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15.TheTeamApproachtotheTreatmentofaTraumatizedMother andChild:LydiaandRyan AnniBergman,withsectionsbyK.MarkSossin,SuziTortora, Lydia(Ryan’smother),PhyllisCohenandBeatriceBeebe
PARTVII:THETHERAPISTS’ PROCESS
16.TheTherapistGroup:ATransformationalProcess BeatriceBeebe,PhyllisCohen,AnniBergman,SallyMoskowitz,K.Mark Sossin, RitaReiswig,SuziTortoraandDonnaDemetriFriedman
PARTVIII:PERSPECTIVESONEARLYTRAUMA –NEUROPSYCHOLOGICALANDCLINICALLITERATURE
17.PrenatalMaternalStressandtheDevelopingFetusandInfant:AReview ofAnimalModelsasRelatedtoHumanResearch
18.DyadicTraumainInfancyandEarlyChildhood:ReviewoftheLiterature SaraMarkese
PARTIX:COMMENTARY
19.TheStrengthofRelationshipsintheFaceofTraumaFromTerror
atPrattInstitute;andtheNewSchoolforGeneralStudies.SheisaBoardMember oftheNewYorkZerotoThreeNetwork.Dr.Tortoraistheauthorof TheDancing Dialogue:UsingtheCommunicativePowerofMovementwithYoungChildren and severalchaptersandarticlesontheuseofnonverbalcommunicationandvideo analysisinparent,infantandchildpsychotherapy.
DonnaDemetriFriedman,LCSW,Ph.D. isaDoctorofSocialWork.Sheisanadult, child,andmother-infanttherapist.SheisthedeputyexecutivedirectoroftheRiverdaleMentalHealthAssociation,anoutpatientmentalhealthclinic.Sheobtained aMastersinclinicalsocialworkandpsychology,bothfromNYU.Shecompleted herPh.D.workingwithDr.Beebe.Sheteachesattachmenttheory,childdevelopment,andclinicalpracticewithindividualsandgroupsatNewYorkUniversity.Dr. Friedmanhaspublishedseveralarticlesandhasco-editedaspecialissueonattachmentfor TheJournalofClinicalSocialWork.Sheiscurrentlyco-editingabook entitled, Attachment-basedClinicalSocialWorkwithChildrenandAdolescents.Dr. FriedmanwasgiventheOutstandingAlumnaAwardforherworkininfantmental healthin2009fromNYU.
INADDITION,FIVEOTHERPEOPLECONTRIBUTEDTOTHIS BOOK.THEYAREASFOLLOWS:
JosephJaffe,M.D. isProfessorofClinicalPsychiatry(inNeurosurgery),Collegeof PhysiciansandSurgeons,ColumbiaUniversity,andheadoftheCommunication SciencesLab,DepartmentofChildandAdolescentPsychiatry,NewYorkState PsychiatricInstitute.Hisinterestsincludeneuroscienceandtheoreticalbiology.With StanleyFeldsteinheisauthorof RhythmsofDialogue (AcademicPress,1970);with ClayDahlberg,heisauthorof Stroke:ADoctor’sPersonalStoryofHisRecovery (Norton,1977);withBeebe,Feldstein,Crown,andJasnow,authorof Rhythmsof DialogueinInfancy (Blackwell,2001).Formanyyears,Dr.Jaffeledaresearch grouponnonverbalaspectsofcommunicationthathascontainedasmembersBeatriceBeebeandDanielStern,whoselandmarkbook TheInterpersonalWorldofthe Infant (1985)consolidatedarevolutioninpsychoanalyticdevelopmentalpsychology.
SaraMarkese,Ph.D. isaclinicalpsychologistspecializinginthetreatmentoftrauma inearlychildhood.SheisaformerpostdoctoralfellowandcurrentresearchcollaboratorintheCommunicationSciencesLabwithDr.Beebe,DepartmentofChild andAdolescentPsychiatry,NewYorkStatePsychiatricInstitute.Shehaspublished onthetreatmentofearlychildhoodtrauma,andsheisco-authorwithDr.Beebeon halfadozenbasicresearcharticles.
MarshaKaitz,Ph.D. headstheLaboratoryfortheStudyofParentingandEarly DevelopmentintheDepartmentofPsychology,HebrewUniversity,Jerusalem, Israel.ProfessorKaitz’sresearchinterestsincludeparent-childinteractionsin normalandpathologicalpopulations;regulationprocessesthroughoutchildhood; theintergenerationaltransmissionoftraumaandanxiety,andtheinfluenceofacute andchronicexposuretoterrorontheantenatalhealthofwomenandfetaldevelopment.ProfessorKaitzalsoheadsaJerusalem-basedhome-visitingprojectfor
Foreword
BeatriceBeebe,PhyllisCohen,K.MarkSossin,AnniBergman, SallyMoskowitz,RitaReiswig,SuziTortora andDonnaDemetriFriedman
InthisbookwedescribetheProjectforMothers,Infants,andYoungChildrenof September11,2001.Thegroupofchapterspresentedhererepresents10yearsof involvementofacoregroupofeighttherapistsworkingwithfamiliesofwomenwho werepregnantandwidowedinthedisaster,orofwomenwhowerewidowedwithan infantborninthepreviousyear.ThesetherapistsareBeatriceBeebe,PhyllisCohen, AnniBergman,SallyMoskowitz,K.MarkSossin,RitaReiswig,SuziTortora,and DonnaDemetriFriedman.
Thisbookwasoriginallypublishedasaspecialissueofthe JournalofInfant,Child andAdolescentPsychotherapy. Wewantedtore-printthejournalissueasabookin ordertoreachawideraudience,forthedegreetowhichthistraumacontinuesto impactthesefamiliesisnotgenerallywellunderstood.Explicationofourworkmay informfutureeffortsatpreventionfollowingtraumaticloss.
ThisProjectwasateameffort.PriortoSeptember11,2001,mostofuskneweach otherinvariousways,butwehadneverworkedtogetherasagroup.Withdiverse backgrounds,eachtherapistbroughtsomethinguniquetothegroup,includingclinical andresearchexpertiseinbodymovementandnonverbalcommunication,aswellas expertiseinadult,child,mother-infant,group,familyandcouplestherapy.Bymeeting togetherforaneveningeveryotherweekoverthepastdecade,wedevelopedourprogramcollaboratively,madeallourdecisionstogether,learnedfromeachother,and evolvedastrong,creative,andmutuallysupportivegroupprocess.
Eachofushadabackgroundasanindividualtherapist.However,weevolvedateam approachinresponsetotheneedsofthefamilies.Weworkedinteamsoftwotothree therapistsinoursupportgroupsformothersandchildren,andinteamsofatleast threetherapistsinour filmingconsultationsformothersandchildren,andinour feedbacksessionsformothers.
Thegroupprocesshasnurturedourthinkingandourabilitytomaintainoureffort tohelpthemothersandchildrenwhohaveexperiencedthisunthinkabletrauma.We havecontinuouslyworkedtounderstandtheinternalworldsofthechildrenandthe motherswholosttheirfathers/husbandsinsuchatraumaticway.
PhotobyLucilleTortora.Reprintedwithpermission.
Thedemandsofthecrisisledustoexpandourpsychoanalytictraining,fostering newapproachestomeetingtheneedsofthesefamilies.ThisProjectwasuniqueforall thetherapistsinvolved.Althoughweallhadextensiveexperiencewithtrauma,wewere nottrauma “experts.” Wesoughtoutthesefamilies,offeringsupportgroupsfor mothersandtheirinfantsandyoungchildreninthemothers’ ownneighborhoods,and bringingthefamiliestomother-child filmingsessionsatColumbiaUniversity,New YorkStatePsychiatricInstitute.In2011,markingthe10 th anniversaryoftheWorld TradeCenterattack,ourProjectcontinuestoprovideprobonoservicesforthese motherswholosttheirhusbands,fortheirinfantswhoarenowapproximately10years old,andforthesiblingsofthesechildren.
Thedegreetowhichthistraumacontinuestoimpactthesefamiliesisnotgenerally wellunderstood.Recoveryfromatraumasuchasthisoneisalong-termprocess. However,thereisnoonepictureoftheeffectsofthistrauma.Thefamilieswithwhom wehaveworkedexperiencedandcopedwiththeeffectsofthistraumainuniqueand personalways.Despitethemagnitudeoftheongoingsufferinginthesefamilies,thereis alsoremarkableresilienceandgrowth.
WhenwebegantheProject,wedesignedtheclinicalservicesthatwedescribeinthe followingchaptersbasedonourownunderstandingofthepotentialeffectsoftrauma oninfantandearlychilddevelopment,adultfunctioning,andthemother-childrelationship.Overthepastdecadetherehavebeenanumberofresearchdocumentations andclinicaldescriptionsoftheeffectsofthetraumaticeventsofSeptember11,2001, onyoungchildrenandtheirparentslivinginthesurroundingareasoftheWorldTrade Center(Chemtobetal,2010;Chemtob,Nomura&Abramovitz,2008;Coates,Rosenthal&Schechter,2003;Danieli&Dingman,2005;Hoven,Duarte,Lucas,Wu,Mandell,etal.,2005;Mowder,Guttman,Rubinson,&Sossin,2006;Neria,Gross, Marshall,&Susser,2006;Schechter,2003;Schechter,Coates&First,2001;Wilson, Lengua,Meltzoff,&Smith,2010).Consistentwithourview,thesechaptersallconcludethatparentsandyoungchildrenwerehighlyvulnerabletothetraumaticeventsof September11,2001,andthatyoungchildrenandparentswouldbenefitimmensely frompreventionandinterventioneffortsinthefaceofsuchtrauma.None,however, havefocusedspecificallyonthegroupwetargeted,inwhichthemotherwaspregnant andthehusbandwaslost.
SEPTEMBER11,2001
InthelateafternoonofTuesday,September11,ImetDr.AnniBergmanbychanceon thestreetinChelsea,NewYorkCity,wherewebothlive,fourmilesfromtheWorld TradeCenter.IknewAnnifromherworkonmother-childpsychotherapy,andbythis pointshehadbeeninaseminarwithmeforanumberofyears.Wewerebothina dazedstate,andweofferedeachothermutualsupport.InthenextseveraldaysI learnedonthenewsthattherehadbeen39pregnantwidowsfromone firmalone, CantorFitzgerald.Icouldnotstopthinkingabouttheexperiencesofthesemothers andoftheirbabiesstillinutero.Iwonderedhowmanyotherstheremightbe.Inthe aftermathoftheterrorandconfusion,IleftNewYorkCityfortheweekend,andIwas fearfulasIreturned.Fromthetrainonthewayhomeattheendoftheweekend,I calledDr.PhyllisCohen,withwhomIhadcollaboratedforhalfadecadeonan intensivemother-infant/mother-childtreatment.Iproposedacollaborationona
dance-movementtherapist,Suziusedvideoanalysisofnonverbalcommunicationin herclinicalpracticewithinfants,children,families,andadults.Suzi’sobservationsof thevideointeractionswereessentialtoourfeedbacksessionswiththemothers.These observationsweretranslatedintopracticalclinicalinterventions.Suzi,aswellasDr. MarkSossin,hadadeepunderstandingofmovementdynamicsandnonverbalprocess basedontheLabanSchool.
Dr.MarkSossinwasmyPh.D.studentwhenItaughtatFerkaufGraduateSchool, YeshivaUniversity,beginningin1978.Thatconnectionbeganabondthatwasalways strongbutonlyfully floweredinthecontextofthisProject.Mark’sextraordinary abilitytoengagechildrenintherapeuticplaybecameanindispensabledimensionofthe videobondingandcommunicationconsultationsatthelab.Hisremarkableabilityto observenonverbalcommunicationbeganwithhisworkwithDr.JudithKestenberg. SuziattendedDr.Kestenberg’ s firsttrainingprogram,whichwasco-taughtwithMark Sossinandothers.MarkSossinandRitaReiswigwentthroughchildpsychoanalytic trainingtogetherattheNewYorkFreudianSociety,whichincludedstudywithAnni Bergman.Anniwasanoutstandingteacher,whomodeledadeeplyrespectfulwayof engagingandthinkingaboutchildren.
Dr.DonnaDemetriFriedmanwasoriginallyoneofmyPh.D.students,whereshe learnedthevideomicroanalysisofmother-infantcommunication.JoeJaffewasoneof herimportantteachersinthestudyofmother-infantrhythmsofdialogue.Becauseof herremarkableclinicaltalent,IinvitedhertojointheProject.Shehadalreadybegun toworkwithfamiliesofSeptember11,2001,attheclinicshedirected,theRiverdale MentalHealthAssociation.DonnaDemetriFriedmanwentontocreateanearly childhoodcenterattheRiverdaleClinic,usingvideotapedinteractionsasacomponent oftheintervention.
Withoutthededicationofthisremarkablegroupoftherapists,thisProjectcould neverhavedevelopedand flourished.
OnlygraduallydidwelearnthatmostofthemothersdidnotliveinManhattanor BrooklynbutratherinNewJerseyandsomeonLongIslandandStatenIsland. Thankstoreferralsfromthepsychoanalyticcommunity,andthanksinparticularto Drs.JamesFosshageandGerryCostaandthetirelessoutreachofPhyllisCohen,we begananintensivesearchfortherapistswhomightliveintownsinNewJerseyorLong Islandnearthewidowedmothers.
TenothertherapistswererecruitedandbecameessentialtothesuccessoftheProject intheearlyyears.Dr.KerstinKupfermann,acolleagueofAnniBergman,wasalso brieflyinoneofmystudygroups.Forseveralyears,alongwithMarkSossinandRita Reiswig,Kerstinwasoneoftheleadersofamother-childsupportgroupuntilher retirement.Dr.NaomiHirschfeldwasanotheroneofmyPh.D.studentsatYeshiva Universityinthe1980s.Naomimadeanoutstandingcontribution,andshecontinues tobeassociatedwiththeProject.Dr.LindaTaylorandIhadcrossedpathsinthe 1990sthroughcolleaguesactiveinmother-infanttreatment,andIhadalwaysadmired Linda’swork.WewereluckythatLindajoinedtheProjectintheearlyyears,andshe andNaomiranamother-childsupportgroup.Dr.KathrynAdorneywassenttousby Dr.JimFosshage.KathrynplayedanabsolutelypivotalroleinorganizingtheProject inNewJersey.SheworkedtirelesslyfortheProject,andweareenormouslygratefulto her.Kathrynalsoparticipatedinamother-childsupportgroupinNewJerseywith NaomiHirschfeldandLindaTaylor.Throughintenseoutreacheffortsspearheadedby PhyllisandKathryn,wewerealsoveryluckytomeetDrs.SarahBehrMoabaand
KristenPeck.SarahandKristenranamother-childgroupinNewJerseyintheearly yearsandtheywereatremendousassettotheProject.Dr.NancieSenetandHelge StabyDeatonalsoparticipatedintheearlyyearsoftheProject,runningamothers’ groupaswellasachildren’sgroupinNewJersey,assistedbyRebeccaMelon.Weare alsogratefulforthecontributionsofDr.IritFelsen,LynnMacarin-Mara,andJane SchacterWalco,whowerebrieflyassociatedwiththeProject.Ourthanksalsogoto colleagueswhoconsultedatthebeginningoftheProject,Drs.MarvinHurvich,Sarah Hahn-Burke,SusanCoatesandStephenRuffins.
LAUNCHINGTHEPROJECT
Dr.SaraMarkese,Dr.MichaelRitter,andEmilyBrodie,studentresearchassistantsat thetimeoftheWorldTradeCenterdisaster,wereinvaluabletotheorganization, administration,andlabvideotapesessionsoftheProject.SaraMarkesestayedonand administeredtheProjectforsixyears.MichaelRitterledthe filmingteamformany years.SaraMarkesebecameaprincipaleditorofthis JICAP specialissueandbook. BriannaHailey,DaniellaPolyak,andEdwardLiebmannwereassistanteditorsofthe specialissue.
Despiteourorganizationalefforts,wehadnoideahowharditwouldbeto findand engagethewidowedmothers.OutreachbeganinNovember2001whenPhyllisCohen visitedthe firmCantorFitzgerald.ThankstothededicationofRobertTalbotandthe assistanceofAllisonLutnick,theProjectwasabletobegininMarch2002,when CantorFitzgeraldbegantointroduceourteamoftherapiststothewidows.Probono clinicalservicesbeganinApril2002.
CONCLUSION
Thevideobondingandcommunicationconsultationandsupportivegrouptherapy,in conjunctionwithstandardadultandchildtherapyandcontinuousoutreach,formthe foundationofthetraumaresponseprovidedbytheSeptember11,2001,Mothers, InfantsandYoungChildrenProject.TheProjectwasconceivedfromtheoutsetas primarilyaclinicalendeavorbutalsowitharesearchcomponent.Atthispointwehave notyetconductedanyresearch,butwehopetodosointhefuture.
AnunexpectedbenefitoftheProjecthasbeenthereparativeeffecttheworkhashad onallinvolvedinitsimplementation,approximately25therapistsand50psychology studentvolunteerassistantstodate.Themothersandchildrenhavedescribedtousthat theyhavebeenhelpedinmanifestwaysbyourclinicalinterventions(seeMothersof theProject,Chapter4).Butaswestandnowattheten-yearmarkandreflectbackon theprogressofthework,anothergroupofpeopletouchedandhealedbytheProject hassurfaced:therestofus.Wesoughttoempowerandsupportthosemostdirectlyand tragicallytouchedbytheattacks,yetwewereallaffectedinsomewaybythetragedy andhealedbyourinvolvementinthisProject.
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