Mental Health Consultation: A Psychologist in Preschool

(Published in The California Psychologist, Volume 43, Number 5, September/October 2010)

I observe children in preschool classrooms. Sometimes, as I am watching, I ask myself how it is possible to get paid to do the job that I do. Perched on a chair at the edge of the room, I apply the same principal that I did when I was a child, crouched over tide pools: watch long enough and something is bound to happen. A child with low frustration tolerance will have an outburst when she cannot complete an activity. How will the teachers handle her tantrum? A child with a history of abandonment will become distressed when the teacher leaves the room. What meaning will the remaining teacher make of his behavior? On a lucky day, a prized moment will occur. At a nearby table a conversation begins.

“My mom says that when somebody dies, they become another person,” one little girl says to two others.

“Like becoming a baby again?” her friend responds, using what she knows about the world to grasp this new and elusive concept.

The third, already envisioning her friend’s inverted development, blurts out, “Are you going to be a baby and wear diapers again?!?” All three explode into a fit of giggles.

Observation is the core of my work in preschool. But as an Early Childhood Mental Health Consultant, it represents only a small (and fun!) part of a much more complex job. I use my observations to 1) Identify children with mental health issues and link them with services and 2) Identify problems in the preschool system as a whole and work to address them. All of my work is embedded in the relationships that I have cultivated with the teachers, parents, children and staff over a period of months or years. The model of Early Childhood Mental Health Consultation that I implement is long term and relationship based (Johnston, K. & Brinamen, C., 2006).

The Case of James

James spent his first two weeks at preschool intently watching the other children and the teachers from a safe spot at the entrance to the classroom, attempting to make sense of what he was supposed to be doing there. When he finally joined the group, the teachers and I quickly noticed that James had some difficulties. During one-on-one conversations and classroom meetings, we brainstormed answers to the following questions: “Why does he provoke the other children with mean language?” “What is the meaning behind his aggression towards his classmates, his teachers and even himself?” “What can we do to help him relax and ease his rigidity when he gets upset?”

Feeling that we needed more answers, we decided to call a meeting with his parents. Since we did not know them very well, the site director, lead teacher and I decided that the meeting should be geared towards building a relationship and finding out more about their family. During the meeting, James’s parents were very forthcoming. We discovered that they were struggling with foul language, aggression and rigidity at home, and asked them to share their strategies for supporting and calming him. My ears perked when James’s mom told us that James had observed her getting attacked by a dog a few weeks before he started preschool. She also shared that, at age two, James had split his forehead and had to be held down by his mom and dad while the doctor gave him stitches. I recalled Alicia Lieberman’s (2008) term “emotionally costly stress” and wondered what James had internalized from these frightening experiences.

Before the meeting ended, I asked James’s parents for their written permission to keep a closer eye on their child, and suggested that we meet or speak on the phone again soon. In a private conversation, I suggested to James’s parents that they address the issues their son is having by engaging in dyadic therapy, and offered them the names and numbers of some agencies and therapists who could help. I expressed my concern about how James’s “emotionally costly” experiences might be preventing him from developing friendships, learning new things in school, and hence progressing developmentally. I explained the neurological processes in the brain that allow young children to be so flexible and hence so amendable to early intervention. Thankfully, James’s parents were willing, and able, to take my advice. The child is now more relaxed and less aggressive, has better relationships with his parents, teachers and peers, and is learning and growing every day.

A Presence in Preschool

With parents like James’s, helping teachers by helping the children in their classroom is easy. More difficult to address are systemic issues in the classroom and the preschool as a whole: a team of teachers in a classroom who don’t get along; differences in approaches to handling children’s problems; discrepancies in teacher training and education; even underlying race and class tensions amongst the staff.

In the beginning, all these problems felt overwhelming to me. I took them on and did my best to fix them, feeling frustrated when I was not successful. As I gained experience, knowledge, and confidence, I began to realize the importance of mere presence. Being there to listen, to reflect and to bear witness to their difficulties is extremely powerful. If there is an argument or misunderstanding between two teachers, I listen calmly, mediate with neutrality and attempt to cultivate understanding about each other’s perspectives. I coach teachers individually on how to communicate effectively, being careful to practice what I preach with my own words.

When confronted with disagreements about approaches to child rearing, I work to create an environment in which the teachers and I can all think together about what is best for the child or group of children. Oftentimes during these conversations, I take on the perspective of those with the smallest voice: the children themselves.

To address discrepancies in education and training, I draw on my knowledge base of psychology and my years of experience in the classroom. Cautious of taking on the expert role, but acknowledging that I have useful information to share, I tactfully interject psycho-education into my conversations. I additionally have created tools to hone observation skills and better understand children’s behavior that I continue to refine. The teachers and I implement these tools together, in vivo, in the classroom.

On rare occasions, I am given the opportunity to do groups with all the teachers and school staff. During these groups, I incorporate exercises that encourage self-reflection and perspective taking. For example, I ask each person to reflect on a difficult experience in the classroom: what they felt, where in their body they felt it, and how their feelings influenced their consequent treatment of a child or co-worker. Each person then shares his/her answers out loud. These exercises highlight how everyone struggles to do the emotionally taxing job of being a preschool teacher, and how similar their struggles are. They additionally create empathy for their fellow teachers and staff, and allow for a release of pent up stress and tension. Following these groups, it is as if the entire center has taken a collective sigh. They are gentler on each other and on themselves, and better able to attune to the children’s needs.

As an Early Childhood Mental Health Consultant, I know that I cannot solve the complicated dynamics and multiple layers of problems so often present in preschool. But I can create a safe space for people to express their points of view, to find meaning in children’s difficult behaviors, and even to talk about how larger issues of race and class intersect in the preschool classroom. By being open to what comes and present for the teachers, parents, children and school staff, I create a container for their experience. By creating a container for the needs of the adults, the adults are then able to create an effective container for the needs of the children. And at the end of the day, that is the real reason why I am a psychologist in preschool.


References
Johnston, K. & Brinamen, C. (2006). Mental Health Consultation in Child Care: Transforming Relationships Among Directors, Staff and Families. Washington, DC: ZERO TO THREE Press.
Lieberman, A & Van Horn, P. (2008). Psychotherapy with Infant and Young Children: Repairing the Effects of Stress and Trauma on Early Attachment. New York: The Guilford Press.