Meet Ana Poole: Infant and Early Childhood Mental Health Therapist

Hi all :) My name is Ana, and I’m a therapist who works a lot with infant and early childhood

mental health. I want to share a bit more about my practice and what it means for parents and

any person who may find themselves wondering: what is infant and early childhood mental

health all about?

I’m a recent graduate from the U of MN, in a program entirely focused on infant and early childhood

mental health–also known by the acronym IECMH. My days (and nights) were dedicated to

courses on theories about child development, family systems and dynamics, assessing

childhood mental health symptoms, and what therapeutic interventions to use when. I loved

being in the program and I loved learning about each of these topics (and more), but after

courses were done, I was left trying to assemble my own working definition of IECMH in the

context of the real world, working with real families. What were the most important pieces of all

that education–the pieces I want to actively call into the treatment room, that I want to share

with families and talk about with colleagues? This article is my slapdash answer to that very

important question. Below are three key concepts in my approach to IECMH–not necessarily

academic, but highly practical themes–that I have found most influential and impactful within my

own work.

The first of these is perhaps the most mysterious to families curious about early life therapy–the

idea of true infant mental health care. Many adults naturally view the concept of therapy

through an adult lens, which generates some confusion if you think about doing talk therapy with

an infant. However, though talk therapy (and other kinds of adult therapy) clearly don’t make

sense for little babies, one mind-blowing fact is that there ARE in fact therapy interventions for

infants (many of them evidence-based!). What’s key to know here is that infant mental health is

almost entirely based in the relationship with primary caregiver(s), usually one or more parents.

Therefore, another way to think about infant mental health treatment would be as a form of

family therapy, rather than individual therapy–I often refer to it as parent-child therapy, dyadic

therapy, or relationship therapy. This understanding helps point the way as to why parents

would be interested in pursuing therapy with their infant at all. Some of the reasons parents

seek out parent-child therapy with their baby are consistent with why we adults seek therapy–for

example, experiencing a really difficult potentially traumatic event with baby, adjusting to a big

life change, or being concerned about the intensity of distress your infant displays or other

aspects of their temperament. But when we view infant mental health through the lens of the

relationship with the parent or primary caregiver, that means it’s also legitimate (and

encouraged!) to seek parent-child therapy for reasons based in your OWN mental health and in

your experience within the relationship with your child. For example, some parents get

interested in this approach after noticing feeling less bonded with baby than they’d like to, or

feeling overwhelmed and irritated (or even full of rage) most of the time with baby. Some

parents have experienced trauma, and are noticing an increase in trauma-related symptoms

following the birth (maybe even related to the birth) that come in the way of being with their child

in the ways they wish. Some parents are experiencing perinatal or postpartum mental health

symptoms and want to get back to the mental health “baseline” they had before delivering. And

some parents notice a sudden influx of painful memories coming up about their own childhoods

after giving birth. With any of these reasons (and infinitely more), these parents are acting on

the understanding that their own mental health is deeply connected to the mental health of their

child, and often seek parent-child therapy in order to protect both, be curious about both, and

over time learn sustainable and joyful ways to relate to one another.

Another foundational concept that follows from the one above is the idea that infants and

children under 5 are different than adults in expressing what we might call mental health

symptoms. Where you may be used to hearing adults describe feelings–worries, fears,

obsessions, patterns in their thoughts–when asked about their own mental health symptoms,

infants and young children generally don’t have this same capacity. So how do providers (and

parents!) get a clue about the mental health experiences of young children? There are many

clues, and trial and error may be a big part of the process, but a key guidepost in noticing these

clues is the idea that behavior has meaning. This is true for adults as well as children, of

course, but within the practice of IECMH we understand children’s behavior as being one way

they express the state of their mental health, and the emotional needs which shape that health.

I’m using the term ‘behavior’ here in a neutral sense–not, as in some other contexts, referring to

some negative concept of ‘bad behavior’ specifically. In fact, understanding that our children’s

behavior has meaning helps us view individual behaviors not as good or bad per se, but as

neutral, informative expressions of some deeper emotional need. For example, the behavior of

happily playing with peers may indicate social needs and play needs are being pursued and met

at that moment. The behavior of whining or crying at you to play with them as you’re trying to

make dinner may indicate a need for more connection. The behavior of angrily refusing to get in

the car seat may indicate a level of anxiety or fear about going to daycare. These are pretend

scenarios, but in each you can see that none of these behaviors are by nature ‘good’ or ‘bad,’

though some may be much more frustrating for parents than others. But in each example, we

are able to think like detectives, using context clues and our best guesses to reverse-engineer a

theory about the emotional need underneath the behavioral manifestation. Of course, there’s no

exact script for responding to these needs, either–most parents might not drop everything to

spend some quality connection time with their child and let dinner burn on the stove. But if we

can respond in some way to the need that may be there, rather than the behavior itself, that

might mean that we make 30 minutes later that evening specifically to play or cuddle, and

maybe we start doing that several nights in the week. When we respond to these needs, we

impact the mental and emotional health of our children in ways much deeper than responding

only to whatever behavior is present on the surface. Many times, parents seek the support of

therapy in figuring out what the needs even ARE! As IECMH therapists, we’re often reflective

partners for parents in their journey as emotional detectives within all that their children say and

do. One of the most rewarding parts of my job is to watch parents over time grow more

confident and sure in their own expertise with what their child may be communicating through

behavior–including the strength of letting themselves guess-and-check in wondering about and

responding to their child’s emotional needs ��

A final concept that I return to time and time again in my practice is the idea of good-enough

parenting. This is a phrase coined by the renowned Circle of Security parenting program, which

has some helpful (read: free) Youtube videos about this idea and others that I encourage you all

to check out. Good-enough parenting is summed up in the name–the idea that no parent is

perfect, and that good enough is truly good enough. The idea is based on research surrounding

the nature of the parent-child relationship, often referred to as an attachment relationship,

suggesting that when parents are able to notice and respond to their childrens’ emotional needs

just 30% of the time, this is enough to support the development of what we call a secure

attachment relationship between parent and child. Notice that this number is 30%--not the more

lofty 100% that many parents find themselves unconsciously aiming for, or perhaps feeling

guilty when they do not hit this mark. However, though we can remind ourselves of these

statistics, it’s a lot more difficult to internalize and really FEEL the idea that good enough is good

enough. Many parents experience this. With compassion, my response is: kids probably actually

benefit MORE from you being just “good enough” than they ever would from you being perfect.

Being human, making mistakes in parenting–and being aware of that–allows your child to

actually learn from each and every ‘mistake’ you make, every moment that didn’t go to plan. If

we can model our mistakes just as much as our times of genius–to really look back and say

“Wow, Mom got a little frustrated there and snapped at you, I’m sorry!” or “I forgot to pack a

snack and now I can see you’re really hungry at the park, my mistake,”–these moments show

immense skill and sensitivity that our children learn from, just as equally as they learn from the

moments where we parent to the T. Feeling out the idea of good-enough parenting can be a

practice, a skill that we flex and grow over time, and this is often part of my work with parents as

well.

I’m very glad to share a few ideas I’ve found important in my work with you all. Please get in

touch at ariana@thefamilydevelopmentcenter.com with questions, comments, or anything you’d

like to talk through–or if you’re curious to get involved with IECMH work with you and your infant and child.