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child (Geller & Foley, 2009). To rush to offer advice or to demonstrate positive play methods, although superficially satisfying, is often ineffective and can add additional stress to an already tense parent–child relationship. Furthermore, language stimulation techniques that might be suggested to develop early language skills are applied during play. I would suggest that if the parent–child relationship is poorly developed, enjoyable interactions between parent and child may not be occurring. Therefore, to recommend a parent target language goals during their time together is likely to cause frustrations and feelings of inadequacy, risking further damage to the relationship. Initial therapeutic goals might instead focus on achieving positive interactions with their child, for example, following their child’s lead during play. In order to develop language through positive play, positive play must first be achieved. As it turns out, this approach works for Sandra and Jonah. Over the course of several weeks, we videotape and jointly review a number of informal play sessions. Videotaping is an excellent method for supporting parents to reflect on how their child communicates, and on their role in parent–child interactions (Marvin, Cooper, Hoffman & Powell, 2002; McDonough, 2005). Sandra notices that Jonah often uses gesture to initiate interactions. She also reflects that she is often quiet because she is not sure if he wants her around. I highlight moments when Sandra successfully attunes to Jonah’s affective states. As she feels more empowered and comfortable, Sandra spends more time in the session focusing on what she can do to achieve positive interactions with Jonah. Sometimes I offer specific suggestions about following his lead during play. At other times, I put the video-camera down to demonstrate positive play methods and occasionally even a language stimulation technique. All the time, I am gathering more data about Jonah’s speech and language skills, as well as developing Sandra’s ability to support his development in these areas. Of course, it is not all smooth-sailing. At times, progress seems painfully slow. I feel pressured to move the clinical work forward. Holding Sandra’s strong emotions is emotionally exhausting but she needs to be helped to co-regulate Jonah. Fortunately, regular reflective supervision and the opportunity to co- work with the family’s psychologist provide much needed emotional support and clinical guidance. I know we have made significant progress when Sandra proudly tells me that she is “getting down on the floor” every day with Jonah at home, and when she begins to ask for copies of the videotaped footage to give to Jonah

when he is older. She is learning that she matters to Jonah, and that she can support him to grow and develop. As her confidence grows, so does mine. Relationship-based practice works! References Chambers, H., Amos, J., Allison, S., & Roeger, L. (2006). Parent and child therapy: An attachment-based intervention for children with challenging problems. Australian and New Zealand Journal of Family Therapy , 27 (2), 68–74. Cohen, N. J., Muir, E., Lojkasek, M., Muir, R., Parker, C. J., Barwick, M., & Brown, M. (1999). Watch, wait and wonder: Testing the effectiveness of a new approach to mother–infant psychotherapy. Infant Mental Health Journal , 20 , 429–451. Geller, E., & Foley, G. M. (2009). Expanding the “ports of entry” for speech-language pathologists: A relational and reflective model for clinical practice. American Journal of Speech-Language Pathology , 18 , 4–21. Mares, S., Newman, L., Warren, B., & Cornish, K. (2005). Clinical skills in infant mental health . Sydney: ACER Press. Marvin, R. S., Cooper, G., Hoffman, K., & Powell, B. (2002). The Circle of Security project: Attachment- based intervention with caregiver-pre-school child dyads. Attachment & Human Development , 4 , 107-124. McDonough, S. C. (2005). Interaction guidance: An approach for difficult-to-engage families. In C. H. Zeanah (Ed.), Handbook of infant mental health , 2nd ed., 485–498. New York: Guilford Press. Weatherston, D. J. (2000). Qualities of the infant mental health specialist. Zero to Three , 21 (2) 3–10. Kristy Collins is the senior speech pathologist at CAMHS Northern Region in South Australia. She has a keen interest in addressing emotional and behaviour concerns in early childhood and recently completed a post graduate Diploma in Infant Mental Health from the Institute of Psychiatry.

Correspondence to: Kristy Collins

Senior Speech Pathologist CAMHS Northern Region Suite 11, Sidney Chambers Elizabeth Shopping Centre

50 Elizabeth Way, Elizabeth, SA 5112 Email: collins.kristy@saugov.sa.gov.au

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing