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168 ACQ Volume 11, Number 3 2009 ACQuiring knowledge in speech, language and hearing
when he is older. She is learning that she matters to Jonah,
and that she can support him to grow and develop. As
her confidence grows, so does mine. Relationship-based
practice works!
References
Chambers, H., Amos, J., Allison, S., & Roeger, L. (2006).
Parent and child therapy: An attachment-based intervention
for children with challenging problems. Australian and New
Zealand Journal of Family Therapy, 27(2), 68–74.
Cohen, N. J., Muir, E., Lojkasek, M., Muir, R., Parker, C. J.,
Barwick, M., & Brown, M. (1999). Watch, wait and wonder:
Testing the effectiveness of a new approach to mother–infant
psychotherapy. Infant Mental Health Journal , 20 , 429–451.
Geller, E., & Foley, G. M. (2009). Expanding the “ports of
entry” for speech-language pathologists: A relational and
reflective model for clinical practice. American Journal of
Speech-Language Pathology, 18, 4–21.
Mares, S., Newman, L., Warren, B., & Cornish, K. (2005).
Clinical skills in infant mental health. Sydney: ACER Press.
Marvin, R. S., Cooper, G., Hoffman, K., & Powell,
B. (2002). The Circle of Security project: Attachment-
based intervention with caregiver-pre-school child dyads.
Attachment & Human Development , 4, 107-124.
McDonough, S. C. (2005). Interaction guidance: An
approach for difficult-to-engage families. In C. H. Zeanah
(Ed.), Handbook of infant mental health, 2nd ed., 485–498.
New York: Guilford Press.
Weatherston, D. J. (2000). Qualities of the infant mental
health specialist. Zero to Three , 21(2) 3–10.
child (Geller & Foley, 2009). To rush to offer advice or to
demonstrate positive play methods, although superficially
satisfying, is often ineffective and can add additional stress
to an already tense parent–child relationship. Furthermore,
language stimulation techniques that might be suggested
to develop early language skills are applied during play. I
would suggest that if the parent–child relationship is poorly
developed, enjoyable interactions between parent and child
may not be occurring. Therefore, to recommend a parent
target language goals during their time together is likely to
cause frustrations and feelings of inadequacy, risking further
damage to the relationship. Initial therapeutic goals might
instead focus on achieving positive interactions with their
child, for example, following their child’s lead during play. In
order to develop language through positive play, positive play
must first be achieved.
As it turns out, this approach works for Sandra and Jonah.
Over the course of several weeks, we videotape and jointly
review a number of informal play sessions. Videotaping is an
excellent method for supporting parents to reflect on how
their child communicates, and on their role in parent–child
interactions (Marvin, Cooper, Hoffman & Powell, 2002;
McDonough, 2005). Sandra notices that Jonah often uses
gesture to initiate interactions. She also reflects that she is
often quiet because she is not sure if he wants her around.
I highlight moments when Sandra successfully attunes to
Jonah’s affective states. As she feels more empowered
and comfortable, Sandra spends more time in the session
focusing on what she can do to achieve positive interactions
with Jonah. Sometimes I offer specific suggestions about
following his lead during play. At other times, I put the
video-camera down to demonstrate positive play methods
and occasionally even a language stimulation technique. All
the time, I am gathering more data about Jonah’s speech
and language skills, as well as developing Sandra’s ability to
support his development in these areas. Of course, it is not
all smooth-sailing. At times, progress seems painfully slow.
I feel pressured to move the clinical work forward. Holding
Sandra’s strong emotions is emotionally exhausting but
she needs to be helped to co-regulate Jonah. Fortunately,
regular reflective supervision and the opportunity to co-
work with the family’s psychologist provide much needed
emotional support and clinical guidance.
I know we have made significant progress when Sandra
proudly tells me that she is “getting down on the floor”
every day with Jonah at home, and when she begins to
ask for copies of the videotaped footage to give to Jonah
Kristy Collins is the senior speech pathologist at CAMHS Northern
Region in South Australia. She has a keen interest in addressing
emotional and behaviour concerns in early childhood and recently
completed a post graduate Diploma in Infant Mental Health from the
Institute of Psychiatry.
Correspondence to:
Kristy Collins
Senior Speech Pathologist
CAMHS Northern Region
Suite 11, Sidney Chambers
Elizabeth Shopping Centre
50 Elizabeth Way,
Elizabeth, SA 5112
Email:
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