The CDIAP (Centres for Development and Early Care) are services contracted with the Generalitat de Catalunya that offer therapeutic care to children between 0 and 6 years old, as well as support for their families and coordination with the educational and health services of each territory.
Early care focuses on the biopsychosocial dimensions of neurodevelopment, the quality of the care relationship and the bonds that are formed between the child, the family and the professional.
The mission of CDIAP Aspace Catalunya is aimed at:
- Promote Integral Development: through therapeutic programs that cover motor, psychological, cognitive, emotional and social aspects of children.
The diagnosis and specific therapeutic approach for each child and their family will be determined by the psychologist, physiotherapist, speech therapist, neuropediatrician and social worker, which will be scheduled with a variable frequency of sessions depending on the case.
- Support for Families: offering guidance and advice to help them understand and address the needs of their children.
- Networking: collaborating with other educational, social and health services to guarantee coherent and comprehensive care.
Our experience in the field of early care and the work we do with families and their children with difficulties, lead us to reflect on the difficulty of this task. A task that involves coming into contact with and taking care of children and families in a situation of uncertainty, and physical and/or psychological suffering.
The emotional experience lived in contact with others is part of the most basic of any relationship. Therapists use structured techniques to delve into mental and emotional processes and produce changes in thoughts, emotions or behaviors.
These emotional and conceptual aspects are essential in the care relationship. The ability to conceptualize this experience requires good training and the ability to deal with the feelings, anxieties and emotional experiences of all kinds that come into play throughout the treatments.
Therapeutic intervention involves approaching a broad relational system (child–family–environment–service). The child and family arrive with stories of bonds, complex dynamics and relational deficiencies. The professional acts as a relational mediator: as a figure of containment, reunion, facilitator of bonds and repair of early experiences.
One of the key points in the sessions is the sensitivity of the professional, that is, the ability to capture the child's signals and respond to them in a contingent and emotional way. This sensitivity creates an environment of internal security that allows the activation of development and exploration. When this functioning is consolidated in therapy and expanded to the relational circles of the environment, the child can deploy all his resources.
Early intervention offers the opportunity to generate moments of relational repair. When the family has difficulty responding to the needs of their child, who presents significant developmental alterations, the professional can act as an 'object' that sustains the relationship and allows the construction of an internal bond that lasts at home.
It is also essential to recognize that in the field of early care, the care relationship mobilizes transferential elements in the child and also in family referents that can be traced back to the relational model they had in their own childhood and that configure their own vision and model of relationships.
Understanding the family group
If we understand the family as a primary group, that is, that its members are linked by intimate and emotional ties, we cannot help but think that the family model is the appropriate one in terms of treatment in an early care service. The family is a living and unique structure, which participates in and shapes the mental apparatus of each of its members, especially in what refers to children. There is not a single psyche, but a group psyche, and it is not a rational group, but rather the relationships are of a group and unconscious nature.
A family therapeutic approach not only helps to resolve the symptom, but also contributes to strengthening all interpersonal bonds, to differentiate them more between them (especially between mothers/fathers and children) and to promote the group playful elements that will facilitate the evolutionary growth of all. In addition, it also helps to develop mental space in the family, to be able to better tolerate the frustrations and anxieties that this evolutionary process awakens, both individually for each member and as a group.
This is an approach that affects each person's internal world and intergroup relationships, containing the anxieties that arise and giving the group time to rebuild its bonds.
That is why, from the CDIAP ASAPCE, we will describe in this article some intrapsychic and interpersonal phenomena, which we consider important as a theoretical-technical basis for our healthcare work.
Beyond behavior: Internal reality
As we have pointed out previously, the child cannot be understood without his referents. As soon as we are born we make our debut as participants in the relational world. The mother (understood as the main caregiver), who has a privileged role for M. Klein , Winnicott or W. Bion , relates to the baby through the breast and food. A food that is not based only on what nourishes the baby, but a food full of affection, looks, expectations.
From a psychodynamic point of view, M. Klein points out that to understand the baby we must refer to the traumatic experience of childbirth, where the child is born with the first anxieties. Childbirth represents the passage from a state of symbiotic union (inside the womb) to another in which it is separated and exposed to the outside world.
M.Klein describes that even babies have an active mental life, which allows them to feel anxiety and create bonds with others (object relations), in particular with the mother (referent figure).
These feelings are greatly relieved when receiving food. These first experiences of sucking initiate the relationship with the mother. The baby's relationships with its first object, the mother, and with food, are very closely linked from the very beginning. The child, therefore, lives with the relationship. And therefore, it is built on the basis of relational experiences and is internally equipped.
The interaction that will emerge from the external attachment figures and the experiences that the baby has with them, will be what will constitute the internal objects. These internal objects collect the experience and perception that we have of external objects. Therefore, we form an internal reality, which we build on a psychobiological basis from the experiences of relationships with others.
Thus, according to Coderch , object relations will be the fundamental driving force of psychic life and the matrix of all the individual's behaviors and relationships with himself and with the people who surround him throughout his life.
It will be our internal reality, the representations we have created, which largely explains our behavior.
It is important to keep in mind the concept of internal reality in order to attend to and listen to what comes to us from children and their families, since we work with the real and the latent.
Abelló and M. Pérez Sánchez , based on the Infant Observation Technique of E. Bick , already point out that the birth of thought takes place in a primitive state of Interplay between father, mother and baby, which will be what we will call Original Unity . It is, in this state, that the baby has the capacity for perception and object relations, and grants the parents the capacity for containment . Here the basis will be created on which the fantasies of a good parental relationship are established. (Understanding by Original Unity all types of family modality).
The matrix of growth is the original unit, and we must be able to respect and understand parental figures. It will be capital, the idea that it is in the family itself where we must find the resources.
Within the Original Unity, processes of introjection and projection occur between the child and the parents, and this will be what will build the object relationships of this child.
The baby immediately finds himself fluctuating between good and bad, between love and hate, between internal and external situations, between expectations and reality... and through these interactions he will build an internal reality. At the same time, the baby will be able to transfer his emotions from one object to another.
And in the care task, the therapist must be able to recognize what the people being cared for make him feel. To be able to understand it as the expression of the patient's internal world projected onto him (the therapist) to be felt. And to differentiate it from his own internal reality.
In this sense, we would equate the maternal function with the therapeutic function. The baby cries in anguish and this worries Winnicott 's good enough mother who, with her capacity for reverie , will do her best to welcome him, calm him and give meaning to his fear.
Therapists have the task of trying to tolerate, internalize and return the anxieties or fears that families bring to the sessions, in a way that allows them to understand them better, with more elaboration and less anxiety.
At CDIAP Aspace Catalunya we understand the importance of containment , which derives from projective identification and which the child uses to communicate an emotional state to the parents so that they can take charge of it , support it, give it meaning and which is central to the care work. The therapist must be able to contain the anxieties and defenses of the people they consult, recognizing them as a relational quality of the other, to enable growth.
In recent years we can see how the complexity of our care has increased. A current pathology where emptiness and discharge predominate, a decrease in the availability of reference figures, the lack of game offers, the abusive use of screens... are interfering with a development that needs much more time, containment and resources to build.
Factors such as immigration, new types of families and changes in parenting have their weight when it comes to seeing how our care activity has changed. We often work with families that accumulate risk factors (different cultures with multiple cultural codes, social and economic precariousness, grieving processes, lack of intimacy, undifferentiated family spaces, etc.). All of these are factors of change that constitute new challenges in our care reality. In many cases it is necessary to combine more psychotherapeutic work with social action.
Coordination with the different professionals who care for the child is one of the essential axes of early care, as it allows for care coherence and promotes adherence to treatment in cases of families with social problems. Coordination work with the area of health, education and social services has become an important task of awareness, prevention and detection.
Conclusion
In conclusion, we would like to point out that the intervention, in order to become therapeutic, has as its core instrument the interpersonal interrelation. And as we have previously commented, one of the most important tasks of work focused on people is the capacity to contain/support the other.
Containment is understood as the professional's ability to welcome, sustain and give meaning to the emotions and anxieties expressed by the child and their family, especially those that may appear confusing or overwhelming.
This function will allow the emotional experience to be transformed into something more thinkable and "digestible", offering a safe and elaborative space that promotes the child's emotional development and the trust of their referents.
Therefore, in the assistance technique we consider it very important:
- the empathic capacity that allows the therapist to perceive and receive the family's projections
- the listening attitude of conscious and unconscious communication
- reflective thinking and mentalization
- the benevolent attitude that represents respect for the feelings and thoughts of others,
- the attitude of hope towards the capabilities of the other, despite the difficulties that may exist.
The therapeutic bond at the CDIAP is not only an instrument to achieve clinical goals, but is also an objective in itself: a place of care, support, recognition and respect for the other.
Brands
Marta Ruiz- Psychologist CDIAP
Margalida Socias – Psychologist CDIAP
Sonia de Abril - Psychologist and CDIAP coordinator
Bibliographic references:
Winnicott, DW (1965). *The maturational processes and the facilitating environment: Studies in the theory of emotional development.* London: Hogarth Press.
Winnicott, DW (1960). The theory of the parent-child relationship. *International Journal of Psycho-Analysis, 41*, 585–595.
Klein, M. (1932). *The psycho-analysis of children.* London: Hogarth Press.
Klein, M. (1946). Notes on some schizoid mechanisms. *International Journal of Psycho-Analysis, 27*, 99–110.
Bion, WR (1962). *Learning from experience.* London: Heinemann.
Stern, DN (1985). *The interpersonal world of the infant: A view from psychoanalysis and developmental psychology.* New York, NY: Basic Books.
Stern, DN (1995). *The motherhood constellation: A unified view of parent-infant psychotherapy.* New York, NY: Basic Books.
Anzieu, D. (1985). *Le Moi-peau.* Paris: Dunod.
