Papers by Robin Balbernie
Paper 7: Delivering psychological services for children and families in Early Years mental health and emotional wellbeing settings
The Child & Family Clinical Psychology Review
Just Chatting with a Baby Is More than You Might Think
Contemporary Issues in Perinatal Education, Aug 4, 2022
Psychotherapy: a resource for use with people with mental handicaps
Journal of the British Institute of Mental Handicap (APEX), 2009
... They'd be happy if1 got up a petition to have him put away. They all pick on him, an... more ... They'd be happy if1 got up a petition to have him put away. They all pick on him, and all the kids too. They say he's a raving loony. The next door neighbours come round and complain because they can hear him banging on the wall! ...
Psychotherapy with a mentally handicapped boy
Journal of Child Psychotherapy, 1985
Journal of Child Psychotherapy, 2007
The concept of intersubjectivity may be used to illuminate the way in which we observe and descri... more The concept of intersubjectivity may be used to illuminate the way in which we observe and describe many of the interpersonal processes that begin in infancy. The more traditional psychoanalytic ideas of holding and containment, as well as relatively recent concepts such as attunement and reflective function, can be seen as belonging within this coexisting area of experience. Intersubjectivity has contributed to human evolution and has a neurological foundation based on mirror neurons; it provides a perspective on psychotherapy (especially within infant mental health) that can oversee the internal worlds of mutually influencing experience.
An infant in context: Multiple risks, and a relationship
Infant Mental Health Journal, 2002
Cet article a pour but de rapprocher certaines des reflexions actuelles sur l'effet d'exp... more Cet article a pour but de rapprocher certaines des reflexions actuelles sur l'effet d'experiences adverses precoces sur le developpement individuel. Bien que la relation de mode de soin soit intensement personnelle, elle reflete aussi une synthese d'influences biologiques et sociales environnantes. Une combinaison exceptionnelle de caracteristiques individuelles et de circonstances environnantes peut modifier l'equilibre entre la vulnerabilite a venir et la resilience. Ceci affecte le bebe a travers la relation avec le parent. Les facteurs de risque plus particulierement consideres sont poses dans un contexte narratif d'une visite a domicile unique, a la fois pour les incorporer et pour mettre en valeur leur correlation systemique dans un contexte familial.
British Journal of Psychotherapy, 1999
This is a study of a boy entering puberty who developed fantasies of sexually abusing younger chi... more This is a study of a boy entering puberty who developed fantasies of sexually abusing younger children; it looks at a number of issues that lie behind such thoughts and the risk that they might be acted out. A child who has been the victim of inappropriate sexual advances from a parent may develop into an abuser themself later on in life, but this is not inevitable. Other risk factors have to be considered, and all taken in the context of the strong possibility that being exploited by a caregiver has left the child with neither a sense of trust nor an organized internal programme for creating fulfilling relationships (disorganized attachment) in the future. The six risk factors considered are: social isolation, unhelpful ego-defences, distorted identity, lack of empathy, a need to dominate, and precipitating oedipal fantasies into reality. Work with a boy in whom all six risk factors coalesced is described.
British Journal of Psychotherapy, 1994
Winnicott's false self concept provides the starting point for an intrapersonal model of the impa... more Winnicott's false self concept provides the starting point for an intrapersonal model of the impact and long-term effect of abuse. Abuse creates a false self personality system which carries a circumscribed set of behaviours and attitudes directed both at self and others. It is the opposite of the reciprocally enhancing relationship he named holding. The Deceptive Baby Personalities all reflect a history of relationships and events which have become cast and set of an internal drama (McDougal 1986, p. 7): Each secret-theatre self is ... engaged in repeatedly playing roles from the past, using techniques discovered in childhood and reproducing, with uncanny precision, the same tragedies and comedies, with the same outcomes and an identical quota of pain and pleasure. The development of personality is an interactional process, a lottery of object relationships; who we become depends upon what we bump into on the way. Years ago Donald Winnicott, when considering what precedes the first object relationship in awareness, remarked:`There is no such thing as a baby'. By this he was stressing that we always observe a`nursing couple'. He developed the idea by saying (Winnicott 1952, p. 99): ... that before object relationships the state of affairs is this: that the unit is not the individual, the unit is an environment-individual set up. The centre of gravity of the being does not start off in the individual. It is in the total setup. By good-enough child care,technique, holding, and general management the shell becomes gradually taken over and thekernel (which has looked all the time like a human baby to us) can begin to be an individual. An example is how the baby whose parents are pleased with it rapidly becomes a baby pleased with itself. He was underscoring how the psychological health of an infant is assembled from the content of significant relationships. Winnicott insisted that what happens to the baby, rather than the innate and inescapable angst of the Kleinian euhemerism, is the basis of identity. With a good-enough start to life most later setbacks can be survived and integrated. A trauma, on the other hand, is an experience which distorts the personality structure, altering its form and content so that this bit of the past then remains as a consequential influence. The false self is an adjustment made in response to the outer world. It perpetuates an interaction that seemed necessary long after the danger has passed; the person carries a past self in relation to an absent other and unwittingly lets this live in the present.
British Journal of Psychotherapy, 1991
speculate as though it were a question of her most vital problems (my paraphrase). Jane was 14 an... more speculate as though it were a question of her most vital problems (my paraphrase). Jane was 14 and an attractive young woman in spite of a bad rash on her face from
Journal of Child Psychotherapy, 1997
In this paper I examine the importance of the smile as an emotional nexus between infant and moth... more In this paper I examine the importance of the smile as an emotional nexus between infant and mother. A series of observations seems to suggest that the infant is almost immediately able to appreciate when the mother, as a special and separate person, is ready to receive such communication. I consider how a mother's physical and mental embrace may have been altered by the presence of an observer in such a way that the necessary conditions were created for the baby to feel that it was then the right time to use the ability to smile, and so become an active initiator of meaningful interaction.
Poised to connect: How early relationships
26 INTERNATIONAL JOURNAL of BIRTH & PARENT EDUCATION u ISSUE 1 2013 T he accidents of evolution h... more 26 INTERNATIONAL JOURNAL of BIRTH & PARENT EDUCATION u ISSUE 1 2013 T he accidents of evolution have led to a situation that might look odd at first sight – the most intelligent and powerful species on the planet is born more helpless than any other and is dependent on parents for far longer. All these characteristics are connected, and the common thread is the human need for relationships and how these come to create the mind through the experience-expectant and use-dependent structuring of the brain. The mind develops throughout life, both psychologically and in terms of neurophysiological processes, as the genetically programmed construction of the brain continues to respond to significant experiences with other people. ‘Human relationships, and the effect of relationships on relationships, are the building blocks of healthy development. From the moment of our conception to the finality of death, intimate and caring relationships are the fundamental mediators of successful human ...
Circuits and circumstances
Relationship-based interventions in the early years
Early intervention with babies and their parents
Critical Issues in Child and Adolescent Mental Health., 2017
All about… Intergenerational trauma
Nursery World
The importance of secure attachment for infant mental health
Vol 1 Iss 4 Pp 210 217 April 2013, Apr 17, 2013
British Journal of Psychotherapy, 1988
Failure is important but usually unpublicised. I mishandled a case when accident compounded inexp... more Failure is important but usually unpublicised. I mishandled a case when accident compounded inexperience, so it can only be retrieved here: a reparative fantasy. Since here were only four sessions they can be reported in detail, with the added perspective of hindsight. The patient was a seventeen-year-old adolescent called Dean diagnosed as psychotic. Psychotherapy was the only form of intervention not already tried. His life was dominated by a compulsion to spin or roll on the floor. He was withdrawn and apathetic with occasional bouts of violence. When he first saw me he had just been expelled from a special Adolescent Unit after trying to strangle a nurse. There was a long history of contact with the family which I shall return to later. We had a brief meeting before our first session to set up a contract, so he had already described`the movements' which he had to do in order to avoid becoming ill. After entering my room he shambled around for a while before slumping down in a chair, facing me but with downcast eyes and looking sullen. I asked how he had been since last week and this led to him talking of what fills his time. Mostly just hanging around the house and watching television, and we also got on to his lack of ambition, or ideas as to alternative behaviour. He had brightened up when challenged before so I said it sounded almost as if he wished to avoid the future. He replied something about not counting chickens until hatched, since his habit of`twisting' meant he could not begin to think about work. He told me that his doctor had given him a certificate saying that he was incapable of work because of`nervous illness'. When I tried to reframe this to the less dramatic idea of having difficulties with life, Dean objected violently. His life was full of mysterious illnesses. When I tried to clarify what these were he became angry and sulked. I got the impression that he had been ill at school, something to do with being unable to concentrate, feeling depressed. Other children had told him that he was ill but he could not explain why. This had been caused by stopping his twisting. I acknowledged how he felt this habit was important as a means of prevention. He seemed to be saying it kept away depression. Dean emphasised his`twisting urge' stopped him becoming ill, insisting that this was purely physical. He decided (wrongly) that this started in Junior School. Then he volunteered that he had also had`pain urges' explicitly masochistic. He produced a strange series of precise dates the previous year related to the urges and their sequelae. These puzzled me so I simply expressed how I felt life must have been very difficult for him then. This got an affirmative response, and for the first time Dean appeared to connect with something I had said. He went on, before leaving, to tell me that the way he dealt with his twisting urge was to lie down. It felt much worse when he stood up and then he could not stop himself but, although he did not say so then, he would also roll frantically about on the floor.
British Journal of Psychotherapy, 1988
Failure is important but usually unpublicised. I mishandled a case when accident compounded inexp... more Failure is important but usually unpublicised. I mishandled a case when accident compounded inexperience, so it can only be retrieved here: a reparative fantasy. Since here were only four sessions they can be reported in detail, with the added perspective of hindsight. The patient was a seventeen-year-old adolescent called Dean diagnosed as psychotic. Psychotherapy was the only form of intervention not already tried. His life was dominated by a compulsion to spin or roll on the floor. He was withdrawn and apathetic with occasional bouts of violence. When he first saw me he had just been expelled from a special Adolescent Unit after trying to strangle a nurse. There was a long history of contact with the family which I shall return to later. We had a brief meeting before our first session to set up a contract, so he had already described`the movements' which he had to do in order to avoid becoming ill. After entering my room he shambled around for a while before slumping down in a chair, facing me but with downcast eyes and looking sullen. I asked how he had been since last week and this led to him talking of what fills his time. Mostly just hanging around the house and watching television, and we also got on to his lack of ambition, or ideas as to alternative behaviour. He had brightened up when challenged before so I said it sounded almost as if he wished to avoid the future. He replied something about not counting chickens until hatched, since his habit of`twisting' meant he could not begin to think about work. He told me that his doctor had given him a certificate saying that he was incapable of work because of`nervous illness'. When I tried to reframe this to the less dramatic idea of having difficulties with life, Dean objected violently. His life was full of mysterious illnesses. When I tried to clarify what these were he became angry and sulked. I got the impression that he had been ill at school, something to do with being unable to concentrate, feeling depressed. Other children had told him that he was ill but he could not explain why. This had been caused by stopping his twisting. I acknowledged how he felt this habit was important as a means of prevention. He seemed to be saying it kept away depression. Dean emphasised his`twisting urge' stopped him becoming ill, insisting that this was purely physical. He decided (wrongly) that this started in Junior School. Then he volunteered that he had also had`pain urges' explicitly masochistic. He produced a strange series of precise dates the previous year related to the urges and their sequelae. These puzzled me so I simply expressed how I felt life must have been very difficult for him then. This got an affirmative response, and for the first time Dean appeared to connect with something I had said. He went on, before leaving, to tell me that the way he dealt with his twisting urge was to lie down. It felt much worse when he stood up and then he could not stop himself but, although he did not say so then, he would also roll frantically about on the floor.
Reactive attachment disorder as an evolutionary adaptation
Attachment & Human Development, 2010
This paper suggests that the behaviours associated with the formal diagnosis of the &... more This paper suggests that the behaviours associated with the formal diagnosis of the "disinhibited" form of reactive attachment disorder (RAD) might be seen as a functional adaptation rather than a mental health problem, a facultative response enhancing the probability of survival that is triggered by certain conditions. Although disinhibited RAD is most commonly observed in institutionalised children, similar behaviours may also be a part of the emotional difficulties displayed by some fostered and adopted children (the latter includes those once institutionalised), and these may demonstrate not so much a discrete attachment disorder as either the need to fend for oneself following loss of dedicated caregiving or a lack of opportunity to build specific intimate relationships with dedicated caregivers. In many cases this may be inextricably mixed with the neurobiological and psychological seqelae of maltreatment. Indiscriminate attachment behaviour, from this proposed evolutionary perspective, is less a syndrome of mental ill-health than an astute survival manoeuvre following being orphaned, abandoned or fecklessly reared. Such a response, allied to the innate facility to access caregiving from different adults, could be expected to be initiated by specific events as are the other attachment configurations. Classing disinhibited RAD as an adaptation has implications for helping children brought up under extreme duress when their caregiving environment has changed for the better.
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Papers by Robin Balbernie