the MeeriNG onwo systems a systemic APUOACH..._6S
THE MEETING OF TWO SYSTEMS:
A SYSTEMIC APPROACH TO SEPARATION ANXIETY IN LITTLE
CHILDREN ENTERING THE NURSERY DEPARTMENT OF THE KINDERGARTEN (PART 1)
Bojana Moškrič
KEYWORDS: child - care, separation anxiety, systemic approach
KLJUČNE BESEDE: otroško varsto, separacijska anksioznost, sistemski pristop
ABSTRAa
The aim of my article is to motivate thinking about a dilemma: whether mother is to be exclusively mother, or has she any possibilities to remain a "good enough mother" and at the same time she does not neglect any of her other human needs'^
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A lot of research projects motivated with Bowlby's attachment theory, ego psychology and object relations theory draw attention to the early nonmaternal care as a risk factor for the development of the personality in the first year of life and even later until between the third and the fourth year of age the object constancy is gained.
Through the example from my clinical practice I discuss the possibility of connecting the family system and the system of the public child - care in a way that would not need to be harmful for the child and could even improve the functioning of the entire family system.
POVZETEK
Namen članka je pobuditi razmišljanje o dilemi: ali mora biti mati samo mati ali ima kakšne možnosti, da ostane svojemu otroku v najnežnejšem obdobju dovolj dobra mati in hkrati ne zanemari vseh svojih ostalih človeških potreb.
Številne raziskave motivirane z Bowlbyjevimi spoznanji o navezovanju, ego psihologijo in teorijo objektnih odnosov opozarjajo na riziko, ki ga za osebnostni razvoj pomeni tuje varstvo v prvem letu življenja, pa tudi kasneje, dokler med tretjim in četrtim letom otrok ne doseže konstantnosti objekta.
Ob primeru iz svoje klinične prakse poskušam predstaviti možnost povezovanja med družinskim sistemom in sistemom javnega otroškega varstva na način, ki naj otroku olajša nujnost ločitve od doma, lahko pa tudi izboljša funkcioniranje družine.
INTRODUCTION
My interest in young children and their families' strategies of coping with everyday separations came from my family therapy work and from my experiences in preventive field. The connection of both, as it sometimes comes up, is systemic consultation work with parents and the kindergarten staff together.
THEMEETiNG Of TWO SYSTtAAS: A SYSTEMS/»>BOACH... 67
If there is a scenario of the children having warm, continuous, and stable relationship which enables them to develop in the direction of healthy, stable, and happy personalities (Bowlby,1991,1993), and of their mothers being "good enough mothers" (Winnicott, 1993), but at the same time enjoying their personal life and professional career - who else would be playing roles in it and what kind of roles would these be^
There would be a long casting list, I believe, and no matter how "devoted" the father is, sources out of the nuclear family boundaries would be also needed. Apart from grandparents and other relatives, kind neighbours or private carers there is also public child care service in kindergartens.
Questions about the influences of child day-care on children's development have fuelled much research and much controversy in the past decade. Results of several studies have indicated that early entrance into day-care (i. e. before 12 months of age) is associated with elevated risk of insecure -avoidant attachment to parents and higher levels of aggression and noncompliance in pre-school years (Egeland, & Hiester,1995; Belsky, Woodworth, & Crnic,1996).
The effect of day care on attachment is theoretically interesting because attachment theory (Bowlby,1991, 1993) has been interpreted as suggesting that the repeated separations of mothers and infants for day-care are disruptive to the caregiving interactions needed for the formation of the secure attachment.
The psychological consequences of separations before the age of three have been and continue to be debated. Some investigators suggest that children cope with separations quite successfully, while the other conclude that separations before the object constancy is gained cause severe and lasting emotional damage. This wide difference of opinion can be partially explained by the source of evidence used.
The first authors who investigated this field used observations gained in extremely unfortunate circumstances for the children (long lasting residential care with a lot of different carers) and the focus of most separation and attachment research has not been on resilience, but rather on risk factors that are associated with poor functioning among children facing separations.
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While Bowlby's attachment theory and his widespread warnings against maternal deprivation (Bowlby, 1979) informed the majority of research work on child's emotional development and early nonmaternal child-care there are a lot of published research reports finding out that nonmaternal care in early age is a risk factor for the quality of the infant/mother relationship and has damaging consequences for the development of the child's personality.
Implications for social policy, based on research on day-care and attachment, have been suggested in many sources and have included arguments against social programs designed to improve the quality or availability of day care for infants. q
But it needs to be taken into consideration that the research literature on infant day-care and attachment may be biased by the unavailability of the "file drawer" studies, unpublished data showing no statistically significant effects (Roggman, Langlois, Hubbs-Tait, Rieser-Danner, 1994).
On the other hand there are more and more authors suggesting that an important variable that may account for outcomes of the studies is the quality of the provided day-care (Burchinal, et al., 1996; Phillips et al., 1994; Furman,1992; Howes,et al. 1994; Greenspan,1992; Robertson 1972).
As Hennessy (Hennessy, Martin, Moss, & Melhuish, 1992) pointed out the most research in day-care is conducted within a damage - limitation model, as a risk factor, or else is investigated in terms of the way it affects children's attachment to their mothers, rather than exploring the more useful questions concerning what different organisations of attachment relationships and caring contexts offer.
On the other hand there is some evidence that a secure attachment to an alternative caregiver may compensate for an anxious attachment to mother (Egeland, & Hiester, 1995 - quoted from Howes, Rodning, Galluzo, & Myers, 1988)
Howes (1990) also reported that, for children who began extensive day-care in early life, it is quality of day-care rather than family factors and processes that predicts later adaptation.
Rather than in "no change arguments" and apportioning blame on mothers for their children being insecure I am interested in facilities that should
THE MgEWNO Of tWO SYStB\ftS: A SYSTEMIC APROACH... 69
support a slight and yet great enough change in the system of public child care to suit the requirements of all parts and not just serve to fulfil seemingly the needs of one part at the expense of another.
I would like to list some of my experiences from different fields of my professional work with children and their caregivers which led me to discuss the possibility of connecting the family system and the system of public child-care in a way that would not need to be harmful for the child.
THEORETICAL CONCEPTIONS OF THE SEPARATION ANXIETY
It seems to me that in comparison with other fields there is less systemic literature on the topic (separation anxiety and child-care organisation) I chose. It looks like the issue is reserved for psychoanalysis with its extensions in developmental ego psychology, object relation theory and Bowlby's attachment theory. All these theories are interested in intrapsychic phenomena in connection with the dyadic relationship and somehow ignore the wider system of which the public child-care facilities are a part, as well. Maybe the lack of systemic research in this field is in part due to the fact that in countries where the systems theory is well embedded and widely used (GB,US) the early child-care is mainly left to parent's inventiveness and there are less public child-care facilities available (Hennessy, et al., 1992).
My approach and the understanding of the term "separation anxiety" draws mainly from the work of Margaret Mahler and John Bowlby. Although they often argued in their published works against each other's arguments and findings about child development (Mahler, 1968, 1987; Bowlby 1969, 1979, 1988), I can see some useful similarities in their explanations of the same topic - the early personality development of the child. While the Bowlby's language is more easily understood than the complicated psychoanalytic terminology of Margaret Mahler they were both focusing on first years of life and agreed that the experience and the treat of separation at that time might have a negative impact to child's intrapsychic development and his/her current and future feelings and behaviour in human relations.
When talking about separation anxiety Bowlby explained it as the feeling of insecurity - a forerunner of the attachment behaviour which could be of different kinds (secure, insecure-clinging or insecure-avoidant) according to previous quality of the attachment - caregiver relationship. He wrote: "By
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the end of the first year the attachment behaviour is becoming organized cybernetically, which means, that the behaviour becomes active whenever certain conditions obtain and ceases when certain other conditions obtain. For example, a child's attachment behaviour is activated especially by pain, fatigue, and anything frightening, and also by the mother being or appearing to be inaccessible. The activation of attachment behaviour in these circumstances (when people are anxious or under stress) is probably universal and must be considered the norm."(Bowlby, 1993)
On the other side Mahler explained her conception: "By 'separation anxiety' we do not mean the behavioural sequelae and reactions to physical separation from the love object, but rather the gradual yet inevitable intrapsychic sensing of a danger signal anxiety on the part of a small child during the normal separation - individuation process." (Mahler, 1968)
She described the study of average mothers with their normal infants during the first three years of life where she observed the intrapsychic separation-individuation process: the child's achievement of separate functioning in the presence and emotional availability of the mother. According to her observations - even in optimal situation, this process by its very nature continually confronts the toddler with minimal threats of object loss.
Mahler concluded that a bit of separation anxiety was entailed by each new step of separate functioning and that small amounts of separation anxiety might been necessary requirement for progressive personality development. (Mahler, 1968)
Maybe Mahler's position was a bit more optimistic as she saw the separation anxiety to be a normal developmental phenomenon and not only the mother's guilt.
Some authors were looking for the resources like the transitional object which the child could invent for him/herself to lessen the separation anxiety but more or less all of them agreed that the relationship in the first year of life had to be appropriate (Winnicott, 1971; Toplin, 1972).
In 1972 James and Joyce Robertson reported about four children ranged in age from 17 to 29 months which they had fostered one after another while their mothers had been at the hospital to give birth to a new baby. It has been shown that when the stress factors which complicate institutional
imtmmo or two syst&>as: a systemic Ai>fti»Li>.._m
studies had been eUminated, and adequate substitute mothering provided, four young children separated from their mothers and homes for 10 to 27 days did not respond with the acute distress and despair described in the literature. In varying degree, reflecting their differing levels of object constancy and ego maturity, all four formed an appropriate attachment relationship with the substitute mother. Individual differences in response, which were obscured by the severity of institutional separation, became apparent. None of these followed the sequence protest, despair and denial/detachment described of institutionalized children.(James and Joyce Robertson, 1972).
The question can be posed: If it is possible in inevitable everyday separations of the child from his/her parents for the day-care to maintain the amount of the separation anxiety inside tolerable measures what strategies should be usedi What impact would this have on the family and on the child-care system's-
EVIDENCE FROM MY PREVENTATIVE WORK
In preventative work with Systematic Preventive Psychological Screening of Three Years Old Children (The original abbreviation is SPP-3) I see every year about 80% of all three years old children in my district with one or both parents.
The SPP-3 procedure was a result of a longitudinal researching project about the cognitive and personality development of Slovene three years old children and was originally constructed and standardized for Slovene population. Besides a short procedure of testing the cognitive development SPP-3 contains a detailed questionnaire for parents about any kind of possible signs of maladaptation that could occur in early age, and a semistructured interview with parents about child's environment and important circumstances in his/her life (data about pregnancy and birth, family, SES, rearing and caregiving practice, special negative factors e.g. absence of parents, alcoholism in family, early hospitalizations, etc.).
In longitudinal study conducted by the author of SPP-3 and his researching team which has begun with the representative sample of three years old children and has continued when the children were five years old they found out that in the whole range of different types of caregiving two types were
H PSIHOUiSkA OBZOiUA > >I0I«Z0NS Of l>SYCH0LU6Y 97 / Ai
connected with signs of worse adaptability in children at both ages: a lot of strange caregivers and upbringing in broadened families where grandparents' and parents' roles were enmeshed or their rearing practices and beliefs about appropriate child-care were very contradictory (Praper, 1980, 1992).
Besides other important topics in my interview with parents I always explore their choice of day-care for the child and their experiences with it.
Although unemployment is increasing in our country, nearly as many women as men have constant employment. In families where mothers are employed, after the maternity leave which lasts one year, parents mainly decide to put their children for the day-care in the nursery department of the kindergarten. For the majority of these children parents report some, but not too difficult problems with adjustment to nursery care at the beginning, while they enjoy the kindergarten activities at the age of three.
Among those less fortunate whose children would have needed more than an "average welcome" to the nursery there are some who refer to offices like mine.
EVIDENCE FROM MY SYSTEMIC FAMILY THERAPY WORK AND CONSULTATIONS
I cannot overlook that a number of my little clients referred to my office with emotional and behavioral problems connected to the extreme arousal of the separation anxiety which seems to be the answer to stressful events in their life. Throughout the evidence of my practice the beginning of the daycare arrangements in the kindergarten may be one of such possible stressful events for the youngest but also for some of the older children.
It would be easy to make a conclusion that early beginning of the nursery care could hinder the emotional development. But in most cases that I remember from my therapy work, the history of previous separations has been much more harmful than the current ones.
The opportunity for corrective experience can be sometimes made by precisely planned intervention aimed to gradually introducing of the child into the kindergarten and to the improvement of the communication between parents and new caregiver.
THE MEETING OF TWO SYSTJMS. A SYSTBWIC APROACH... 73
There are also some cases where the childcare arrangement in the kindergarten provided the first step to the beginning of the problem-resolving process in the family. In this context I often remember the following case:
A young woman with two little boys sitting in her lap, the older one at the age of three to four and the younger one less than two years old. The boys were clinging to the mother and at the same time kicking each other. With tears in her eyes she said she came because she could not bear it any more. She told me that two days ago she had become so furious that she had grabbed her older son, pushed him out and locked the front door behind him.
She had lost her job after the maternity leave for her second son. Her partner was working overtime to ensure the financial support for the family but in spite of all their best efforts they couldn't hire more than a very small flat.
When she became pregnant with their first child she has gave up her studies and she accepted a job far below her level of education. At the time she came to my office she tried to continue her studies to make herself an opportunity to get a better job. But with both children at home she could not manage to study except during the night. She was exhausted and often ill, as well.
She tried to put her children in the kindergarten but they were ill a lot and because they were hospitalized several times with serious attacks of asthma doctors advised her to take them out of the kindergarten.
She was deeply disappointed with doctors who "had just experimented with medications on her children". On the other hand she lost her trust in governesses in the kindergarten, too. Her feeling was that they did not care well enough for her crying boys and they were often dripping with sweat and then fell ill again and again.
She felt herself caught in an endless circle of troubles with her image of being a good mother seriously damaged. She also felt as she had to deal with all the problems on her own and didn't want to burden her partner more than he was already.
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She claimed she did not have any relatives available to offer her any help. When she had been five years old she had lost her father and her older brother in a traffic car accident in which she and her mother had been seriously injured, too. Her mother had not been able to recover from the terrible loss which had deeply affected the relationship between her and her daughter. My client's experience had been that after the accident her mother had become either hostile and neglectful or overintrusive towards her. She had left home at the beginning of her studies and had nearly completely lost the contact with her mother.
She found a warm and understanding person in her partner's mother but unfortunately she died of a cancer three weeks before her wedding day. The wedding was cancelled and they were just living together as if they were married. As she said it meant no difference for her.
While our first session proceeded she became a little bit relaxed and both boys climbed from her laps to the floor and began to investigate the toys in my office.
Her story as she had constructed it for herself was a story of a loser who had fought hard against her destiny but found herself at the point of the resignation with a lot of suicidal thoughts.
At the beginning she didn't accept family therapy work I offered. She wanted just some counselling how to deal with her children and she did not want to engage anybody else, especially not her partner who she felt was overburdened already.
In the next session we began to construct a new story step by step which was a story of a survivor who had suffered much but still wanted to make the world and the life better for her and her children; a story of a mother who could be in the contrast to her own mother very sensitive to her children and her partner.
In that session we also found out that besides good parents children also need the company of peers of which she had also been deprived. (As preschooler she had been in her mother's care at home and after the accident when she had been a school girl yet she had spent years in hospitals due to chronic headaches. In short periods between hospitalizations she had not been able to form close relationships with her peers.)
THiiMNG OF TWO SYSTEHftS; A SYSTEMtC APROACH... 75
She decided to discuss once more with her partner whether to put their children into the kindergarten again or not. She agreed with me to arrange a consultation to them and the kindergarten staff together before they would have made a final decision.
I knew it was risky to try once again and fail because it would be one more point for her old story. I prepared for the consultation very precisely. I did not want to convince anyone of anything but I felt responsible for the creation of a conversational context that should allow for mutual collaboration in the problem-defining process so that each part should have got all the informations needed for better understanding and cooperation with each other (Huffington, Brunning, 1994).
The conclusion of the consultation was an agreement about introducing both boys into the kindergarten gradually and in the presence of their mother or father.
Two weeks later my client informed me that both boys seemed to be well adjusted in kindergarten and did not seek her presence there any more. Two months after that she reported that they were still healthy and especially the older one missed his friends from kindergarten during the weekends.
In next year she finished her studies and now she is employed again. Now we are going on trying to do some work on her grief. She accepted the presence of her partner. The time comes to "Saying hullo again" - to her brother and her father and then maybe to her mother, as well.(White, 1988)
I think the systemic consultation work that was done presented an opportunity for constructive communication between the two systems and thus enable family system to change further in its desired direction.
For this illustration I may have chosen one of the more complicated cases but I think not such an infrequent one. Above all it challenges the popular story of devoted mother and happy children. My client's maternal devotedness grew either to a little short of maternal deprivation for ever (suicidal thoughts) or of the violence towards her beloved children. I agree with Burman that concerns with abusing mothers may seem far from those of attachment, but the discourse of maternal sensitivity and maternal deprivation draws them together (Burman, 1995).
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In a lot of other cases I found a systemic consultation work in dilemmas around child-care to be helpful; especially in cases of intensive separation anxiety in children of all ages entering the kindergarten. The child's vulnerability is connected with his/her past experiences and current circumstances of the life in family, but the lack of trust and feelings of being safety in the kindergarten are often also due to obscure communication and lack of confidence between parents and kindergarten staff. That can be the point of intervention and the framework proposed here is of the family and the kindergarten as the two interconnecting systems.
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11. Egeland, B., Hiester, M. (1995) The Long Term Consequences of Infant Day - Care and Mother - Infant Attachment. Child Development, (1995) 66: 474 - 485. Society for Research in Child Development.
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22. White, M. (1988) Saying Hullo Again: The Incorporation of the Lost Relationship in the Resolution of Grief. Dulwich Centre Newsletter, 7-11.
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