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Collaborative Consultation with Parents and Infants in the Perinatal Period

Collaborative Consultation with Parents and Infants in the Perinatal Period

Author: Zack Boukydis Ph.D.   Chapter Author: Alexandria Stockman M.S.

ISBN: 978-1-59857-078-6
Pages: 240
Copyright: 2012
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Size:  7.0 x 10.0
Stock Number:  70786
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When professionals listen to and support new parents in the perinatal period, families enjoy long-lasting benefitsfrom stronger attachment to increased parent responsiveness and confidence. This guidebook shows practitioners how to conduct effective, collaborative consultation sessions that help parents and infants in the critical first few months of life.

Developed by an experienced clinician and researcher, this accessible guide helps practitioners form productive, equal partnerships with new parents, based on warm and attentive listening and responding. A wide range of professionalsincluding doctors, nurses, psychologists, social workers, and home visitorswill discover how to

  • understand and document key aspects of infant behavior and child-parent interaction
  • observe the baby together with parents, engaging in thoughtful observation and respectful communication
  • develop strong active listening skills so they can better understand and support parents
  • guide parents in “reading” their baby’s cry patterns and developing strategies for soothing
  • transform potential misperceptions of the infant that may interfere with parent-child bonding
  • collaborate with parents during a structured neurobehavioral assessment
  • conduct ultrasound consultations with mothers-to-be to increase their sense of connection with the baby
  • explore how the consultant’s own feelings, intuitions, and bodily reactions can help uncover what parents and infants need
  • tailor the consultation framework for preterm and/or substance-exposed infants and their parents

Principles of effective consultation come to life with clear examples and engaging vignettes, and the forms and tools—including Observation of Infant Neurobehavior, See Me Develop form, My Baby’s Behavior Diary, Cry Consultation Interview, Ultrasound Session Coding System, NETHELP social support interview, and Six Steps of Focusing— help consultants collaborate successfully with parents and record key information.

A positive, strengths-based approach for supporting infants and families, this book will help practitioners effectively nurture parent-infant attachment and give newborns the best chance for healthy development.

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Review by: Kathleen VandenBerg, Center Director/NIDCAP Master Trainer, West Coast NIDCAP & APIB Training Center, University of California San Francisco
“Some authors break through our current understanding with applications of former work that guide professionals to provide best practice. This book does just that . . . This is a must-read for NICU and perinatal professionals.”
Review by: Alison Steier, Director, Harris Infant and Early Childhood Mental Health Training Institute, Southwest Human Development
“Dr. Boukydis attends to and is deeply respectful of the experiences of the infant, the parent and the consultant. This book will be a valuable resource for students and practitioners from the many disciplines in the infant–family arena.”
Review by: Rosemarie Bigsby, The Warren Alpert Medical School of Brown University
“Sensitively navigates previously uncharted waters, to instruct clinicians in an essential area of practice—how to optimally engage caregivers in neurobehavioral assessment and intervention with their neonate. Highly recommended for all practitioners who are conducting neurobehavioral assessments.”
Review by: Angela Tomlin, Indiana University School of Medicine
“Very practical, but still grounded in research . . . a novel and valuable contribution to the infant mental health literature.”

About the Author

Introduction: Essentials of Consultation in the Perinatal Period

  1. Observing Infants and Sharing Observations with Parents
  2. Use of Neurobehavioral Assessments as a Context for Consulting with Parents and in Prevention/Intervention
  3. Consults with Parents and Caregivers of At-Risk Infants: Prematurity and Substance-Exposure
  4. Consulting with Cry Problems in Early Infancy
  5. Watching Babies in Pregnancy: Ultrasound Consultation
    with Alexandria Stockman
  6. Key Concepts and Attitudes Underlying the Consultation Process
  7. Attention to One's Felt Sense While Observing Infants and Parent–Infant Interactions
  8. Seeing and Supporting Change in Parent–Infant Relationships


Excerpted from the Introduction of Collaborative Consultation with Parents and Infants in the Perinatal Period, by Zack Boukydis, Ph.D. Copyright© 2012 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Introduction: Essentials of Consultation in the Perinatal Period

The primary purpose of this book is to develop the ability of practitioners to listen to, support, and help parents and infants in the perinatal period. The book teaches several essential frameworks and methods for relating to and working with parents and infants. This book has an interdisciplinary basis and is relevant to a wide range of health and mental health professionals. The book discusses how various professionals working with infants and families can integrate the material in the book with their particular foundational professional training. Much of the content of this book arises from the interdisciplinary field of infant mental health (Fraiberg, Adelson, & Shapiro, 1975; Heffron, 2000; Heffron, Ivins, & Weston, 2005; Sameroff, McDonough, & Rosenblum, 2004; Shah, 2007; Tomlin & Viehweg, 2003; Tronick, 2010; Weatherston, 2001; Zeanah, 2009), a relatively new and important field that has, at its core, practices involved with nurturing the parent-infant attachment relationship (Raval et al., 2001; Sroufe, 2000; Stern, 2004). One basic assumption of infant mental health practice is that to the extent mothers are well supported and emotionally healthy, their infants will receive the essential nurturing and emotional sustenance they need for healthy development. As infant mental health practice has evolved, so has understanding about how to attend to all relationships that are integral to the lives of infants (mothers, fathers, siblings, relatives, caregivers, and others; Fivaz, Frascarolo, Keren, & Fivaz-Depeursinge, 2009; Stern, 2004).

Overview of the Book

The organization of the book represents essential frameworks for

  • Observing and documenting infant neurobehavior and behavioral organization
  • Understanding the implications for using the observational framework to engage in joint observations and commentary with parents and infants
  • Listening to parents and engaging in an equal, collaborative consultation about care and interaction with their infant
  • Understanding change in parent–infant interactions

Rationale for the Book

A great deal of writing in the interdisciplinary field of infant mental health pertains to older infants and toddlers, but less has special emphasis on the perinatal period. This book focuses on that important time. In the framework presented in this book, the role of the consultant is to recognize and support the intrinsic abilities (Papousek & Papousek, 1987) that most adults have in becoming parents; help parents, at times, to perceive their infant more clearly; and, when necessary, help resolve emotional difficulties that may be preventing a parent from being able to see and respond consistently to the infant. The book addresses the complex work of seeing who an infant is and what he or she presents in his or her neurobehavioral functioning, learning about the parent and family, and then seeing how this infant and this parent match up.
    Research and evaluation evidence is accumulating that well-developed programs and services in the pre- and perinatal period can reduce later human and economic costs (O'Connor & Parfitt, 2009). This book is intended to increase the capability of those who work in programs or services aimed at prevention and intervention with parents and infants in the perinatal period. Along with this understanding of the importance of early intervention is a continuing recognition of the indigenous supports that are present in naturally occurring relationships and families—including families who have not received early intervention services organized by various governmental or private organizations. Parallel to learning the consulting emphasis in this book, professionals should be able to recognize existing, naturally occurring supports for parenting and learn how to support and strengthen informal contacts between parents and other parents, including self-help parenting groups (Boukydis, 1986, 1987; Boukydis & Moses, 1995).

How the Term Consultant Is Used in This Book

The use of the term consultant in this book is slightly different from several other uses as a professional designation. The term was chosen to recognize a practitioner who provides a special kind of service and attention to parents and infants in the perinatal period. There are several variations in how the term and the associated activities apply. A practitioner may already be trained in his or her foundational discipline and may be providing care and services that are similar to the activities in this book. In this situation, the practitioner is taking on an expanded role as a consultant, taking time to observe an infant with his or her parents and discuss implications for care, play, and loving interaction. The expanded role may or may not be recognized as part of the practitioner's daily activities. In other situations, the practitioner may be a specialist who provides services similar to the ones indicated in this book and who joins an existing team of care providers as an infant-parent specialist, developmental care specialist, and/or infant mental health specialist. Practitioners may also be providing other care, such as visiting homes or visiting mothers involved in drug treatment programs, a role in which many of their responsibilities overlap with those indicated in this book.

Important Considerations in the Consultation Process

The model of consultation in this book involves observing babies with parents and learning how to communicate with the parents about their infant's behavior and their own perceptions and feelings. Underlying the consultation are several important considerations.

  1. The consultant must have a differentiated understanding of infant behavior. Chapter 1 presents a framework for observing infant behavior and for understanding interrelationships between five levels of infant behavior. Consultants must be competent in this type of observation so that they can recognize deviations from typical neurobehavioral functioning and, by watching on all five levels simultaneously, can determine when the parent is able to respond to the infant and promote infant attention, soothing, and so forth.
        In a current program with nurses and doctors in a neonatal intensive care unit (NICU) in Turku, Finland (Boukydis, Ahlqvist-Björkroth, & Lehtonen, 2011), staff received training in the observational system detailed in Chapter 1. They then learned to engage parents who are watching their infant, comparing observations and noticing the infant's unique response to the timing and intensity of different modalities (talk, touch, look) of parental care. This training program highlights the importance of having a differentiated framework for understanding infant neurobehavior as the basis for talking and consulting with parents.
  2. The consultant must have an understanding of infant neurobehavior, socioemotional development, and parents' attributions of intentionality to infant behavior. Consultants must already be trained in recognizing and assessing expected patterns of socioemotional development in infants (Damon & Lerner, 2006; Kopp, 2003; Leach, 2010). With this knowledge they can compare their observations with a parent's verbal and behavioral responses to his or her infant and offer input when a parent attributes intentionality to the infant's behavior. Sometimes the parental attribution of intentionality is positive or neutral. For example, a 2-day-old infant has a smiling facial expression, and her mother says, "She is so happy to be with me!" There are times when this positive attribution is more a statement about the parent's emotional state than about the infant's behavior. There are also times when attributional statements can be problematic: either widely divergent from the infant's actual developmental level and functioning or stating an intention (on the part of the infant) that is harmful and manipulative. For example, a mother looks at her 2-month-old, who has been fussing and frowning, and says, "He's a wild one—he's got it in for me, just like his daddy" (in a situation where the infant's father has been abusive to this mother in the past).
  3. The consultant must have a desire to listen to parents and provide conditions in which the parents can listen to themselves. The willingness of the consultant to listen must be accompanied by a curiosity to hear about the meaning parents give to their infant, their infant's behavior, and their evolving understanding of being a parent. The consultant's being "present" can be an essential attitude in providing conditions in which parents can be attentive to their bodily felt experience (their "felt sense") and thereby connect with their intuitive parenting capacity. Papousek and Papousek (1987) describe this intuitive parenting capacity, which is biologically grounded in human beings and includes the ability to anticipate an infant's needs and interpret an infant's communicative signals. If a consultant is willing to listen and exhibits curiosity about parents' feelings, parents are more likely to pay attention to the source of their intuitive parenting capacity, which can be felt in their bodies, in their felt experience.
  4. The consultant should be attentive to the parent, as the emotional climate of the consultation process can influence the emotional energy between parent and infant. As consultants are more able to listen to themselves, they can dissolve their own possible barriers to care and empathy for a particular parent. There is evidence (Heffron, 2000; Heffron et al., 2005) that indicates that a consulting relationship based on warmth and attentiveness can help parents become more aware of their own feelings. For the consultant, just being an attentive human presence and witnessing the parent and the infant together is absolutely the most important aspect of the early consultation. Over time, it is important for the consultant to continually "be there"—that is, to show up in the present moment. Consultation with different parents and infants inevitably brings up one's own feelings. When appropriate, the method of "focusing" (Gendlin, 2007) taught in Chapter 7 can be useful in helping the consultant attend to his or her own feelings while remaining consistently capable of being present with a particular parent and infant.
  5. The consultant must move from being seen as an authority to being a collaborative partner with the parent. Throughout this book are descriptions of how the consultant can move from being seen as an expert to being seen as a partner/collaborator. To most parents, an expert means someone who knows their infant—how to comfort, care for, or play with their infant—better than they do. The main message of equality starts with the consultant's understanding that this is the parent's infant. The ideal consultant attitude is to join with the parent in "looking together" at the infant and sharing both human reactions and thoughtful observations. This kind of sharing does not mean that the parent's or the consultant's observations predominate; rather, the two meet on equal ground of thoughtful observation, curiosity, and respectful exchange (Sparrow, 2010). However, encouraging such partnership does not mean that the practitioners give up their experience or professional responsibility.

Understanding Consulting in the Perinatal Period

The transition to parenthood (Cohen & Slade, 2009; Kitzinger, 2003; Susuki, 2003) leaves most parents feeling "in process." After their baby is born, parents may not have very much time to notice fully all that they are feeling, and the process of understanding what was felt during the transition (including the birth experience) can take hours, months, even years. At this time of transition, the consultant must be especially able to recognize and attend to the self-righting tendencies and natural parenting instincts in parents, even where there is disruption.
    Sometimes, consultants can inadvertently create more problems with their approach and, possibly, their anxious or intrusive presence. Whatever a consultant may be feeling privately, the basic preconditions of welcoming the infant, witnessing this event in the parents' life, and knowing how to identify strengths in parenting (sometimes in the midst of real concerns) are prerequisites to the consulting process taught in this book.
    During parent–infant interactions, the physical presence of a calm and attentive consultant can reduce tension or anxiety enough for parents to attend to feelings from their interaction with their baby. One fundamental of the consulting process is that the consultant must learn to watch, to be less active, and to offer comments sparingly, with good timing. This does not mean that consultants remain passively silent but that they use silence to both watch the parent and infant and attend to their own feelings about the interaction. As a result, consultants have a better sense of when to offer comments and watch what effect those comments have on the parent.

Key Attitudes Underlying the Consultation Process in This Book

It is important for consultants to continually question how they see parents, particularly a given parent's potential for change and development. One must consider whether this change comes from the infant and their emerging developmental capabilities, the parent and their changing perceptions and feelings, or new conscious efforts by the parent to change problematic, recurring interaction patterns. This book asks consultants to consider their own assumptions about changeability and barriers to change in parents and human beings in general.
    Much of the essential practice in work with parents and infants starts with a base of encouraging practitioners to be empathic, caring, and able to listen to what parents are saying about their relationships with their infant (Boukydis, 1990; Heffron et al., 2005; Pawl, 1995; Pawl & St. John, 1998). The essence of the consultation process in this book puts a special emphasis on listening to parents so that they may be more able to notice and attend to their bodily felt experience of their interactions with their baby. It is essential that practitioners know for themselves how to engage in active listening with parents (Friedman, 1987, 2007; Klein, 2007; McGuire, 2007). In consultations, parents may at times be disoriented or distracted from their own immediate feelings. Some parents may be hurting and deceiving themselves and have temporarily lost the ability to listen to their own basic felt experience. It is helpful to know a great deal about active listening when the consultant is unsure what, and how, the parent is feeling. When consultants are unsure what to do or say, they listen to the parent for a short while, and they can also pay attention and listen to their own felt experience of the parent and infant interacting. The attention to the consultant's own experience and the discernment that arises from this process can be especially necessary and compelling during the contacts with people who have just become parents.
    Several important concepts and assumptions about the consultation process underlie the practices in this book. This introduction has provided a review of those concepts and assumptions and what the reader may expect from the consultation framework laid out in this book. Chapter 6 provides more detail on the underlying concept and assumptions about the consultation process indicated in this book. Chapter 7 discusses the importance of the consultant's reference to his or her felt sense of parent–infant interactions and teaches the process of focusing (Gendlin, 2007). Chapter 8 expands on the concepts and philosophy of change in parent–infant relationships introduced here.