In 1985 the Australian and New Zealand Journal of Family Therapy published a paper called ‘Therapy of the Expectant Family: The Foetus as a Force to be Reckoned With’ by John Condon where he argued for the importance of work with families expecting a baby. Now, 28 years later, the most recent edition of this journal includes a qualitative study ‘exploring infant-family mental health experts’ perspectives and experiences regarding the inclusion of infants in the family therapy setting.’ While there have been other publications in this time the importance and inclusion of the youngest family members has been of limited interest.
What Were They Exploring?
The authors note that infant development is socio-relational and unfolds in the dyadic attachment relationships and the broader socio-relational world of the family. Why, they asked, do family therapy interventions rarely include the infant when working with families at this life stage?
How was the Study Conducted?
Information was collected from researchers and clinicians with at least 5 years’ experience working in this domain who were active in the field. A qualitative approach using individual semi-structured interviews which allowed participants to expand on areas they deemed important, sought their perspective on the inclusion of infants in mainstream family therapy settings.
What Did They Say?
The participants expressed concern at the widespread exclusion of infants, believing that ‘there was a merited, natural position for the infant within a range of family therapies.’ They supported an expansion of collaboration between infant mental health professionals and family therapists and recognised that both approaches believe children are best served when the full socio-relational world is included, and intervention aims to address relational issues.
Constraints to Collaboration
The authors identify a negative feedback loop that perpetuates the lack of integration of infant mental health approaches into mainstream family therapy. This comprises graduate and professional training issues, theoretical differences, clinical practices, research biases and sociocultural barriers which are mutually reinforcing.
What is to Be Done?
Integration requires change in each of these domains. One recommendation in the clinical arena, is that practitioners work together in co-therapy providing a richer experience for families and bi-directional training for each professional. The experience would equip family therapists to recognise and work with the communication and spontaneity of infants while infant mental health practitioners may benefit from the skills of family therapists. This informal training should be supported by education processes that adopt a developmental and life-course approach where the inclusion of infants is assumed, rather than an exception.
In Conclusion
This research draws attention to an area of family therapy practice which has been consistently neglected. A preference for narrative frameworks and techniques and reliance on words has meant that the rich non-verbal communication of infants which is the basis for the formation of the earliest relationships has been ignored. Non-verbal communication remains vital to all relationships throughout the lifespan with affective communication the foundation on which verbal language is built. As any good family therapist can tell you we need to look at what is happening between family members, not just listen to the words. Its amazing what we can see.
Opie, J.E., Booth, A.T., Rossen, L., Fivaz-Depeursinge, E., Duschinsky, R., Newman, L. et al. (2023) Initiating the dialogue between infant mental health and family therapy: a qualitative inquiry and recommendations. Australian and New Zealand Journal of Family Therapy, 44, 412–439. Available from: https://doi.org/10.1002/anzf.1569