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Making Room for Uncertainty

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Austen Riggs Center staff member Dr. Claudia Gold is part on the Human Development Strategic Initiative.By Claudia Gold, MD

When world-renowned child development researcher Dr. Ed Tronick spoke in April 2018 for a mixed audience of Austen Riggs staff and community members who work with children and families, he began with a quote from Steven Hawking, “One of the basic rules of the universe is that nothing is perfect. . . .Without imperfection, neither you nor I would exist.”

Perhaps best known for developing the Still Face Paradigm, an experimental manipulation designed to demonstrate the young infant’s tremendous capacity for connection and communication, Dr. Tronick shared his decades of research, revealing not only the inevitability, but also the necessity of imperfection in human interaction.

In contrast to the expectation of a kind of mythical idealized attunement, he found, through detailed microanalysis of interactions in our primary love relationship, that healthy, typical parent-infant interactions are in fact mismatched 70% of the time. Through the repair of these moment-to-moment mismatches we develop sense of agency and hope, a sense that “I can act on my world to make it better.”

Psychologist Dr. Jayne Singer continued the afternoon presentation for the community, sharing the Touchpoints model, developed by Dr. Tronick together with pediatrician T. Berry Brazelton, who passed away in March at the age of 99.  Touchpoints offers a way to apply the core concept of mismatch and repair beyond infancy in a range of clinical settings.

Pediatricians, early intervention specialists, educators, child protection workers, home visitors, literacy advocates from Berkshire United Way, and others from across Berkshire County engaged in lively discussion. Bringing home the importance of investing in early relationships, Dr. Singer showed a picture of a newborn infant, saying, “This is early literacy.” She encouraged audience members to suspend certainty inherent in being the “expert” and to instead create a space for listening with curiosity.

The Austen Riggs Human Development Strategic Initiative in collaboration with the Massachusetts Association of Infant Mental Health, of which Dr. Singer and I are board members, sponsored the afternoon.

On the Saturday and Sunday that followed this event, another group gathered for the Human Development Initiative’s second annual Newborn Behavioral Observations (NBO) training. While the medical model of care often puts the professional in the role of expert, this intervention seeks to shift that mindset, mobilizing parents’ unique capacity to tune into and respond to their newborn. The 18 neurobehavioral observations of the NBO are not an assessment or evaluation. Rather, they offer a frame in which to support parents’ earliest efforts to get to know their baby.

Pediatricians, maternity nurses, infant daycare providers, home visitors from different organizations including Berkshire Nursing Families, Parents as Teachers, and the Pediatric Development Center learned from Dr. Kevin Nugent, who developed the NBO, about listening to a baby’s earliest communications. On the second day the group devoted time to thinking together about how to collaborate to provide a holding environment for vulnerable families such as those struggling with opiate addiction. We acknowledged the need to support all families, recognizing the “normative crisis” of the transition to parenthood and the need to destigmatize asking for help.

In addition to training community practitioners in the NBO, the Discovering Your Baby Project is collaborating with the Family Birth Center at Fairview Hospital, supporting the efforts of the maternity nurses, who have all been trained, to incorporate the tool into routine care. As Doreen Hutchison, RN, vice president of operations and patient care wisely observed, “We want parents to go home with their baby feeling confident that they know their baby best.”

Many parents today are burdened by an expectation of perfection. When we can protect time to listen to parent and baby together, we convey the idea that, in contrast to a “right” way, they will figure things out together. Growth happens through the inevitable mistakes we make along the way.

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