Scaffolding the Brain: Key Areas of Evaluation in Infant Parent Psychotherapy

ABSTRACT

Clinicians are often challenged by the complexity involved in early childhood infant/parent dyadic assessments and interventions. Working within a right hemisphere developmental period requires clinicians to have a good enough natural relational style that moves easily between the nonverbal implicit worlds of the infant and parent while attending to the parent’s verbal narrative. The author suggests using an evidence informed neurobiological scaffold called Integrative Regulation Therapy (iRT) with evidence based Infant Parent Psychotherapy (IPP) and introduces an iRT assessment that creates a Probable Map of the parent’s neurobiological organization to facilitate intervention by assessing clinical impressions in nine key areas: 1) attachment experience, 2) self-concept, 3) arousal organization, 4) soothing of dysregulated states, 5) use of defenses, 6) use of instinct, 7) use of reflection, 8) hopes and desires, and 9) current level of agency. A composite case will be presented illustrating the clinical use.

Acknowledgments

The author wishes to thank First 5 San Diego/Healthy Development Services/Family Health Centers San Diego for grant funding and allowing her to use iRT/IPP as a primary intervention in NCAR infant/parent dyadic interventions. A particular thanks goes to Pradeep Gidwani, M.D., Medical Director, Healthy Development Services and First 5 First Steps Home Visiting Services, American Academy of Pediatrics, California Chapter 3; Susan G. Nevitt, M.A., CCC-Sp., Director of Program Development, FHCSD; Claudia Gastélum, MBA, Director, Pediatric and Healthy Development Services, FHCSD; Khawla Suleiman-Qafiti, MD, MAS, Chief of Pediatrics for Strategy and Program Development, Pediatric Developmental Services Medical Director, FHCSD; Flavia Gastélum, Manager of Developmental and Early Intervention Services, FHCSD; Manuel Angeles, M.S., Evaluation Manager, Healthy Development Services, FHCSD; and Jennifer Kennedy, MPA, Sr. Project Specialist, Healthy Development Services, Countywide Coordination and Support, American Academy of Pediatrics, California Chapter 3 for their continued support of our work with infants and their parents. The author also wishes to thank and acknowledge the dedication and excellence of the entire NCAR team.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. This case is a composite case. The author wishes to acknowledge iRT trained clinician Maria Ortega, LMFT for her helpful review of this composite case.

2. Family Health Centers San Diego (FHCSD) is a large community based nonprofit organization dedicated to providing primary medical, reproductive, prenatal, pediatric, mental health, and other supportive care to largely low-income families in San Diego.