“As we are nurtured, so we are enabled to nurture.” Jeree Pawl (1995)
The ﬁrst home visit to a new family was always the hardest. Like the sting of a hot tub before your body adjusts to the heat, I would be left shell-shocked those ﬁrst few days. I would lie awake at night thinking of the baby, the mother, wondering where we should begin, hearing their cries echoing through the silence of my own baby’s slumber. Maybe it was my newness to the ﬁeld, maybe it was my newness to motherhood, maybe – it was both. This was, after all, only my ﬁrst year as an IMH therapist and barely my second as a mother. It was my MSW internship; my son was 14 months at the beginning and 22 months at the end. I was taking four classes each semester in addition to my internship and motherhood. I was writing papers in bed while my husband slept. I was balancing, oh so precariously, the weight of my role as parent and my role as clinician.
What do those of us who are parents make of the often difficult work of holding our own children while also holding our clients? How do we cope? During my ﬁrst year of attempting to hold so many, my coping mechanisms improved immensely. In the ﬁrst half of my internship, my husband and baby became my release. I took my frustrations with my clients out on my husband. I criticized his (actually quite good) parenting because it was not perfect, and if I couldn’t ﬁx all of the “problems” in my clients’ parenting, then at least I could ﬁx all of his. I would smother my baby in the love and attention that I wished my clients could give their own babies. I would spend every minute of my time with my son striving to implement my readings about attachment parenting, the importance of play, social-emotional development, and holistic health. If I couldn’t give these gifts to my clients’ children, at least I could give them to my own son. But these coping mechanisms made for an emotionally exhausted mother, a frustrated husband, and a smothered baby. Time to revise.
During the last portion of my internship, I became more cognizant and intentional about my coping strategies. I understood how the concepts of displacement and countertransference had inﬁltrated my life. And this simple awareness was almost enough. Instead of watching my baby sleep after ﬁnishing a paper at 3 a.m. and feeling guilty for our beautiful life, I kissed him goodnight and went to bed. I held my son and my clients differently, separately. This is not to say though, that these holding chambers didn’t sometimes leach into each other. When a baby runs to me open armed on a home visit, throwing himself into my lap just like my own son does… when he bounces in my lap with that same 25 pounds of excitement as my own son… when I feel that very familiar weight, it is sometimes hard to remember that this weight belongs to someone else, this weight may be carried and held, but differently, separately.
So, does being a parent improve our capacity to provide infant mental health services? Does our role as therapist improve our parenting? The easy answer is “yes.” But of course there are many superb therapists who are not parents, or who are caregivers in other capacities. And of course, simply being both a parent and a therapist does not quite get to the heart of the matter – the heavy, heavy heart of the matter. This work is far from easy. We may feel weighed down by our clients’ struggles. We may feel weighed down by our daily separation from our children. This weight can make us better clinicians and better parents. Or, it can become so burdensome that both roles suffer.
Unlike other professions, our roles as parent and clinician are inextricably linked. In other careers, we could be walking into disparate environments every day; we could be surrounded by computers, or racks of clothing, or other advantageous distractions. But, we are not. We are going from our own homes into someone else’s. We are surrounded by parents and babies and toys and that same teether we just saw in our own baby’s hand. We are surrounded by their laughter and cries and tiny hands waving goodbye. We are reminded every minute of our own babies, our own goodbyes.
So, how do we cope? How do we balance those very similar weights, those very familiar cries? According to Seligman, we develop an analytic attitude of self-reﬂection. Fortunately, the process of Reﬂective Supervision affords us the perfect opportunity to engage in this essential reﬂection. Reactions to our clients are unavoidable, especially in the uniquely personal venue of parent-infant therapy. But, “whether these responses become exhausting obstacles or sources of insight and vitality will depend on how we handle our reactive thoughts and feelings” (Seligman, 1993).
We infant mental health therapists are good balancers. We are accustomed to balancing the needs of the mother with the needs of the baby. We are adept at focusing on both mother and baby simultaneously. And just as we must be careful to not over-identify with the parent or the baby (to the detriment of the other), we must also be careful balancers of our own holding chambers.
Unfortunately, this balancing act is rarely discussed; throughout my graduate work, very little emphasis was placed on the concept of therapist self-care. Perhaps it is assumed that we, as therapists, understand the importance of developing effective coping strategies. Or perhaps, we are simply expected to have tougher skin than most. Whatever the reason, it appears both in research and in practice, that we don’t like to admit that our skin might not be as tough as it seems, that we might not be immune to the stress of this work, that our roles as parent and clinician might raise a unique and distinct set of challenges.
We seem to understand the signiﬁcance of the concept of transference. We understand if a client greets us with hostility and suspicion, that it is most likely a very appropriate mode of self-protection based on her past experiences with helping professionals. We understand how easily a client’s feelings about others can impact her relationship with us. But we do not as willingly understand or accept how our personal lives can impact our feelings toward our clients, and how our clients’ situations can impact our personal lives. We do not like to admit that we may experience counter-transference and displacement. But it is exactly this admission and reﬂection that will allow us to move beyond it.
So, what is counter-transference and displacement? In the most general terms, countertransference is the concept of a therapist’s personal life or history impacting her work with a client. We all bring with us our unique backgrounds, and those backgrounds are bound to evoke certain emotions in us as we work with our clients. Similarly, a therapist experiencing displacement might shift her feelings about her client to a more immediate substitute like her family.
The process of Reﬂective Supervision should provide the clinician with the space to discuss her experience of counter-transference and displacement. In this space, she is free to discuss the intersection of her roles as parent and therapist, and her ability to balance the weights of both worlds. “As the person at the greatest remove from the storm of affect that so often surrounds the treatment of traumatized young children and their parents, the supervisor is the one with the primary responsibility to ensure that there is room for everyone to be held in mind” (Lieberman & Van Horn, 2008).
Just as our clients’ pasts and presents intermingle subconsciously, so do our professional and personal lives – especially when those lives contain such similar elements. To separate them entirely seems impossible. To never think of our clients at home or our families at work would be an impractical and unhealthy endeavor. To allow them to coexist without impeding each other’s progress – this is a more attainable and realistic goal. The weight of our clients’ children will always remind us of our own – their weight in our laps, their hugs goodbye, their smiles, their cries. This weight will not go away. We will carry the weight of these babies home with us as we open our arms to our own children. But we hold them differently; we place them in separate spaces. We remain present in the present. We lean on each other and reﬂect honestly. We balance the weight of both worlds. We hold our own babies in our arms and remember that we are doing the best we can. We hold our clients and remember the same. And we hope beyond hope that they – the parents and babies we serve – can eventually do the same.
Lieberman A., & Van Horn P. (2008). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York, NY: The Guilford Press.
Seligman, S. (1993). Why how you feel matters: Counter-transference reactions in intervention relationships. WAIMH News, 1(2), 1-6.
Reprinted from The Infant Crier, Fall 2010, No 127, Michigan Association for Infant Mental Health