Book review. Clinical skills in Infant Mental Health: The First Three years.

Clinical Skills in Infant Mental Health: The First Three Years, 2nd Edition (2011)

As interest in infancy and early parenthood grows, professionals who work in a variety of ways with very young children and their families are eager for practical information about the relatively new field of infant mental health. It was not so long ago that Selma Fraiberg coined the phrase, “infant mental health” and introduced developmental and clinical practitioners to the early identification and treatment of the parent-child relationship (Fraiberg, 1980). Fraiberg understood that an infant’s capacity for love and learning begins in the first years of life. She also understood that how a parent cares for a very young child has a significant impact on the emotional health of that child. Most importantly, she helped us understand that history is not destiny. Parents have the capacity to change the ways in which they relate to and care for a baby; babies have the capacity to change, too. From Fraiberg’s perspective, it is our shared responsibility as professionals to support parents during pregnancy and in the first years of life to promote healthy social and emotional development and to reduce the risk of relationship disturbances, disorders of infancy, abuse and neglect.

Clinical Skills in Infant Mental Health: The First Three Years, 2^nd Edition, written by Sarah Mares, Louise Newman, and Beulah Warren, Australian clinicians well-known for their work in Sydney, offers a guide to professionals all over the world who with families in effort to reduce the risks that Fraiberg described and to restore emotional health in infancy and early parenthood. The knowledge and skills addressed should be seen as “a treasure that should be returned to babies and their families as a gift from science” (Fraiberg, 1980, p. 3). It is a volume offering theoretical and skill-based information to inform research and practice with children birth to three and their families.

The first chapters introduce the reader to the multi-disciplinary field of infant mental health, with attention to both research and clinical practice during pregnancy and in the first three years. The authors offer a theoretical framework within which infant mental health principles and practices may be considered- psychoanalytic theory, object relations theory, attachment theory, neurobiology and brain research. Of additional interest, there is a succinct overview of infancy, including the exploration and significance of early emotional and psychosocial experiences to development, the identification of disorders of infancy and disruptions to the parent-child relationship, as well as discussion of current models for early intervention. There are also references for further reading and vignettes that illustrate key concepts.

Later chapters introduce a bio-psychosocial and developmental perspective for infant mental health assessments. The approach invites careful consideration of infant, family and contextual factors. Principles to keep in mind include the assessment of both capacity and risk; the understanding that parents want what is best for their babies or toddlers; that a relational approach is essential; and that development is transactional. The invitation to consider effective clinical assessment includes practical guidelines for interviewing families, observing parent-infant interactions, and carrying out developmental assessments of each infant to assure an understanding of the risks and the strengths of those referred for services. The authors include many examples from their clinical experiences with very young children and their families that enrich the reader’s capacity to consider a broad range of things when assessing risks in infancy and early parenthood.

In later chapters, Mares, Newman & Warren discuss problems that are often arise in infancy and result in referral to a professional for assessment, consultation and intervention services. The most problematic include regulatory difficulties (sleeping, feeding, crying), relationship disturbances, and trauma that place development and caregiving at high risk. The authors offer guidance to practitioners to help them determine what therapeutic approaches might increase parental confidence in caregiving and strengthen the quality of the infant-parent relationship.

After focusing on infancy, the authors present developmental changes throughout the second, third and fourth year of life. They examine emotional and behavioral milestones and challenges, offering many examples of emotional processing, the development of symbolic capacities and empathy. Essential tasks of parenting are clearly presented, with attention to the challenging behaviors that toddlers may present and the need for careful developmental and family assessments and supportive interventions.

Careful discussion of special issues appears in the final chapters where the authors address trauma, gender identity, perinatal mental illness, parental substance abuse, and high-risk caregiving environments that threaten the social and emotional health of infants and young children. There are levels of intervention that practitioners can provide to reduce these risks, from prevention to early intervention and long term care. The authors discuss a range of evidence-based practices and conclude with a discussion about training and the preparation of professionals to provide an array of infant mental health services.

In sum, the book is an extraordinary guide for those who want to build infant mental health services into their local or state systems. It is beautifully written and offers vignettes to illustrate theory and clinical practice. Most importantly, the authors offer hopefulness for change through supportive interventions that take into account, the infant, the parent and the early developing relationship.