As part of routine practice, pediatricians often see parents with their babies and young children. Typically, our visits are joyful, and we get to see a beautiful lifelong relationship develop and blossom. Sometimes, however, pediatricians will have a visceral reaction to the parent/child interaction. The gut says “something is wrong here” and detects a problem.
Too often mothers, in particular, carry most of the load of early child-rearing while they do not have enough support themselves; they are depressed, anxious, and/or overwhelmed. Often, too, parents have their own unexamined and untreated childhood trauma that affects whether and how they form an attachment bond with their infant. Individual therapy approaches cannot capture the complexity involved as parent, baby, their relationship, their family system, and the culture they are in, all interact.
Dyadic therapy, where parent and infant/young child are treated together, addresses all levels of these interacting factors: the parent’s health and needs, the baby's health and needs, their relationship, and their family system— all within an understanding of their culture. Because babies are completely dependent, parents must meet their physical and emotional needs, which means that caregivers must be physically, emotionally, and mentally resourced to attune to and be in sync with their nonverbal infants.
Attunement—the ability to feel and understand an infant’s interior world in a good-enough fashion—gives an infant the experience of security (“my parent gets me”) and creates emotional synchrony (“she/he will respond to help me”) that is needed for emotional security and regulation.
A skilled dyadic therapist can help a parent and young child come back into sync and improve their relationship. Dyadic therapy begins with getting to know how the parent perceives their infant or child, and how they understand and respond to the child’s behavior. During therapy sessions, the therapist and parent observe the baby together, and the therapist listens to the parent’s explanation of their child’s behavior with respect, empathic concern, and positive regard, creating a safe environment.
As the therapist and the parent observe the young child together, the therapist reinforces perceptions that are attuned and in sync with the child, and helps to support the relationship. When the parent’s observations and perceptions appear distorted, the therapist can create a space for the parent to reflect on the accuracy. For example, does the baby’s cry indicate she is tired? Or is she hungry? As the therapist gently explores alternative interpretations of an infant or child’s behavior, she provides a natural corrective experience for the parent that is helpful but not judgmental.
Often, when a parent’s perceptions are distorted, it is because their own needs were not met when they were a young child. With dyadic therapy, the therapist helps the parent distinguish current thoughts and feelings from past relationships, and helps the parent form positive ideas about themselves, their baby, and their self in relationship to others, especially their child.
Dyadic therapy helps parents meet their own psychological and practical needs so they can be fully attuned to their children. The quality of the parent/child relationship has everything to do with secure attachment and emotional regulation,1, 2 which support the critical first two years of brain development.3,4
As a result of the dyadic therapy process, parents can expand their sensitivity to their young children as well as how they respond. When we identify and treat these dyads early, we create positive outcomes for both the parent and baby—and a more joyful experience of child-rearing and childhood along the way.
Pradeep Gidwani, MD, MPH, FAAP, is Medical Director of Healthy Development Services and First 5 First Steps Home Visiting Services in San Diego, and Past-President of the American Academy of Pediatrics, California Chapter 3.
Ruth P. Newton, Ph.D., is a Clinical Psychologist at the Newton Center for Affect Regulation (NCAR), specializing in the Neuroscience of Attachment. Dr. Newton is endorsed by the California Center for Infant-Family and Early Childhood Mental Health as an Infant-Family and Early Childhood Mental Health Specialist and Reflective Practice Facilitator III/Mentor.
1Zeanah, C. H. (Ed.). 2019). Handbook of Infant Mental Health, 4th Edition. New York: Guilford.
2Cassidy, J., & Shaver, P.R. (Eds.). (2008). Handbook of Attachment, Theory, Research, and Clinical Applications, 2nd Edition. New York: Guilford.
3Newton, R. P. (2020). Scaffolding the brain: Infant parent psychotherapy during the primary biological entrainment period. Journal of Infant, Child, & Adolescent Psychotherapy, 19(1), 56-70. doi: 10.1080/15289168.2020.1717207
4Schore, A.N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Mahweh, New Jersey: Erlbaum.
Alexandra Parma • Jun 19, 2020
This week California released an important new policy making family therapy a covered benefit for children in Medi-Cal. This is a significant step forward in approaching children’s health from a whole-family wellness perspective.
Sarah Crow • Jul 19, 2021
Among the many important investments in this year’s state budget, California’s new dyadic care benefit in the Medi-Cal program is particularly significant.
Kathryn Margolis • Jun 9, 2021
Dyadic care models like HealthySteps provide important support to families with young children. Such care is particularly important in this pandemic- recovery time, which exacerbated mental health concerns, family stress, isolation, and income insecurity, particularly for BIPOC families who already face health inequity due to structural racism and oppression.