infant - parent psychotherapist marie clarke in conversation with emily suggett

Marie Clake with Emily Suggett

Emily: Marie would you like to begin by introducing yourself?

Marie: My name is Marie Clarke, and I am a Child Psychotherapist, I work part time as an Infant Parent Psychotherapist, and I also have a private practice working with children, adolescents, and adults.

Emily: What was your previous professional background and what brought you to training as a child psychotherapist?

Marie: I was a nurse for a long time, and I worked in various settings such as community hospitals, I then moved into management within the health service where I worked with GP practises and hospitals managing commissioning, quality, and clinical governance. Then a big political change came, and the primary care trust changed so I took voluntary redundancy and re-embraced my general nurse qualification. At the same time, I decided to retrain in a different profession, I had engaged in my own counselling and this experience left me wanting to explore a future career in that area. During my time training at Northern Guild, I maintained a job as a general nurse working on secure wards with children and young peoples who were detained under the Mental Health Act. The training was incredibly helpful as I began to understand what had led to a child or young person being removed from society. At the same time, I was doing my own infant observation for the training, and I found that to be the most profound and useful experience. Doing the two alongside one another began to change the way I started to view the patients and their families.

Emily: That leads us nicely to hearing what then lead you to your job as an Infant Parent Psychotherapist?

Engaging in the Infant observation part of the training was so important in understanding more about myself and my own are infantile experiences as well as what happens in a parent infant relationship. The impact of the observations stayed with me so once I was qualified, and I came across an advert for an Infant Parent Psychotherapist who would be working for a new service which was being set up in Newcastle I applied and I was successful.

Emily: What does an infant parent psychotherapist do?

Marie: We are working in a relationship and with preverbal experiences both for the infant and the parent. So, what we're thinking about when doing this work is what was the parents experience of being an infant and being parented and how is that impacting upon the infant parent relationship. The work is about both the infant and the parent and what goes on in between them. This means creating a space for infants and parents to come together and be supported in thinking about what's going on in their relationship and to help them to make sense of it.

Emily: How would you receive a referral?

Marie: Referrals come from health visitors, midwives, the parental mental health team, GP’s, and people can self-refer. Midwives are informed by the 1001 critical days agenda so when a woman becomes pregnant, they are mindful of the stirred feelings, expectations, fears, previous losses or birth traumas.  

Emily: You mentioned earlier about the infant and the parent, who is involved in the work?

Marie: It is mostly the mother that we work with so I will say mother throughout although we work with whoever is caring for the infant and this can often be both parents. The criteria is that the infant must be under the age of 2. It is early intervention at its most honest because we are thinking about the infant and the parent and helping them to find their way together as a preventive measure against future difficulties. One of the things that we will often talk about, and it can be very painful to hear is how our first relationship is the blueprint for all others. It provides us with the sense of who we are and how we are in the world. So, what we do in the work is think about the developing sense of self and how the infant is able to develop their own sense of self without too many projections.

Emily: Are you able to provide an example of what a referral would look like?

Marie: The caseload can be a mixture of ages and backgrounds, quite often educated professionals, and we see both single parents and couples. There is not one type of referral as quite often becoming a mother stirs up infantile experiences which have been defended against for some time and this can happen to anyone. The referral can arrive with concerns such as sleeping, separating, weaning, eating, toileting. Quite often mothers will talk about the bond and how they expected it to be, describing the image of something which is portrayed in a photograph or movie and of course that's not real. There can also be a difficulty with the ambivalent feelings we experience when we become parents and that can be overwhelming, so there's lots of things that we might be looking at.

Emily:  When you become involved what is the sort of work that you would be doing?

Marie: It begins with adult work as we establish a relationship with the mother and the family in order to understand their worries and what their own infantile experience was. We utilise a few assessment tools, such as the mother observation relational scale where the parent scores what they feel about their infant, we might hear things like the infant is manipulative or demanding. We also do a narrative assessment where we ask parents to describe their fears, worries and expectations.  Then we work on the floor because that's where the infant is, we get down to the infant’s level as much as we possibly can, we sit, and we talk, and we reflect, and we play and notice. We wonder what is going on in the communication, what the infant communicating and if the parents notice. We help the parents to wonder about the infant’s communication and what it might be like for their infant. The service I work for is called little minds in mind because what we want to do is help the parents to think about what their infant is experiencing. To help the infant know they are being thought of and held in mind. Often parents will say my infant doesn’t look at me or I think they hate me, so it might be noticing when the infant is looking and sharing we see to support the parents in seeing the infant in a way which is not intrusive or frightening.

Emily: Sounds like you focus a lot on the nonverbal communication which is taking place between and then help that communication to meet somewhere in a way that has not been seen before?

Marie: Yes, to see it without the projections. To see what I might see or what the infant is communicating. For example, when the mother experiences the infant as not sleeping, we will help them consider what it might be like when the infant falls asleep, what it might be like to close your eyes whilst in your mother’s arms and then open your eyes in a different room. We support parents in wondering about the infants’ experiences.

Emily: Has your work as an infant parent psychotherapist changed the way you work in your clinical practice with clients?

Marie: It has definitely changed how I am with my clients, I am braver in my reflections, and work phenomenologically, noticing body language, remaining open and curious to what is not being said whilst also paying attention to my own somatic responses.

Emily: listening to you, it sounds like you have a greater confidence in expressing what you experience and notice in the room, inviting a space to reflect on what is not being verbalised?

Marie: The work that we do is based in psychoanalytic thinking, so the papers that we might refer to or the ideas and concept are around psychoanalysis theory. What I really loved when I started working with the team was their ability to sit with the difficult feelings, I think I previously avoided this as much as I could. I didn’t want to be the bad object or have the difficult feelings or tolerate anger, so I had a low tolerance for staying with something which I deemed as difficult. My ability to stay at depth in these feelings has significantly developed and I feel more confident in being able to name difficult feelings. Previously I couldn’t tolerate the concept that someone might not like their infant and of course now I know that sometimes people don't like their infants and that is quite ordinary, they are demanding, and it is Ok when those thoughts come and go, it is when they stay, we are concerned. The empathy I have for the parents of the children I work with has changed because I now see that no parent wants to have a difficult relationship with their child. I am more thoughtful of what it is must be like for a parent to leave their child with me for 50 minutes knowing they may never know what has happened in that time. Whatever the age I am working with I am always curious about their first two years of life. It is vital when doing any sort of intake that I know what happened during the pregnancy, the birth, and the first few months following the birth. This information is what supports me with the assessment and planning of the work. I wonder with clients about what that time might have been like, often no-one has ever asked or provided a space to allow the held emotions to be expressed. The transformation in a person’s life can be fundamental and I am not sure I fully appreciated this until I paid closer attention to the parent infant relationship and started to attend the relevant trainings and read the associated articles.