Parent-Infant Psychotherapy for Sleep Problems

Through the Night

Dilys Daws, Sarah Sutton

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9780367187798
• eBook ISBN: 9780429582370
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Sleep problems are among the most common, urgent and undermining troubles parents meet. This book describes Dilys Daws' pioneering method of therapy for sleep problems, honed over 40 years of work with families: brief psychoanalytic therapy with parents and infants together.

Offering tried and tested ways of helping parents work things out better with their babies when such problems arise, this new edition of Dilys Daws' classic work, updated with expert help from Sarah Sutton, frees professionals from the burden of feeling they need to rush to give advice to families, showing instead how to begin the challenging journey of discovering new emotions that every baby brings. It sheds light on the sleep problem in the context of a whole range of aspects of the early world: the regulation of babies' physiological states; dreams and nightmares; the development of separateness; separation and attachment problems; and connections with feeding and weaning.

This much-needed, compassionate and well-informed guide to helping parents and babies with sleep problems draws on twenty-first century development research and rich clinical wisdom to offer ways of understanding sleep problems in each individual family context, with all its particular pressures and possibilities. It will be treasured by new parents struggling with sleeplessness and is enormously valuable for anyone working with parents and their babies.

Chapter 1

What is a sleep problem?

‘Does your baby sleep through the night?’ parents ask each other. This book is about infants’ sleep, with thoughts about babies who do, as well as those who do not. I will be mainly concerned with the relationship between parents and child within which sleep develops well or badly. This naturally involves exploring the emotions between them which influence the baby’s capacity to sleep. The parents’ lives, family histories and relationships are the framework within which they bring up their families. I look at how these connect with their baby’s development, for which sleep is vital. I will not categorize kinds of sleep problems or systematically give solutions, but I will look at the context and some of the causes of sleep problems.

This book is above all clinically based. It describes my own method of therapy for sleep problems, developed over ten years or so: brief psychoanalytic therapy with parents and infants together. I use many examples from this clinical work, both in order to demonstrate the method itself and as illustrations of my and others’ theoretical ideas. Many writers have found statistical connections between infants’ sleep problems and other aspects of development or relationships, and I describe some of them here. My purpose is not to add to these statistical findings but to illuminate their connections with particular, individual experiences, so that the nature of the findings can be better understood.

‘Through the night of doubt and sorrow’, as the hymn says; a highly coloured phrase, but perhaps not too exaggerated a way to describe the long nights that sleepless crying babies and their parents endure. Sleep problems may punctuate uncertainties between parents and baby at any stage of the baby’s development and bring out doubts in parents about their parenting abilities. They are among the most undermining troubles a parent has to deal with.

Sorrow is, indeed, also one of my themes; in particular how parents’ losses and traumas, for instance the death of the mother’s own mother or a birth experienced as disastrous, go on resonating inside the parent and colour such an apparently simple operation as putting a baby to bed. Separations in a parent’s life, felt to have been unbearable, may make the small separation of putting a baby down in its cot also seem unbearable.

This book is not so much about how to make sleepless babies behave differently – in fact it is argued throughout that the problem is rarely in the baby alone – it is about how to think differently and more widely about the problem. The sleep disturbance can then be a jumping-off point for real creative thinking by a family about how they all – parents, baby, and other children – interact with each other.

I hope to show that the interchange between parents and baby about going to bed and getting to sleep is, like feeding, one of the crucial transactions between them. First, the way in which this is handled may influence the length and quality of the baby’s sleep. Second, it may provide one of the most powerful and influential memories of someone’s childhood. Third, the emotional tone and the way in which negotiation happens between parents and child may influence later transactions, even into adolescence. Furthermore, sorting out aspects of what is going on between parents and baby during the day may be just as necessary in helping with the sleep problems as going head-on for the events of the night.

In the course of the book, I consider various thoughts that parents have had about their babies’ sleep and suggest that parents’ dreams about their babies are one form of this thinking. Here, as an illustration, is a dream of my own; I think it shows how dreams can highlight vital aspects of the connections between parents and their children.

On the night before my younger son’s first A-level exam I dreamt that he was a little boy again. We were staying in a strange place and I gave him a warm bath, pleasantly confident that he would fall asleep easily afterwards.

In this brief dream are several of the themes of my book. It examines the relationship between parents and baby within which a baby is able to sleep easily or not. It opens up the idea of how much the baby’s sleep is a result of his parents’ care and how much it is a ‘letting go’ by the parent so that the baby can attain his own physiological rhythms. How does a parent appropriately follow the changing needs of babies and children at different ages? When a baby falls asleep, do she and her mother experience this as a continuity between them or as a separation? We know now how much experience in the first weeks and months affects what happens later (Perry et al., 1995).

My dream about my teenage son was obviously in part a wish to ‘mother’ him inappropriately for his age. But mainly perhaps it was a memory of the way he and I had negotiated in the past how I could help him towards what only he could do for himself. No one can fall asleep for someone else, and parents cannot take their children’s exams for them! Parents are guardians of their children’s sleep, in the words of the psychoanalyst Joyce McDougall (1974, p. 446), who echoes Freud’s idea that dreams are the guardians of sleep (1916–17, p. 129). Paradoxically they can often do this best while asleep themselves. The parent who sleeps and dreams about her child leaves the child free to have his own dreams.

This is also a book about strong emotions. I hope to convey the desperation with which parents have told me about their baby’s sleeplessness, and the life and death feelings sometimes associated with this. In 40 years of work with such families in a child health clinic and previously at the Tavistock Clinic in London I have, I think, been able to help many of them improve their situation. I will describe my method in the next chapter; in this one I want to give a context to the problems. This context is in my mind when each new family tells me their problem, their attempted solutions and the expectations about childrearing that have informed their behaviour.

You may be at times taken aback by the connections I make, with little apparent evidence, between parents’ own experiences and their children’s difficulties. I ask you to bear with me as we look at this throughout the book. The parents I have worked with have often, I think, been relieved and supported by finding these links. It can be liberating for parents to look honestly at the intertwining between themselves and their child, not for blame or self-blame, but as a new chance to take the initiative in a more benign interchange with their child. Something falls into place and problems start to dissolve.

Looking at sleeping problems makes us aware of the complexity of the emotions involved in being a parent. We see just how subtle the process is by which mothers and babies move from such early closeness to seeing themselves as two separate beings. Sleeping problems illustrate difficulties at every stage. Receptivity to the needs of a baby, sensitivity to their fears and spontaneous offering of comfort need to be tempered with a gradual setting of limits. Understanding of a baby’s fears enables a parent to contain those fears; the baby gradually learns to manage them himself. A parent does not need to take on the baby’s fears as though they are her own.

Having given the context for the book, I will turn now to outline its contents.

A summary of the contents

Part I examines ideas about how to work with families of infants with sleep problems. In Chapter 2, I describe the clinical method that is the foundation of this book. The work I do with families is psychoanalytically based, although it is usually very brief. By this I mean my approach is to take in and reflect upon what parents tell me, so that an understanding and integrative process begins in my mind. A similar reflective understanding can then take over in theirs. I look together with parents at their baby, acknowledging the baby’s uniqueness and so helping them to stand outside fixed ways of thinking and reacting. Although some of the success of this work derives from the experience of seeing many families with sleeping problems, it cannot be done in a routine way – the impact of each family’s stress and bewilderment must be received afresh each time.

The connections I make between relationships in the family and parents’ own early experience also hinge on thoughts about immediate practical solutions. However, I actively suggest these solutions much less often than do some of my colleagues working with sleep problems, although I always have in mind the many devices and practices that help a child to sleep better. I am much informed here by what other parents have told me works for them. Solutions are as much the province of parents as of myself; my task is to help them restore their ability to think effectively so that they can provide an answer for their child. In trying to evaluate the usefulness for families of this kind of brief work, I compare and contrast it with behaviour modification.

I hope to convey some of my own astonishment and delight at the effectiveness in many cases of this work and also my reactions to the intensity of it. Families come bursting with emotion, not only about their baby’s sleeplessness but also about their ordinary hopes and fears for their children. At the risk of sounding sentimental, it is a privilege to be involved with such feelings. Baby clinics, as the health visitors, nurses and doctors who work in them know, are a concentrated experience of life and death feelings about pregnancy, birth and caring for vulnerable little babies. It is exhilarating but also exhausting to be confronted by these everyday dramas.

In brief focused work about a problem like sleeplessness, families come distressed and confused and often feeling fragmented. However, in most cases these are not seriously disturbed families; they are most of the time capable of looking after their own and each other’s emotions. What they need is not to have the problem ‘solved’ or removed, but for an integrating process to start to happen. This putting-together seems often to need an outside person to start it off. Perhaps one of the satisfactions of the work is that the therapist also benefits vicariously from this process of integration. There is a deep pleasure in being involved with the intense feelings of an ordinary baby’s development.

Chapter 3 gives a case study of a family I saw with Dr Julia Nelki, the ‘Armitages’, who have allowed me to give a detailed picture of work with them (I have anonymized all my clinical examples). In this I highlight some of the issues raised in the previous chapter.

This book is principally about people, although it also examines theories; perhaps it is mainly about people’s struggle to work out their ideas. In Part I, I describe my own efforts with families to sort something out from a confusion of thoughts and emotions, for the families who come to see me are themselves striving to make sense of their experiences and ideas.

In Part II, I look at research into normal developmental processes in infants, both emotional and physiological, to provide some essential background knowledge for thinking about sleep problems. This is part of an attempt to integrate two very different disciplines – psychoanalysis and physiology. With contributions from Dr Sarah Sutton, who writes on the interface of psychoanalysis and neuroscience, I introduce relevant psychoanalytic ideas and their links with infant development, familiar to me through training as a child psychotherapist. I look too at what can be learnt from the physiological data on the function of sleep for both adults and young children and on the development of the baby’s sleep and other states.

It has been fascinating for me to discover neurobiological language for describing developmental processes in infants. I have tried here to continue the work of writers (for example, Stern, 1985) who have already combined neurobiology with psychodynamic ways of describing the infant’s emotional development. In this vein, Chapters 4 and 5 describe the functions of normal sleep and the way in which the establishment of the baby’s sleep rhythms and other bodily functions is influenced by the parents’ handling of their baby, including all the bedtime routines.

Chapter 6 describes the usefulness of dreams and nightmares, both in the physiological organizing function of rapid eye movement (REM) sleep and in the creative imaginings of the mind in remembered dreams. Both of these are different ways of describing how the mind deals with and metabolizes the experience of the day. I show how dreams can illustrate both a person’s individual thoughts and anxieties and the connection between the minds of parents and child. Dreams are the dramatizations of the mind. The sleepless families I see have lost much of their time for dreaming. I think that the dramatic playing with ideas about crucial emotions in my meetings with them helps start some of them dreaming again.

Chapters 7 and 8 examine the central hypothesis that separation issues underlie many sleep problems. Here we look at the normal emotional development of a young infant in the context of his relation to his parents. We see how the infant builds up a loving and trusting relationship and from this is able to develop a sense of his own identity. Sleep disorders may be to do with something going wrong in this process and, surprisingly perhaps, it may be the parent who has the difficulty with separation. For vulnerable parents who have themselves experienced rebuffs, putting a baby to bed may seem as though they are rejecting the baby, and a baby who closes his eyes and goes to sleep may seem to be similarly excluding the parent. But it is most important to realize that periods of being sleepless are part of normal maturation. We will look at how new stages of awareness of themselves or of the parents’ relationship quite naturally produce anxieties that keep babies awake or give them frightening dreams, or indeed they may simply be a sign of a passionate involvement with all the achievements and pleasures of the day.

Part III takes specific topics and looks at their connection with sleep problems. In Chapter 9, on feeding and weaning, I note that the establishing of both sleep and feeding patterns is an essential part of what goes on between parent and child. Feeding and sleeping also influence each other, and parents may be confused about whether a baby’s waking is because of a need to be fed. Problems about feeding, especially in a baby who needs feeding constantly, can often be clearly seen as relationship problems. Problems about weaning may reflect a feeding situation that never quite got sorted out or may represent a mother and baby’s reluctance to move on. Sleep problems often accompany these difficulties and, especially when babies have only been able to go to sleep at the breast, mothers may be dismayed at the prospect of losing this when they wean their baby.

Chapters 10 and 11, on parents’ own childhood experiences, the father’s role, the parents’ relationship, single parents and the demands of work outside the home, show how personal experience both in the past and in the present colours how parents interact with their child. Many of the parents I have seen have had difficult relationships with their own parents or have been to some degree deprived. Several of the mothers who came to me had their own mothers die before the baby was born. They have not had confirmation of themselves as a mother from their own mother. This brief work can only touch on such experiences, but making the connection between their own experiences and their interaction with their child does seem to enable parents to differentiate themselves better from their children. Just as there is a drive towards development and integration in young children, so there seems to be a similar integrative thrust towards the development of parental capacity for most people even while carrying personal difficulties inside them.

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Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgements
• 1 What is a sleep problem?
• PART I
• PART II
• Bibliography
• Index