision. Ellen feels that this process has been beneficial not only to Tony but to her, and that while it was extremely difficult initially it was worth the effort. Her attachment to Tony also appears to be ambivalent; While Ellen clearly loves Tony and has a strong desire to meet his needs, she also views him as something of an inconvenience, particularly in the evenings. Ellen and Roger both feel that sleep training has been extremely beneficial to their relationship with one another, by allowing them to spend quality time together after Tony has gone to sleep. Ellen has stated that she feels sleep training has contributed to her ability to parent Tony during the day by facilitating her own sleep. Ellen and Roger were high school sweethearts who married after graduation from college. The two consider one another the best of friends, and share a profound respect and appreciation for one another. Both describe their relationship in superlative terms such as “soul mates” and “perfect.” All evidence indicates extremely secure attachment to one another. Ellen and Roger both have solid emotional relationships with their own parents, and enjoy the support extended families and a robust group of friends. They engage in social activities with other adult friends on a regular basis. The initial assessment interview revealed that while Ellen maintained the belief that sleep training was the correct course of action, as a mother she found the first week of separation extremely unpleasant and difficult to endure. Often she would find herself crying along with her son, and she claimed that she “would not have been able to endure” without significant emotional support from Roger. Both parents related feeling as though they had been “fighting their instincts” when they failed to respond promptly and actively to Tony's cries, but reasserted that they were acting on Tony's behalf and “for his own good”. Ellen in particular had a high propensity toward defensive statements about the Ferber Method and her election to participate. Roger maintained a less reactive, less emotional response to questioning throughout the assessment. Discussion As an infant mental health specialist, I would attempt to modify this working model as it played out between parent and infant by encouraging Ellen to contemplate her response to the sleep training itself, and extrapolating that to apply to Tony. Ellen reacted to the stress of hearing her son cry by turning to her husband, who reassured and supported her throughout the stressful period. If, as an adult, the stress was overwhelming, how could she expect her infant son to respond differently? Ellen's instinct was to seek comfort from a familiar source, but she actively subverted her first instinct-- to comfort her child. Roger would not have dreamed of ignoring Ellen when he sought comfort from him, but that same comfort was denied to his son. If these facts are stated in these terms, Ellen and Roger would likely develop a new understanding of their behavior from Tony's perspective. Recent neuropsychological research suggests that the lessons of sleep training, while explicitly forgotten, are imprinted in an infant's central nervous system as intrinsic memory, or memory which alters the structure and function of the brain (Mate, 2006). While Tony will not remember his sleep training, the effect of having his cries ignored was to change the paradigm by which Tony understood the world. Ellen and Roger have actively denied that their choice to sleep train was a harmful one, and feel very strongly that the benefits of sleep training far outweigh any potential consequences, particularly for Tony. Indeed, they appear to be relatively involved and caring parents, if guided more by egocentric desires than by neuropsychological research. The belief shared by Ellen and Roger that the Ferber Method was extremely successful, despite the obvious stress induced in themselves and their son during the sleep training, could prove an insurmountable obstacle to creating a working alliance with an Infant Mental Health (IMH) specialist. The IMH specialist working with this family is likely to have very strong concerns not as to the efficacy of the program, but with regard to the long-term and neuropsychological impacts of a methodology which so flagrantly violates the tenets according to which we have evolved (Dewar 2006). Despite intense feelings and a considerable body of evidence on the subject, the IMH specialist would be absolutely required to maintain an actively clinical affect as well as a critical awareness of their own potential for bias due to overwhelming emotional response. Researcher bias is easily modulated by maintaining professional standards and making only factual assessments of the situation at hand, that of Tony's less than secure attachment to his parents as a direct result of sleep training. The IMH specialist must acknowledge the fact that from the shared perspective of Ellen and Roger the process of sleep training must be considered successful, as it has had the desired effect. Tony does indeed fall asleep on his own each night without causing difficulties for his parents, and if he wakes during the night he entertains himself quietly in his crib rather than crying out for his parents. Without a clear acknowledgment of the benefits which Ellen and Roger have derived from sleep training, which are quantitative as well as qualitative, neither parent is likely to be receptive to any suggestions made by the IMH specialist. Indeed, they would likely be offended to hear their relationship with Tony classified as “ambivalent,” as they believe that their son is emotionally healthy and secure. Tony rarely tantrums or cries loudly, and his parents consider this to be another benefit derived from his sleep training regimen. Despite the overwhelmingly stressful nature of the parent-infant interactions involved in graduated extinction sleep training, the literature suggests that in the majority of cases, this method does have the desired effects of reducing bedtime tantrums and increasing both quantity and quality of sleep in the long-term (Dewar, 2006). As such sleep training must be considered successful, and the Ferber method will continue to have strong advocates among parents of small children. References Barnard, Katherine E. "Keys to Developing Early Parent–Child Relationships." Nurturing Children and Families: Building on the Legacy of T. Berry Brazelton (eds B. M. Lester and J. D. Sparrow). Oxford, UK: Wiley-Blackwell, 2010. Web. doi: 10.1002/9781444324617.ch5. Dewar, Gwen. "Sleep training: The Ferber method and its alternatives." Parenting Science, 2008. Web. Retrieved from Ferber, Richard. Solve Your Child's Sleep Problems. New York, NY: Fireside, 1985/2006. Print. Mate, Gabor. "Why I no longer believe babies should cry themselves to sleep." The Globe and Mail. Web. Last updated 2011 March 10. Retrieved from: Read More