Posts Tagged ‘attachment and bonding’

Pass The Bomb: who is going to contain your anxiety when you are with your newborn baby?

January 26, 2016

iStock_000064471321_SmallNew parents are anxious. And according to research, they are getting more and more anxious. I often hear cases of mums unable to sleep because they are terrified. Terrifed that their babies aren’t breathing. Terrified that the room is too hot. Terrified that baby hasn’t fed enough. Terrified that they will damage their baby. Dads are getting postnatal depression too, at rates almost as high as for women. They are scared too. I want to talk about a psychological piece of gold, that can ease anxiety, but that new parents are lacking in our modern lives.

Containment is a psychology term that basically means; the process of stopping anxiety from bouncing around the room.  Containing situations and emotions is something that all good parents do (and therapists too). It’s not easy to explain, but I’ll give you an example of when containment is NOT happening. My son may come to me in a flap because his friends have said to him (in a flap) that he has to start job hunting now, because a teacher said to his friends (in a flap) that jobs are very competitive and they need to take this seriously and start job hunting now. I can continue the flapping by saying “what? Are you serious? Now? That’s crazy. Can it really be that bad? Oh my goodness, I don’t know what we are supposed to do with that information, it’s a crazy world out there”. And in my exasperation, I tell my friends, who are also parents, and pass the flapping on. The anxiety continues down the line, because no one has contained it.

Or, as a parent, I can provide some containment. In doing so, the anxiety disperses. I do this by “containing” my own feelings of exasperation or anxiety, and I can calmly and warmly say “honey, that sounds very pressurising, I can understand that you’re worried (empathy). But you know what? It’s going to be fine, because you have at least a year before you need a job, you’ve already got a great CV, and I’m going to help you get yourself sorted. Shall we take a look this week-end?”  He relaxes, and the “containment” goes back down the line, because he tells his mates “actually, we do have a year, and we’ve got our CVs done already, and I’m not worried about it” and so on. Containment kills anxiety.

I was watching an episode of the British Sitcom “On the Buses” recently. It’s an amazing watch, because it is a rare glimpse into social history. It is set in working class London, in the early 1970s. It is clear, watching this, that it was normal to go through your first pregnancy, birth and babyhood, whilst still living with your parents. This was common before the 1970s, because newly weds couldn’t afford their own house. In one particular episode, a pregnant woman and her mother were chatting about the baby in a tiny kitchen, which serves as a wash room and a living room all in one. The pregnant woman was expressing anxieties about becoming a mum. The mother’s mother responded with something along the lines of “I’ll be ‘ere anyways, so you ain’t got narfin’ ta worry abart” (I made that bit up, I can’t remember exactly what she said). She was replying with reassurances, in a tone that kind of said “I totally get why you’re anxious, because I was” (empathy) and added “but really, it is so easy to look after a new baby, that you have nothing to worry about”. She was nonchalant, but empathic too, and containing.

Nowadays, new parents go home to their own house when they have their baby. And they don’t really want the mother in law around too much. And they don’t want her advice, because advice has changed so much. So they go home and do it themselves. Here-in lies the danger: What they don’t realise is, they have no-one to contain the anxiety. This is critical, but overlooked. Hazel Douglas defines containment as being “when one person receives and understands the emotional communication of another without being overwhelmed by it, processes it and then communicates understanding and recognition back to the other person. This process can restore the capacity to think in the other person.” Thus, it is a powerful tool for helping the person become unstuck from paralysing anxiety, to help them become functional again, to “think” again. Because, you know what? Working out what to do when a baby cries, learning how to pick up a baby, rock a baby, feed a baby, change a baby, keep it alive, is quite a big task when you are new to it.

And when there is no-one around to contain the anxiety in the middle of the night, it all gets a lot more stressful. And if you are scared and anxious, you are passing that on to your baby. Your baby picks up on “something is the matter”. So your baby is more likely to cry. So it gets worse. What you need, is someone to come in and contain the situation. Some-one who has done it before, who can calmly, empathically and warmly turn the situation around with one look and one smile. She sprinkles magic fairy dust into the room, just like a real life fairy godmother. Who is going to do that for you? Traditionally, it would have been mothers, sisters, midwives or aunties.

Nowadays, fathers are courageously trying to fill this gap. They are mucking in with the night time nappy changes and the job of caring for the baby. That, in itself, is a big job if you’ve never done it before. But dads, you have an extra job. You are also there to support the mother, so that when she is crying on day three of the baby blues, you can hold her in your arms and tell her that you love her. All very well, but can you tell her, knowingly, that it’ll be okay? Can you tell her, from experience, that it’ll pass? Can you tell her, and feel, that you are calm and strong and capable of handling all of this? Can you contain the situation?

Probably not. Because you have never done this before, either. You are tired from the birth too. You are on unknown, scary territory. You haven’t got the benefit of wisdom and experience on your side. You need some-one to come in and say to you “it’ll be okay, hold her in your arms, tell her you love her, let her cry all over you, you are doing an amazing job by just being there for her”. Dad needs containment too, so that he can be there for the mother. The mother needs containment so that she can be there for the baby.

So, how can you build in the psychological gold nugget that is “containment” into your postnatal birth plan? Well, you haven’t got time to wait for the NHS to provide it in the form of regular midwife visits postnatally with continuity of care, so you need to do it yourself. Think about which members of your family help you feel safe, nurtured, and cared for. Bring them in to help. Ask them to move in! If no-one is available, think about paying for this kind of help. Lactation consultants, postnatal doulas, night nurses, private midwives, all do a fantastic job. Postnatal doulas are not expensive. They are trained in all aspects of new parenthood, and they are exceptional at taking care of your needs so that you can take care of your baby. This will take the pressure off the father too, so that he can remain strong, and enjoy the process.

Think twice before you spend your money on a travel system, or on pretty wall paper with matching bedding. Think about your emotional wellbeing before your physical wellbeing, and you, your partner and your baby can thrive as early as possible in your incredible journey as that most precious thing in the world: creating your very own family.

mia brochure photoMia Scotland is a Clinical Psychologist and author specialising in the Perinatal Period. See her website at www.yourbirthright.co.uk or buy her book, Why Perinatal Depression Matters from Pinter and Martin.

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Can a two year old be traumatised?

October 28, 2015

Can a two year old be traumatised?

I was asked recently how to help a two year old settle at night. The wonderful book “The Rabbit who Wants to Fall Asleep” wasn’t working, along with countless other things that the beleaguered parents had tried. This came up in conversation during a mindful hypnobirthing class, and myself and another CBT therapist both got completely side tracked, and set about trying to find the answer to the problem, by asking the parents (who are tired, sick of advice, and frankly, stuck), lots of questions about their troublesome two year old.

Given that I was supposed to be running a hypnobirthing class, I had to curb my curiosity, and my urge to help, and get the subject back to talking about birth and babies – which was the object of the day. However, my brain remembers that there was unfinished business, so I’m going to finish it in the form of this blog.

It got really interesting when they said that their little girl’s sleep patterns had been fine, until, during the summer, their cat had jumped in through the window, onto her bed, in the middle of the night, waking her up with an awful shock.

Since then, she fusses about going to bed, she imagines all sorts of things that are scary in her bedroom, and she waked up in the middle of the night, and can’t go back to sleep unless she gets into her parents bed. Sound familiar?  Of course it does. This is classic two year old behaviour. At the age of two, there is a strengthening of the child’s “attachment behaviour” (there is also one at about nine months old).  This means that she is more likely to get clingy and want to know that her parents are around, so they can keep her safe. It kind of makes sense, because at the age of two, a child becomes more independent physically (she can run much faster) but she is also becoming more independent psychologically, because her neocortex is developing at a very fast rate. This means she can plan ahead, be persuaded into things by others, she can plan exciting things like how to run away from home and have an adventure, and so on.  Thus, she is arguably a little more vulnerable to getting lost, or getting eaten by a wolf.  Nature protects her by providing an in-built mechanism to keep her parents close.  The attachment process is even stronger at night, because the child needs to be kept safe from the dark. Her imagination of “monsters” is formed at this age (tigers, wolves, strange men from warring tribes, etc.).  These monsters are as real to her, as dangers of heights, flying, spiders, or whatever your personal fear might be. She just does not feel safe, and she can’t explain why, just as we can’t explain why we don’t feel safe in the presence of a tiny cute spider that we know can’t harm us.

So, unfortunately, in the case of our little girl and her cat, this cat jumped on her bed at a critical point in her development. It fast tracked and heightened her need to know that her parents are close in the middle of the night, and made her needs for a strong attachment much stronger. However, I also think it traumatised her. This means, that the experience got “wedged” in the limbic system (the alarm signal of our brain) and hasn’t been processed as a memory. In other words, when she goes to bed at night, her alarm system triggers “oh no, this is where I’m not safe, this is where scary things happen to me”. Her alarm system is trying to protect her, but it has got it wrong. Her alarm system thinks that she is still in danger, when in fact, she is perfectly safe (the window is closed, and the cat cannot jump on her again).  However, with her amygdala firing off, she is struggling to settle at night, even when a lovely hypnotic cd is being played.

In therapy, when I help a person recover from trauma, the single most important thing is for the person to feel safe. You cannot recover from trauma while your alarm system is firing. It will listen to nothing else, no logic, no reason, no nothing. To get the brain to “listen” and process the memory, we have to calm the amygdala first and foremost.  I do this with relaxation and hypnotic techniques. But in the case of the little girl, the thing that helps her feel safe is the proximity of her parents. So, here is my advice for how to help this little girl settle at night, and how to help her parents get some much needed sleep.

  1. Go to bed with her (or sit in the room with her) and stay there silently, while she falls asleep. You can use this time to practice your meditation, or mindfulness techniques. You can use this time to notice her breathing near you, to notice the warmth of her body, to notice how jittery and lively your own mind is, and to learn to calm it. Do not focus on whether she is sleeping or not, as she will notice this tension. Just focus on your own wish to relax and be mindful. You might even get a power nap yourself. The need to do this will pass. It might take a few months to be honest, but a few weeks might be enough. At some point, she won’t care whether you are actually in the room or not, so long as she feels safe, and so long as she feels sleepy. The argument about whether you can “spoil” a child, or whether she might be attention seeking, or “playing you” is worthy of a whole other blog.  Just trust me for now, that if you meet her needs (for security) without additional gains (such as playing, or fun), then you will not make things worse.
  2. At other times in the day, talk to her about the cat incident that “happened when you were so little” or “that happened so long ago” or “that cannot not happen any-more”. Get her to tell the story, draw it, or act it out between the two of you. Make it a game, make it fun. Finish the “story” with a definitive “it’s over”. For example, if you are “playing” the cat game, and you are the cat, make a point of being thrown out of the room, and not ever being allowed back in. Or she can pretend to be “mummy” and cuddle her doll better, after the doll got a shock from the cat, and explain to her doll that the cat won’t do that again because the window is locked now.  (Being cuddled better might be important, because in my experience, a lot of trauma comes from a sense of having felt alone at the time of the trauma). You won’t need to do this more than a few times for it to have done the job of helping her brain to process the event as a “memory” rather than an ongoing “danger”.

I know that these parents have the wholehearted sympathy of so many parents who are tired, exhausted, confused, fed-up, worried, beyond caring, bewildered, all because they have the joys of a two year old in their lives.  Good luck with it, and know that it really does get an awful lot easier as they get older J

Happy mummy, happy baby

September 1, 2015

So, I’m eating a slice of toast while reading a blog from my facebook page this morning.  I can do that now, because my children are older.  I can even finish my cup of tea, and make sure that I am wearing appropriate clothes to walk the dog in. I no longer find myself rushing around to make sure my children have their hats and scarves on, and then to go out realising I am wearing no jacket.  Putting others first seems to be what mothers do, to the detriment of their own mental health. This is partly related to guilt.  Guilt is a big deal in new mothers.

So, as I read this blog about babies’ mental health, I am struck by how easy it would be for this blog to make mothers feel even more guilty.  It is littered with phrases such as “what parents do profoundly shapes who we will become” and “early experiences matter – a lot”. It tells us how our handling of our babies shapes their personality, their future mental health, their critical thinking skills and so on.

Then it goes on to say that the good news is that “nurturing strong mental health in young children is not a specific undertaking in which parents need to engage – as if it were a “job” or task.  It is how parents are with their babies that matters….delighting in the joy of young children’s daily discoveries”.  Well, frankly, that this is good news is debatable.  If it were “a task” it would be easier to complete.  You could have a checklist in the morning, and make sure you have done your jobs.

  1. Dress baby
  2. Feed baby
  3. Smile at baby and make eye contact

But no.  Now, we have to “delight in the joy of young children’s daily discoveries”.  Actually, if you have ever tried to get a toddler out of the house on your own, with a baby still in their jumpsuit, having to get to pre-school on time, not having eaten yourself, or finished your cup of tea, with baby sick still on your shirt, and your toddler says “look, a leaf on the ground”, you do not delight in this.  You do not feel like cooing, smiling and delighting in your toddler’s very slow progress along the pavement.  You grit your teeth and say “come on” in a voice that is far too squeaky, desperately wanting your toddler to move it, so that you won’t be late again.

The blog is correct. It is the delight and joy that people share with their babies, that helps the baby develop.  Mother and baby create a “dance” of interaction.  With each positive interaction, the baby’s brain fires more neurons, lays down the foundations for feeling loved, trusting and explorative.  Nature designed mothers to look into their baby’s eyes and feel joy, for this very reason.  But nature did not design us to be able to do this on our own in a rather large, otherwise empty, house.  It is not fair to tell a mother who is doing this job on her own, that she “just” needs to be joyful, if you expect her to do a job that is stressful, lonely, unsupported and practically impossible, and then ask them to be joyful while they are doing it.  Not only do we as a society do just that, but we then actually have the gall to suggest that if they aren’t joyful they are damaging their baby’s mental health!  You cannot feel guilty and joyful at the same time.   This is because stress hormones (associated with feelings of guilt, shame, depression, anxiety, worry) and very different to calm and joy hormones (associated with relaxation, mindfulness, connection, warmth, compassion, mutual joy and sharing).  Stress cuts across joyful feelings immediately because nature designed us to prioritise being alive over being happy.  So if a mother is stressed, she will find it harder to “delight in the joy of young children’s daily discoveries”.  When a mother has her baby, she is recovering from a birth physically and psychologically, she is learning to adapt to being a mother (being responsible for a little being, no longer able to put her needs first, no sleep and so on), she is  grieving her old life and adapting to her very different new life, she is having to manage the housework, cleaning, ironing, cooking, school runs, worrying about her weight, worrying that her husband still feels included and loved, and so on.  This is too much for a new mother.  She needs to rest.  She needs to be looked after.  She needs people around her.  She needs her privacy.  I have to say, a little part of me envies Mormon mothers (yes, I actually wrote that!). While some people think it dreadful that they should share a husband, I see it slightly differently, because in Mormon households, the mother is not alone. Imagine if you always had other “wives” around you in the house, to help with housework. Imagine if you only had to be responsible for feeding your children one or two days per week, because some-one else is cooking the other five days.  Imagine if, when you need a wee, but your child needs to put their shoes on because you are late, imagine some-one saying “I’ll do it, you pop to the loo”.  Imagine, when your child has had a dreadful tantrum, and you feel like you’ve been dragged through a hedge backwards, some-one says “you poor thing.  I’m going to make you a cup of tea, and settle your toddler down with a drawing for you”.  Imagine, when you are about to shout at your toddler because you are tired and wired, you can turn to some-one and say “I feel like screaming” and she can laugh and say “I know that feeling.  Off you go, I’ll spend 5 minutes with her”.  Imagine on a day when you have a cold and you feel wretched, a woman says firmly to you “go to bed and stay there.  I’ll do this”.

The point isn’t that we should become polygamous, the point is that society needs to look after mothers if we want mothers to look after babies.  The research shows us that mothers who feel the “joy” of parenting do a great job raising kids.  However, one cannot force “joyful” parenting on some-one, especially not by increasing guilt.  You create the conditions for joy.  In response to the research, society has to do a great job taking care of mothers. The flipside of joyful parenting is sad, scared parenting.  Perinatal mental health problems are on the rise, and we know that this is not good for babies.  The government is addressing this by increasing “identification” and “treatment”.  This is important, but we are putting sticking plasters on a bigger problem.  Isolating and burdening women is the problem.  And it’s affecting fathers too now, as they are increasingly expected to juggle full time work, house, children and looking after mum.  They are getting sick too.

Stop the guilt. Stop the scare mongering.  Prioritise taking care of our families, so they can thrive in joyful, relaxed interactions.  Simples.

Mia Scotland, Clinical Psychologist and Author of “Why Perinatal Depression Matters“.

Website:  www.yourbirthright.co.uk.

Leave mum holding the baby at your peril: Postnatal depression and what we expect of women

December 31, 2014

trauma mum n babyI just left a woman in her house with her baby.  I was her doula, and I was visiting her after the birth, to congratulate her, and make sure she is okay.  My role wasn’t actually to check that she is okay.  Most people want a doula for the birth process itself, not for after the birth.  But as a doula who is also a psychologist, I know that the time of settling in after you’ve had a baby can be much more of a roller coaster ride than the birth itself.  And it lasts much longer.

Knowing how hard it is to adjust to a new baby, I found it difficult to walk away.  She is doing really well.  I have no concerns about her or the baby at all.  She expressed the usual bewilderment, lack of confidence, tiredness, tearful days, that all new mothers experience.  Her tiredness and anxiety are “normal”.

But I came away questioning this once again.  How can it be that we accept it as “normal” to feel overwhelmed, anxious, tearful  and tired, after having a baby? Neuropsychology actually suggests that parents and babies are primed for joy, love and connection, not misery.  In fact, every time there is a joyful and loving interaction, the baby’s neural connections become stronger.  The baby’s brain literally grows in response to joy and oxytocin.  Evolution has encouraged this, and we can see it every time some-one comes in to look more closely at the baby (which, as it happens, is the prefect distance for the baby to be able to focus on you) and then smiles and coos at the baby.  And we simply can’t help ourselves when babies smile back at us.  We immediately laugh, smile, and coo even more (or is that just me?).  We all do it, adults and children alike.  In other words, the need for joy and connection is not just met by the mother, it is met by all of the baby’s social circle.

However, in our society, we seem to think it is normal to feel exhausted, overwhelmed and wretched in the first 6 weeks of babyhood. And if we “expect” mum to be struggling, then how do we spot when “normal” becomes “depression”?   Women I speak to whose diagnosis was missed,  say that they did tell their midwives and health visitors that something wasn’t right, and that they didn’t feel normal.  But they were told that that was normal.   We are also missing the signs in fathers too.  Postnatal depression amongst fathers is on the increase. This, I am sure, is related to the enormous pressure they are under to be a hands-on dad, to be at the birth, to look after mum, and to continue to work full time, with barely any paternal leave or additional support.

How did we get to a place where it is considered normal to feel rubbish after you’ve had a baby? Is it really normal to feel miserable and trapped and overwhelmed and exhausted?  While I was vaguely musing about this in the back of my head, I left my doula client on her own in her house.   As I left, I said “it doesn’t feel right leaving you alone”.  And it really didn’t feel alright.  Not because there’s anything wrong with her, or her ability to cope, or her mental health, or her bonding with her baby.  But because I was leaving a woman on her own in a house with a four week old baby.   If that seems okay to you, then that is because that is what our society does.  It’s normal in our eyes.  We have stopped being able to see just how wrong that is.  But it is wrong.

Looking after a baby is a full time job. Well, no, it isn’t actually.  With a full time job, we get to go home, sleep, eat, shower, tidy up, switch off mentally, and choose what to do in between the job.  A baby does not give you predictable time to do any of the above.  You might get to take the lunch out of the fridge and microwave it, but you might not get time to eat it.  You can never switch off, and you have to be always instantly interruptible.  Just having one other person in the house makes such an enormous difference to all of these things.  You can shower.  You can prepare lunch.  You can leave the house for hours!  You can sleep for hours.  You can turn to some-one and say “oh my goodness, this is ridiculous” and have a bit of a laugh together.  Just having one other person in the house makes such a difference.  And yet, we leave women on their own in the house all day every day, and think nothing of it.  Single women also have that burden all night too (I can’t even imagine how our society can fail to grant them utmost respect .  They certainly have mine.).  Not only are new mothers left with the constant rolling demands of looking after a baby, but they are left in a house which needs attention.  If it isn’t given attention, she will be living in her own mess and dirt.  No-one wants to do that, and yet, we happily say to new mothers “leave the housework, it will wait”. I disagree.  It won’t wait, unless you actually want to live in your own dirt.

Contrast this with other cultures.  Imagine , for a moment, that you have just had a baby.  You are tucked up in your bed, with your baby beside you (yes, you are allowed to sleep alongside your baby, just like every other mammal on the planet does).  Your room is clean and tidy, because some-one else is looking after that for you.  Every four hours, some-one comes in with delicious home cooked food for you to eat.  Every morning, some-one is there so that you can get out of bed and shower and freshen up.  Once a day, you are given a hot stone all-over body massage.  Yes, this really does happen in a number of cultures!  The daily food and massage are considered to be an essential part of your recovery, both physical and mental.  You and your baby are together. Your job is to get to know your baby, and enjoy being with your baby.  You feed and change your baby.  You get to know your baby. You sleep and recover.  After a number of weeks of this, you are considered transformed enough to emerge into the real world as a fully-fledged mother.  Like a butterfly emerging from its chrysalis, the transition to motherhood is viewed as a psychological and physical process, not as a on- off biological “event”.

Our culture doesn’t do that.  And we pay the toll.  Perinatal mental illness is a rising problem generally, and the government are trying to put in place strategies for identifying and treating people who are suffering. While identification and treatment is important, it does place the emphasis on the individual woman, with the risk of blaming her as some-one who “couldn’t cope”.  Also, thinking that all we need to do is “treat” her with tablets and therapy also risks us reducing postnatal problems to discreet illnesses that just need “medication”.  Postnatal depression is not the women’s fault, and it is not a discrete illness like diabetes.  It needs attention from our culture too.  We need to treat women better when they come home with their new babies.  We need to realise that what we are asking of them is too much.  Being on your own regularly in your house with a baby or toddler is asking too much.  We need to start honouring, and caring for, mothers and fathers, because that is how we built parents strong enough to really care for our future generation.    power of compassion