Joanne wrote us about a mother who most unfortunately had been told by: "a child psychologist that "attending to her child`s needs was ``controversial in the psychological literature`` and that ``she owed it to herself to explore other approaches to parenting``. 

I agree with the psychologist that there is a lot of controversy in psychological literature regarding "attention" to children's needs and parenting styles. Similar to other scientific disciplines, there are a variety of theories presented in psychological literature. Hence, clinicians who wish to apply professional literature to clinical practice must be able to ascertain the scientific accuracy of a research model as well as the appropriateness of the model for the individual client. The ability to decipher and implement psychological theory, is enhanced by an understanding of the principles of human psychology and development, a working knowledge of scientific process, an ability to comprehend the client's reality as well as an in-depth awareness of the effect of client issues on the clinician i.e. counters transference. 

The application of these concepts to the context of psychological work with breastfeeding mothers, such as the mother described in Joanne's letter, indicates that optimally clinicians who work with breastfeeding clients should be able to interpret and realize which professional literature, research and paradigms are truly useful and appropriate for nursing families. In a practical sense, this means that clinicians apply theories of psychological function and human development, for example, to understand the role that nursing plays in child and female development. An understanding of concepts of physical, emotional and cognitive development in children inform the therapist and client of the age appropriate behaviors and needs of the child whom the mother is nursing. Comprehension of relational theories, for example attachment theory, indicates that engaging in nurturing relationships has a positive effect on one's sense of self and self in relation to others. Family systems theories provide insight into the role of nursing in family process. 

Optimal clinical work with clients involved in breastfeeding relationships is also contingent on a concise understanding of the interplay between the physiological and psychological aspects of breastfeeding at all levels. This illuminates the manner in which act of nursing is dependent on and also affects other behaviors at individual and family levels. Psychological work is promoted when therapists acknowledge the manner in which extended breastfeeding and related parenting behaviors, influence the therapist's feelings towards the client and therapeutic interventions. 

Unfortunately, it does not appear that Joanne's client was provided with an experience that reflects the principles noted above and hence, her mothering experience was devalued rather than validated. One might suggest that the therapist in this case is similar to so many other clinicians who choose to ignore the theories in the literature that provide insight into the psychological reality of nursing. This might be due to out right disregard for or lack of knowledge of psychological theories that promote parental child intimacy, children's individuality,principles of human development including child, female or male development. On the other hand, it appears that there are many clinicians who do understand and promote relational as well developmental principles yet, their apparent discomfort or lack of understanding of nursing, interferes with their ability to connect concepts that they cherish to the context of nursing. It is interesting to note, for example, that even some of the theorists, who provided us with an understanding of underlying processes that draw mothers and children close together, also do not seem to acknowledge role that the nursing relationship plays in defining and strengthening these bonds (Bolwby for example). While the source of non-empathetic clinical interventions are dissimilar, the results are the same and issues such as co-sleeping, frequent maternal/child interactions and child led weaning are pathologized rather than viewed as normal.

This seems to be the case for Joanne's client. Joanne told us that the psychologist asked ".. who the ``guru`` of``what did you call it, attachment parenting?`` The tone of that sentence seems to suggest that this psychologist is not open to the client's world view. Joanne also wondered if: "...she would get anywhere if she asked the psychologist to provide evidence?". It seems this step would be futile and a waste of the client's precious energy. It is important to remember that there is a lot of literature that encourages less attuned parenting styles and thus, the psychologist would likely be able to produce apparent evidence with little effort. This might lead to further confrontation rather than understanding. Since empathy and validation are integral to psychotherapeutic relationships, it seems that, based on Joanne's narrative, Joanne's client and other mothers like her, would be benefit more from finding other sources of support.

I am well aware that finding the right psychotherapist is not always an easy task. However, other sources of support are available and include group interactions, such as those provided by the La Leche League, and relationships with client advocates like Joanne. Hopefully, the availability of good research on the psychology of breastfeeding will eventually increase in clinical circles and families will be provided with the understanding that they deserve.

Keren Epstein-Gilboa MEd BScN RN LCCE FACCE IBCLC PhD (Candidate)

researcher psychology of  breastfeeding, psychotherapist and mother who practiced attentive parenting, despite controversy, and sees the positive results 

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