Does your baby need therapy?

Sarah Elton tried everything to get her infant to sleep. Then someone suggested psychotherapy

For the first six months of her life, my daughter would not sleep unless I held her in my arms. During the day, and for most of the night, she always wanted to feel her mother’s touch. I’d spend my days either sitting at home cradling her as she slept or wandering around the neighbourhood with her fast asleep in the baby carrier. The moment I tried to ease her into the crib — or the stroller or car seat — her eyes would pop open and she’d start to scream. Nighttime wasn’t any better. She’d sleep on her own from about 6:30 to 10 p.m., but when it was time for me to get some rest, she’d start waking every two hours, crying out for a feed or a cuddle.

Needless to say, it was exhausting. I was so desperate for one night’s rest — just one night, I thought — that when my good friend’s newborn was hospitalized for dehydration and she was told to go home for the night, I actually felt envious of her uninterrupted sleep. We tried everything. When the gentle techniques in Elizabeth Pantley’s The No-Cry Sleep Solution didn’t work, we turned to Richard Ferber’s rigorous cry-it-out regime. And so ensued nine endless weeks (yes, nine weeks) of hours-long, blood-curdling screaming. We followed Ferber’s words, never cheating even once to pick up our shrieking daughter. That didn’t work either. Everyone in our family was distressed and I was worried about what was going to happen when I went back to work. Something had to change. Then someone suggested an unconventional solution: psychotherapy.

Elizabeth Tuters, a child/adult psychoanalyst, and Sally Doulis, a registered social worker and psychotherapist, work at Toronto’s Hincks-Dellcrest Centre, where they help families with sleep troubles. They believe that when a baby or young child doesn’t sleep well, it’s often the result of some complication in the parent-child relationship. They see the baby in the context of the family environment — taking into account what mom’s and dad’s childhoods were like, and how they feel as new parents — and try to understand how this larger picture affects the child’s sleep. When parents talk about the situation in therapy, Tuters and Doulis say, the source of the problem is identified and the sleep difficulties go away. They also use the approach to help families deal with issues like extreme clinginess and eating troubles.

They call it infant-parent psychotherapy; Tuters and Doulis developed their methods based on the ideas of D.W. Winnicott, a renowned British paediatrician and psychoanalyst. Using psychotherapy to help with childhood sleep problems is practically a secret — not many paediatricians are familiar with it, and few parents know the option is available to them. That’s no surprise, considering this area of study is so young. Infant-parent psychotherapy has its roots in developmental psychology, the study of the emotional development we experience as we progress from babyhood to adulthood, and how this affects our personality and our future relationships. Tuters had been working in the field for 15 years when Doulis joined her at the Hincks in 1994, where they’ve since developed their methodology. They grounded themselves in attachment theory, which holds that the way a mom responds to her child’s needs affects his ability to feel secure and independent. They surmised that this interaction between mom and baby could affect sleep too. “We began to develop this notion that the most important thing here is the relationship between the parent and child,” says Tuters.

Not all babies who wake up in the night have a sleep problem. It’s normal for babies older than six months to still need some attention in the wee hours. Other babies can’t sleep because of a medical reason, such as acid reflux or sleep apnea. The families who visit Tuters and Doulis for sleep problems have children whose sleep habits disrupt everyday life — they are unable to nap without being held by mom, like my daughter was, or can’t sleep at night without a parent’s body beside them. “The distress of the parent is a big part of it. That’s a trigger that tells you something isn’t going as it should be,” explains Doulis. It’s also a signal that some emotions from a parent’s past are being stirred up. “As you go on in your life, you repress things that are uncomfortable, so as to be able to survive,” she says. “When you have a child, all of it comes back to bear on you. It’s as if it happened yesterday.” When I first met with Tuters and Doulis, I wasn’t sure how psychotherapy could help my daughter — she was a baby after all, and she couldn’t exactly lie on the couch and talk about her feelings. My husband wasn’t thrilled about the idea because he worried that we were pathologizing normal behaviour.

I’d never been to a therapist before, but I persuaded him that the therapists might be able to “fix” our daughter and help us sleep again. But that wasn’t the case. During our first meeting in the small room we would return to over the next eight months, with a black leather sofa, two large beanbag chairs and some toys, Tuters gently pointed out to me that my seven-month-old didn’t actually have a sleep disorder, as I had feared. There wasn’t a problem with my daughter. Rather, something else was getting in the way of her sleeping well, and that something was my own fear. The two of us started going to weekly therapy sessions. (My husband could have joined us if he had wished, since Tuters and Doulis work with one or both parents.) Among the things they asked me to describe was my pregnancy and my labour and delivery, as well as the first days and weeks of my daughter’s life. I had had a difficult pregnancy that ended with six weeks of bedrest. When my daughter was born at 38 weeks, she lost a little too much weight and we were kept in the hospital for five stressful days. Then, not long after we finally made it home, she developed a severe diaper rash — painful ulcerations, not unlike canker sores on her behind, that didn’t go away for three months.

All these experiences had turned me into one nervous mom who worried about the health of her baby. This was worsened by a pamphlet I’d read warning that two babies die of SIDS every week in Canada. Nothing freaked me out more than leaving her alone in her bed in a dark room. Then, when she awoke and made a small noise in the night, I continued to hear her crying in pain from the rash, long after it had gone away, and rushed to soothe her. I got in the way of my daughter developing her own ability to soothe herself and regulate her own emotions, an important part of every infant’s development. I know it sounds like I’m blaming myself, but I don’t see it that way. I think my daughter could sense the tension in my body, the anxiety I was feeling, in the same way that I might respond negatively to someone else’s bad mood. As I talked about these feelings, my daughter played with the toys, and Doulis, who usually led the discussions, alternated between responding to me and engaging with the baby.

While I wasn’t aware of it at the time, she was observing the impact my words had on my daughter. One time I suddenly burst into tears, and my daughter crawled over and tried to climb onto my lap. Doulis reached out and rubbed her back. “It’s OK that Mommy is crying. I know it’s difficult, but Mommy sometimes cries too,” she said. I was amazed by how soon things turned around. Within weeks, I could put my daughter in the crib awake and, instead of screaming as she used to do, she’d look up at me with wide eyes. I’d pat her back and sing to her, like they’d advised me to do, until she snoozed. I felt more relaxed at bedtime, and I think she sensed that I felt better about leaving her alone in her room and it was OK for her to sleep. The night waking did take a while longer to settle. To accomplish this, we used a modified cry-it-out technique that Tuters suggested — it involved helping the baby learn to soothe herself, while ensuring that she knew her mother and father were nearby. So when she’d wake up at 3 a.m., I’d go to her every five or so minutes, rub her back and say, “Mommy’s here. Go back to sleep. Sleep is good. Hush.” I felt better about leaving her to cry because the people guiding us through the process were experts in attachment theory. Nevertheless, it was tough — some nights she would cry for two hours straight. But before her first birthday she was sleeping through the night. And so was I.

Tuters and Doulis say that my positive experience is not unique. I spoke with another mother who went to see them for a case of severe separation anxiety. Before starting, she couldn’t leave her daughter for even five minutes without the baby becoming hysterical. But with the help of Tuters and Doulis, she realized that her experiences with her own mother during her childhood were affecting her relationship with her daughter. Once she came to terms with this, the problem faded away.

The success that this pair are having in Toronto is catching the attention of their colleagues on the world scene. Psychoanalysts from England have come to Toronto to observe their technique, and Tutors and Doulis have presented their findings at international conferences. This summer, they’ll head to Latvia to teach people there. And they do all this with very little money. The Hincks is a small agency that relies on a patchwork of private donations and government funding. The families they work with don’t pay directly for the service, as it’s covered by the Ontario Health Insurance Plan. This means they can help families of all socio-economic backgrounds as long as they live in the agency’s catchment area.

Tuters and Doulis hope that by helping infants sleep better (or eat better, or be less clingy) they can avert other problems that could manifest themselves later in life, particularly in the teens. “We know that the earlier you get in, the earlier you can prevent all these problems,” says Tuters.

Some might say it was just a coincidence my daughter started to sleep better at the same time as the therapy began. Maybe they are right. But my emotional journey with Doulis and Tuters has led me to believe that when I found peace within myself, my daughter was able to find it too.

Where to learn more

I spent months trying to learn more about infant-parent psychotherapy as I was going through the program but, unfortunately, there is little information that’s specific to this method. I did find these resources to be helpful:

zerotothree.org is a good online resource for infant mental health. The handbook Building Strong Foundations: Practical Guidance for Promoting the Social-Emotional Development of Infants and Toddlers, by Rebecca Parlakian and Nancy L. Seibel, is available at this site’s bookstore.

• Psychiatrist Daniel N. Stern has written two books that are widely available: Diary of a Baby and The Birth of a Mother: How the Motherhood Experience Changes You Forever.

hincksdellcrest.org provides information about programs at the Hincks-Dellcrest Centre.