The Oxford Parent Infant Project (OXPIP) has been providing counselling and therapy for vulnerable parents and their babies since 1998. Founded by inspirational writer and therapist Sue Gerhardt (Why Love Matters), the project has become a key part of mainstream preventative child mental health services in Oxfordshire.
But while its own future is secure for the moment, there is controversy over the council’s proposals to close most of the county’s network of children’s centres, where OXPIP’s therapists are often found doing their work.
On 26 February, speakers at OXPIP’s sell-out annual conference, Things Fall Apart, discussed the delicate processes involved in engaging vulnerable mothers in therapy with their infants, but also the wider politics of what is happening to our frontline mental health and childcare services. The care of young babies evokes powerful feelings in everyone, the neglect or withdrawal of care even more so, and the packed conference venue was awash with a potent mixture of emotions for most of the day.
Many of these babies are at serious emotional and physical risk and therapists must work closely with social workers and others in the multi-disciplinary network. Parent infant therapist Joanna Chapman’s presentation focused on how vulnerable young mothers with their own difficult parenting histories can be suspicious of a regular contract of therapeutic work, making life tricky for the therapist who can see patterns repeating in the mothering relationship. Attendance becomes erratic, but experienced workers know the importance of ‘sticking with it’.
She described watching a mother say how close was the bond with her baby, while holding him upside down, as though to drop him on his head. A memory flashed through her mind of a film in which a climber decides to cut the rope holding his partner who is dangling over a precipice. Joanna reflected on the way this represented how ‘cut off’ the mother was from her feelings about the baby, and how she herself could not bear to be emotionally linked to her in that moment. Perhaps the mother was also attacking the helpful link to her therapist. When ‘things fall apart’ between baby and mother, the therapist needs all her own inner resources to understand what is happening and keep working to help them link again.
To remind us how exquisitely attuned young babies are to their caregivers, she showed us a short film showing the famous ‘still face’ experiment. A mother briefly presents a blank face to her own baby, rather than her familiar emotionally responsive one, and we watch the infant’s distressed, confused and frightened reaction. A securely attached infant recovers quickly once mother resumes her usual way of relating. But many of the audience were close to tears while watching this brief, agonisng breakdown in ordinary maternal care. Joanna’s presentation was a powerful reminder of the vital importance of services offering skilled intervention in the early phases of life.
Professional lead and consultant perinatal psychotherapist Amanda Jones’s talk in the afternoon extended these themes, closely tracking her therapeutic work with a mother whose internal ‘care system’ had broken down, leading to a painfully ill-attuned relationship with her tiny baby. I think we were all on the edge of our seats, wondering what the outcome would be. In this case it proved possible for baby and mother to stay together, but Amanda also spoke of the cases in which the decision went the other way. Sometimes, in the child’s long-term interests, it is right to separate baby and parents, but the decision is always agonising.
In between these two talks, I spoke of a different sense in which things are ‘falling apart’. ‘Austerity’ is a polite term for political decisions to make poor and disadvantaged citizens, including children, pay for the economic problems of the past decade. Cuts to NHS and social care services, allied to intense scrutiny of their performance and ‘quality’, means everyone is afraid for their professional futures. The work itself makes us anxious because we are caring for vulnerable people. But when we are also anxious for ourselves, and our managers are fighting to show they are providing ‘value for money’, it becomes hard to focus steadily on the primary task – being emotionally available to others who need understanding, help to resolve their traumas and losses, and support to do their own job of caring.
I told stories of creative and dedicated professionals ‘holding it together’ in the service of others, pushing back at the constraining forces we live with. OXPIP is a wonderful example in its own right. In the day’s final discussion, someone said, ‘I profoundly believe that children are the most important resource any society has.’ Defending and protecting children, and the people and organisations who protect and heal the relationships they depend upon, are ideals worth fighting for. This conference showed us the truth of these sentiments.
Andrew Cooper is professor of social work at the Tavistock Centre,and director of the Centre for Social Work Practice
