Info for Professionals
What is OXPIP?
The Oxford Parent-Infant Project provides a service for parents and their babies, offering confidential weekly therapy sessions where parents can be supported in their worries and where parents and babies can be helped to develop a more secure and loving relationship. OXPIP is a registered charity, founded in 1998. OXPIP employs 8 Clinicians, a Clinical Director and an Executive Director on a part-time basis, and one Office Manager on a full-time basis. There are eight trustees working as volunteers.
What is the theoretical basis for OXPIP’s work?
Attachment Theory
OXPIP approaches its work with parents and babies on the basis of attachment theory as developed by John Bowlby, Jeremy Holmes, Peter Fonagy and others. Clinicians encourage parents to observe their babies closely; by noticing babies’ behaviour and feelings, parents can think about their meaning and then understand the baby’s needs. A baby who is understood and whose needs are met will be securely attached to its parents/caregivers and will have a basic unconscious expectation that its feelings will be regulated and that its attachment figure will restore its well-being. An insecure child or adult will not feel this.
“Regulation” starts with the adult caregiver paying attention to all the baby’s physical needs, for example, body temperature and so on by touch and feeding and body warmth. The baby cannot regulate these for himself. It expands into the management of the baby’s distress or discomfort by the caregiver – soothing the crying baby, leading the baby towards calm by taking down voice levels or rocking. It also involves responding and engaging the baby when he is restless or listless.
These then behaviours expand into a further level of regulation as the parents help the toddler to manage negative states of anger and disappointment by helping the toddler to bear them for increasing periods of time, to think about feelings or by teaching distraction techniques. If these processes are not well managed, the growing child will not be equipped to learn how to manage himself and his own emotional and physiological states. He may also have problems at school such as difficulty in concentrating and learning because he is likely to have more difficulty in controlling his attention and holding back impulses.
If a parent has a history of not being well responded to and well regulated herself as a baby/child, it will be much more difficult for her to respond to her baby and regulate him or her. As parent-infant psychotherapist Roy Muir put it “when people think parenting comes naturally, they are correct… but it comes naturally the way you learned it, it doesn’t necessarily come naturally to do it differently.”
Brain Research
The latest scientific research confirms the unique importance of infancy and of the importance of intervening in infancy if things go wrong. The baby’s central nervous system can be easily disturbed during pregnancy and birth, not only by inadequate diet or drug abuse, but also by insensitive care. Difficulties in early relationships can make the baby hyper-reactive to stress in later life and can undermine the development of good emotional regulation and control.
Any form of prolonged anxiety or fear in infancy and toddler-hood (caused by, for example, prolonged separation or violence in the family) affects the stress response. The hypothalamus and the amygdala are the parts of the brain most involved in the stress response and they trigger off a complicated biochemical reaction which ends in the production of the stress hormone, cortisol. When stress is chronic, the body produces harmful amounts of cortisol. There is evidence to suggest that the stress response in infants can be put right by a lot of physical holding and soothing.
The pre-frontal cortex is the part of the brain (essentially the social brain), which manages emotions. The pre-frontal cortex develops almost entirely post-natal and its development is strongly influenced by experiences with important adults in infancy and toddler hood. Positive relationships help this social part of the brain to grow, by triggering a process that takes beta-endorphin and dopamine into the pre-frontal cortex, enhancing the uptake of glucose, helping new tissue to grow. Different neural pathways are created by positive and negative emotional experiences. Once the neural track through the brain cells is established it is much easier to follow it than to forge a new one.
Emotional health and “emotional intelligence” depend very heavily on these parts of the central nervous system. Their development isn’t automatic but rather depends largely on experience with other people, particularly the first caregivers.
Early intervention is crucial for the well-being of the baby, the family and for society. Current research, which has followed infants from birth, has shown that babies who have an insecure relationship with their parent have an 80% chance of becoming disruptive at primary school, in adolescence and into adulthood (Sroufe).
What happens during a clinical appointment?
The OXPIP clinicians work as flexibly as they can. Although clinical practice is based largely on psychodynamic principles, clinicians use a variety of approaches depending on the needs of the client. Parents can be seen either before or after the baby has been born.
Mothers who come to OXPIP when they are pregnant may be afraid of the pregnancy itself, or of childbirth. A previous miscarriage or a cot death may persuade them that they will not be able to produce a live baby. Identifying these anxieties will help to reduce them and enable the mother to look forward to the birth of her child.
Most often the parent or parents are seen with their baby, but sometimes a parent is seen on his or her own, so that painful problems parents may have experienced in their own childhood, which are affecting the way they parent their own children, may be explored. Through support in facing these “Ghosts in the Nursery”, the parent can separate her childhood in the past from her mothering of her baby in the present.
A parent may bring a baby who has problems with sleeping, eating or excessive crying. A baby may be apathetic, or failing to thrive. A mother may be depressed and ignoring her baby. A mother may be critical of her baby and worried about violent feelings towards it. OXPIP clinicians observe the parent and baby together and help them build on the strengths in their relationship. This one-to-one observation is the foundation of the therapeutic process. The clinicians may video a session with parent and baby and then use the video for a feedback with the parent to increase understanding of what is going on in the relationship between them.
The clinician may encourage mothers to use massage or teach them how to conduct a “Baby Dance”.
OXPIP also offers mothers and their babies the opportunity to join a parent-infant baby massage therapeutic group. However difficult the problems seem, OXPIP clinicians are time and again elated and encouraged by the quite obvious growth of love and delight between parents and baby.
How does OXPIP work?
The Clinical Coordinator will assign a client to a clinician. Clinical appointments are held at the Healthy Living Centre - Oxford, Rosehill-Littlemore Children’s Centre, Blackbird Leys Children’s Centre, Sunshine Centre – Banbury, Didcot Health Centre, Witney Health Centre and Kidlington Health Centre. Sessions with a clinician will last 50 minutes. Sometimes one or two sessions are enough; sometimes, extended work with parent and baby is needed and support can extend over six months or more if necessary, but finishes when the child reaches the age of two.
How is the work of OXPIP funded?
OXPIP is a registered charity and relies on payment or contributions from the families it serves, the generosity of charitable foundations, corporate donors and private benefactors to continue its work. OXPIP is constantly developing networks with voluntary agencies and schools in order to give information about its work to as many agencies as possible.
OXPIP, in common with the Child Psychotherapy Trust and the Association for Infant Mental Health, wants to develop a widespread understanding of the importance of the early months and years of life for the development of mental health. OXPIP would like political parties, at local and national level, to support its work. OXPIP intends to persuade political parties that early intervention is hugely cost effective.
OXPIP needs to work within professional partnerships with existing organisations, and to this end has engaged in discussions with local Primary Care Trusts and Social Services departments. In order to grow, OXPIP needs support. If you have contacts in any of the areas mentioned, would you be willing to give a name, organise an introduction or facilitate in some other creative way?
Suggested Reading
P Cooper and L Murray, “Postnatal Depression”, BMJ, 1998, 316
M F Erickson, L A Sroufe and b Egeland, “The Relationship between quality of attachment and behaviour problems in preschool in a high-risk sample”, Monographs of the Society of Research in Child Development, ed I Bretherton and E Waters, 50, (1-2), pp 147-166
P Fonagy, “Prevention: the appropriate target of infant psychotherapy”, Infant Mental Health Journal, 1997
S S Rode, P Chang, R O Finch and L A Sroufe, “Attachment patterns of infants separated at birth”, Developmental Psychology, 1981, 17, pp 188-191
L A Sroufe, “Infant-caregiver attachment and patterns of adaptation in preschool: the roots of maladaptation and competence”, Minnesota symposium in child psychology, 1983, ed M Perlmutter, vol 16, Hillsdale, NJ, Erlbaum
B Vaughan, B Egeland, E Waters, L A Sroufe, “Individual differences in infant-mother attachment at 12 and 18 months: Stability and change in families under stress”, 1979, Child Development, 50, 971 – 975.
S Gerhardt “Why Love Matters” published by Routledge ISBN1-58391-816-7